1 Start 2 Preview 3 Complete You're almost there!Before completing your purchase, we need you to provide us with a little more information. This data will be used to gain course access as well as grant you access to your specific Core Antimicrobial Stewardship Curriculum Enrollment Group for your Institution. Please make sure that the information you enter is as accurate as possible. Please note: Curriculum access and enrollment groups cannot be completed until users have logged in or created an account within this new system. A notification will be received once course access is provided. In the boxes below, please provide the name of your Institution, Program type, along with the full name and e-mail address of all fellows/trainees and faculty that you are purchasing the Advanced AS Curriculum on behalf of. The names entered should match the quantity of courses selected in the next screen. How did you hear about us? * SelectSearch engine (Google, Yahoo, Bing)Social media (LinkedIn, Twitter, Facebook)IDSA NewsMyIDSA forumIDWeek outreachStudent interest groupRecommended by colleagueAMA ED HubOther How did you hear about us? Other Name of Institution * Please spell out your Institution name Program Type (Pediatric or Adult ID) * Please select your program type. Pediatric Adult ID Other Program Type (Pediatric or Adult ID) Other Are you an IDSA member? * Yes No Membership number Program Director/Faculty Advisor * Enter first name, last name Program Director/ Faculty Advisor E-mail address * Are you registering Faculty? * Yes No Faculty Registration Faculty Member 1 Enter first name, last name Faculty Member 1 E-mail address Faculty Member 2 Enter first name, last name Faculty Member 2 E-mail address Faculty Member 3 Enter first name, last name Faculty Member 3 E-mail address Faculty Member 4 Enter first name, last name Faculty Member 4 E-mail address Faculty Member 5 Enter first name, last name Faculty Member 5 E-mail address Still need to add more Faculty? Yes No Additional Faculty Registration Faculty 6 Enter first name, last name Faculty 6 E-mail Address Faculty 7 Enter first name, last name Faculty 7 E-mail Address Faculty 8 Enter first name, last name Faculty 8 E-mail Address Faculty 9 Enter first name, last name Faculty 9 E-mail Address Faculty 10 Enter first name, last name Faculty 10 E-mail Address Are you registering fellows/trainees? * Yes No Fellow/Trainee Registration Fellow/Trainee 1 * Enter first name, last name Fellow/Trainee 1 E-mail Address * Fellow/Trainee 2 Enter first name, last name Fellow/Trainee 2 E-mail Address Fellow/Trainee 3 Enter first name, last name Fellow/Trainee 3 E-mail Address Fellow/Trainee 4 Enter first name, last name Fellow/Trainee 4 E-mail Address Fellow/Trainee 5 Enter first name, last name Fellow/Trainee 5 E-mail Address Fellow/Trainee 6 Enter first name, last name Fellow/Trainee 6 E-mail Address Fellow/Trainee 7 Enter first name, last name Fellow/Trainee 7 E-mail Address Fellow/Trainee 8 Enter first name, last name Fellow/Trainee 8 E-mail Address Fellow/Trainee 9 Enter first name, last name Fellow/Trainee 9 E-mail Address Fellow/Trainee 10 Enter first name, last name Fellow/Trainee 10 E-mail Address Still need to add more fellows/trainees? Yes No Additional Fellow/Trainee Registration Fellow/Trainee 11 Enter first name, last name Fellow/Trainee 11 E-mail Address Fellow/Trainee 12 Enter first name, last name Fellow/Trainee 12 E-mail Address Fellow/Trainee 13 Enter first name, last name Fellow/Trainee 13 E-mail Address Fellow/Trainee 14 Enter first name, last name Fellow/Trainee 14 E-mail Address Fellow/Trainee 15 Enter first name, last name Fellow/Trainee 15 E-mail Address If you need more fields for faculty or fellows/trainees than the form allows, please e-mail academy@idsociety.org, for more information.After you have successfully entered the contact information for Faculty and Fellows/Trainees, be sure to complete the payment process on the following screens. Access will not be granted until payment is received*. Once payment is received, please allow 24 -48 business hours to gain course access.* If paying by check and require more immediate course access, please contact IDSA. Leave this field blank
