REGISTRANT INFORMATION:

RSVP Request Date:  Your Name: (required) eMail Address: (required) Ticket Mailing Address: Ticket Mailing City: Ticket Mailing State: Select State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY OTHER - List in additional comments area Ticket Mailing Zip: Prefered Contact Telephone: Fax: Are you a WDS member: (required) Yes I am a WDS Member Pending WDS Member Not a WDS Member NOTES:     • Please include preferred mailing address above ensure you receive your luncheon tickets     • Current WDS Members can update and renew membership for 2009 by CLICKING HERE

GUEST INFORMATION:

Number of tickets required (including yourself) for WDS Annual Meeting Luncheon at San Francisco Marriott, Sunday, March 8th 12-1:45 p.m.: Quantity $ Per Ticket Amount Required - Please Select 0 1 2 3 4 5 6 7 8 9 10 $45.00 $  WDS Member and/or WDS Member Guest Required - Please Select 0 1 2 3 4 5 6 7 8 9 10 $25.00 $  WDS Resident Member (Non-WDS Member Residents please use non-member rate) Required - Please Select 0 1 2 3 4 5 6 7 8 9 10 $75.00 $  Non-WDS Member (*) $ TOTAL AMOUNT DUE (required) (*) PLEASE NOTE: Non-members may join WDS on-line by clicking HERE. Annual dues are $100; application fee $25. For residents, dues are waived. Thanks to generous sponsorship support, the luncheon fee for residents has been reduced. List the FULL NAME of each luncheon guest, including yourself, below. Please specify if you are not planning to attend in the 'Additional Comments' box below, or if you wish to sponsor a resident. To secure tickets, each residents’ full name is required. Individuals will not be admitted without a ticket. If submitting more than six (6) names, please use the 'Additional Guests' box below: 1.   2. 3.   4. 5.   6. Additional Guests: Other WDS Events taking place during the Annual Meeting: Number attending the Networking Reception     Friday, March 6 • 5:30 p.m. - 7:00 p.m. Required - Please Select 0 1 2 3 4 5 6 7 8 9 10    Free Number attending the WDS Fireside Chat     Saturday, March 7 • 8:00 p.m. - 9:30 p.m. Required - Please Select 0 1 2 3 4 5 6 7 8 9 10    Free     Details On Additional Annual Meeting Events & Registration Advance registration is required and must be received by February 20, 2009. All cancellations must be made in writing to the WDS office by February 20. Refunds, less a $15 administrative fee, will be available for cancellations received in writing at the WDS office before February 20, 2009. No refunds are issued if cancellation is received after February 20. Your ticket(s) will be mailed in advance if you register before February 13. Registrations received after that date will be available at the WDS Center at the Pacific I Room of the San Francisco Marriott, or at “WILL CALL” for pick up.

WOMEN’S DERMATOLOGIC SOCIETY FOUNDATION INFORMATION:

The Women’s Dermatologic Society Foundation Contribution (optional) ...a non-profit organization dedicated to supporting the objectives and activities of the WDS welcomes your optional donation. Donors to be Recognized at WDS Annual Meeting Luncheon If you have ever contributed to the WDS Foundation with a cash gift or gift of volunteer time, you will receive a new special donor pin to wear at the annual meeting luncheon. The donor pin will be mailed to you in advance with your ticket(s) when ticket request/ donation is made prior to February 1st. (WDS Foundation • Tax-ID#20-0084052) Contribute Online (Opens a new web browser window so you can continue with this registration) Details about the WDS Foundation (Opens a new window)

ADDITIONAL INFORMATION:

Questions? eMail: wds@womensderm.org -or- Call toll-free: 1-877-WDS-ROSE (937-7673) Additional Comments or Special Request: List Comments or Request Here

Women's Dermatologic Society
575 Market Street, Suite 2125, San Francisco, CA 94105
toll-free : 1-877-WDS-ROSE (937-7673)
Ph: (415)764-4925 • fax: (415)764-4933