ATS 2018 SAN DIEGO REGISTRATION FORM PAGE A

FIRST/GIVEN NAME* MI* LAST/FAMILY NAME* DATE OF BIRTH* GENDER*

INSTITUTION, AGENCY* MAILING ADDRESS* THIS IS: ¨ HOME ¨ OFFICE

CITY* STATE/COUNTRY* ZIP/POSTAL CODE*

OFFICE TELEPHONE* FAX NUMBER E-MAIL ADDRESS:*

MEMBER ID NUMBER (If applicable)* NAME OF SPOUSE/PARTNER/GUEST (FOR BADGE) (See Part 3 for registration fee.)

¨ Check here if you have special needs under the Americans with Disabilities Act (we will contact you.)¨ Check if attending the International Conference for the first time. ¨ Check if you do not want your contact information available to exhibitors.Do you need a printed copy of the Final Program onsite? ¨ Yes ¨ NoConference Affirmations:Please indicate your agreement with the following Conference Affirmations by clicking the box.¨ Code of Conduct: I have read and will adhere to the ATS International Conference Code of Conduct.¨ Recording of Sessions: The use of cameras and audio recording equipment (including, but not limited to cellular phones, film, digital, and video) is prohibited in the Exhibit Hall. Photographs may be taken during sessions or poster presentations, provided that the photographs are strictly for personal, noncommercial use and are not to be published in any form. Attendees are prohibited from using flash photography or otherwise distractingv the presenters or members of the audience. Conference attendees cannot share pictures and information from sessions or poster presentations on their social media accounts unless they have permission from the presenter.

Open Payments (“Sunshine Act”)In order to comply with Section 6002 of the Affordable Care Act Open Payments Program, U.S. physicians are asked to provide information in addition to what is requested on this form. If you answer “Yes” to the following question, you will be contacted via email for additional information.Are you licensed to practice in the U.S. as any one of the following: Doctor of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of Dental Surgery, Doctor of Podiatry, Doctor of Optometry, Doctor of Chiropractic Medicine? ¨ Yes ¨ No

NAME/BADGE AND ADDRESS INFORMATION1 * Required information

mm / dd / yyyy ¨M ¨ F

FOR OFFICE USE ONLY # Amount Date Check#

METHODS OF PAYMENT* All fees must be paid in U.S. Dollars

¨ CHECK OR MONEY ORDER: Make check or money orderpayable to American Thoracic Society.NO VOUCHERS OR PURCHASE ORDERS ACCEPTED.WIRE TRANSFERS ACCEPTED FOR GROUPS ONLY.(Any checks received drawn on an overseas bank will be returned.)

¨ CREDIT CARD: Credit Card information required to confirm hotel reservation.¨ MC ¨ AmEx ¨ VISA ¨ Discover ¨ JCB ¨ Diner’s Club

CREDIT CARD NUMBER EXP. DATE (mm/yyyy)

SIGNATURE PRINT NAME AS IT APPEARS ON CARD

TOTAL REGISTRATION FEES (FROM PART 3) $TOTAL SESSION/EVENT FEES (FROM PART 5) $

SERVICE CHARGE (required) $

TOTAL PAYMENT $

Adjustment Clause: In the event that the total amount due is miscalculated on this form, ATS reserves the right to audit or adjust any total charges due.

CONTACT IN CASE OF EMERGENCY:NAME:

TELEPHONE #:EMAIL:

RELATIONSHIP:

$10.00

REGISTER & RESERVE HOTELBY INTERNET:https://www.xpressreg.net/register/THOR0518/start.asp

BY MAIL: ATS 2018 c/o Convention Data Services107 Waterhouse RoadBourne, MA 02532

BY TELEPHONE: Credit Cards Only866-635-3582 (9am-5pm ET)508-743-8518 (outside the U.S. & Canada)508-743-8519 (International groups of 10 or more)

BY FAX: 24-Hours, Credit Cards Only508-743-9673

BADGES ARE REQUIRED TO ATTEND ALL CONFERENCE SESSIONS AND EVENTS.

ATS 2018 SAN DIEGO REGISTRATION FORM PAGE B

A. Education/Credentials (indicate up to 3 in preferred order for badge by marking each 1, 2, 3)*___ 01 BA___ 02 BDS___ 03 BM BCH___ 04 BPharm___ 05 BS___ 06 BSc

___ 07 BSN___ 08 DA___ 09 DDS___ 10 DDSc___ 11 DMD___ 12 DO

___ 13 DPhil___ 14 DrMed___ 15 DrPH___ 16 DSc___ 17 DVM___ 18 JD

___ 19 MA___ 20 MBA___ 21 MBBS___ 22 MBChB___ 23 MD___ 24 MHS

___ 25 MPH___ 26 MRCP___ 27 MS___ 28 MSc___ 29 MSN___ 30 NP

___ 31 PA___ 32 PharmD___ 33 PhD___ 34 PT___ 35 RN___ 36 RPh

___ 37 RRT___ 38 ScD___ 39 Other: _________________

D. Indicate how much of your time is spent:Patient Care (Check one) ¨ 0% ¨ 1-25% ¨ 26-50% ¨ 51-75% ¨ 76-100%Research (Check one) ¨ 0% ¨ 1-25% ¨ 26-50% ¨ 51-75% ¨ 76-100%Teaching (Check one) ¨ 0% ¨ 1-25% ¨ 26-50% ¨ 51-75% ¨ 76-100%

C. Major Areas/Nature of Professional Work/Training (check all that apply)*¨ 01 Administration/Management¨ 02 Advocacy¨ 03 Allergy/Immunology¨ 04 Anesthesiology¨ 05 Assistant Professor¨ 06 Associate Professor¨ 07 Basic Microbiology¨ 08 Behavioral Science¨ 09 Biochemistry¨ 10 Biomedical Engineering¨ 11 Biophysics¨ 12 Biostatistics¨ 13 Cardiology (Adult)¨ 14 Cardiology (Pediatric)¨ 15 Cardiology (Other)¨ 16 Cell & Molecular Biology¨ 17 Clinical Microbiology

¨ 18 Clinical Research Coordinator

¨ 19 Critical Care (Adult)¨ 20 Critical Care (Pediatric)¨ 21 Critical Care (Other)¨ 22 Dentistry¨ 23 Education/Teaching¨ 24 Emergency Medicine¨ 25 Environmental Medicine¨ 26 Epidemiology¨ 27 Family Medicine¨ 28 Fellow¨ 29 Full Professor¨ 30 Genetics¨ 31 Geriatrics¨ 32 Health Policy¨ 33 Health Regulation¨ 34 Hospitalist Practice

¨ 35 Immunology¨ 36 Infectious Disease¨ 37 Informatics/Info. Systems¨ 38 Internal Medicine¨ 39 Interventional Pulmonology¨ 40 Journalism¨ 41 Law¨ 42 Marketing or Commercial¨ 43 Medical or Scientific Affairs¨ 44 Neonatology¨ 45 Neuroscience¨ 46 Nursing¨ 47 Occupational Medicine¨ 48 Oncology¨ 49 Palliative Care¨ 50 Pathology¨ 51 Pediatrics¨ 52 Pharmacology

¨ 53 Pharmacy¨ 54 Physical Therapy¨ 55 Physician Assistant¨ 56 Physiology, Cellular¨ 57 Physiology, Integrative/

Organ System¨ 58 Post-Doctoral¨ 59 Preventive Medicine¨ 60 Psychiatry¨ 61 Psychology¨ 62 Public Health¨ 63 Pulmonary (Adult)¨ 64 Pulmonary (Interventional)¨ 65 Pulmonary (Pediatric)¨ 66 Quality Improvement¨ 67 Radiology¨ 68 Regulatory¨ 69 Rehabilitation

¨ 70 Research (Basic Science)¨ 71 Research (Clinical)¨ 72 Research (Epidemiology)¨ 73 Resident¨ 74 Respiratory Therapy¨ 75 Retired¨ 76 Sleep Medicine¨ 77 Social Sciences¨ 78 Student (Non-Physician)¨ 79 Student (Physician)¨ 80 Surgery, Thoracic¨ 81 Surgery, Other¨ 82 Technician/Technical

Support¨ 83 Veterinary Medicine¨ 84 Other: _________________

B. Work Setting (check all that apply)*¨ 01 Academic, Private¨ 02 Academic, Public¨ 03 Community Health Center¨ 04 Government, Federal¨ 05 Government, International¨ 06 Government, Local

¨ 07 Government, State¨ 08 Government, Other¨ 09 Health Maintenance Organization¨ 10 Hospital, Community ¨ 11 Hospital, University ¨ 12 Hospital, Other

¨ 13 Industry, Biotech¨ 14 Industry, Devices¨ 15 Industry, Pharmaceuticals¨ 16 Military/Public Health Service¨ 17 Practice, Group¨ 18 Practice, Individual

¨ 19 Professional Society (employee)¨ 20 Veteran Affairs¨ 21 Other:______________________

E. Indicate which of the following disease or procedure areas are of interest to you (check all that apply)*¨ 01 Air Movement and Airways

Diseases, Other¨ 02 Alpha-1 Antitrypsin¨ 03 ARDS¨ 04 Asthma¨ 05 Bronchiectasis¨ 06 Bronchoscopy¨ 07 CAP¨ 08 Chronic Thromboembolic

Pulmonary Hypertension¨ 09 Congenital, Genetic and

Developmental Lung Diseases, Other¨ 10 COPD¨ 11 Cough¨ 12 Cystic Fibrosis¨ 13 Duchenne Muscular Dystrophy

¨ 14 Environmental, Exposure-Related and Occupational Lung Diseases

¨ 15 Fungal Lung Diseases¨ 16 Global Health¨ 17 HAP/VAP¨ 18 HIV/AIDS¨ 19 Idiopathic Pulmonary Fibrosis¨ 20 Infectious Lung Diseases, Other¨ 21 Interstitial Lung Diseases, Other¨ 22 Interventional Pulmonology¨ 23 Lung Cancers¨ 24 Lymphangioleiomyomatosis¨ 25 Mechanical Ventilation¨ 26 Mesothelioma¨ 27 Myasthenia Gravis¨ 28 Narcolepsy

¨ 29 Non-Invasive Ventilation¨ 30 Non-specific Interstitial Pneumonitis¨ 31 Nontuberculous Mycobacteria

Infection¨ 32 Obstructive Sleep Apnea¨ 33 Parasomnias¨ 34 Pleura and Chest Wall Diseases,

Other¨ 35 Pleural Effusion¨ 36 Pleural Infections¨ 37 Pneumonia¨ 38 Pneumothorax¨ 39 Primary Ciliary Dyskinesia¨ 40 Pulmonary Embolism/Deep Vein

Thrombosis¨ 41 Pulmonary Hypertension

¨ 42 Pulmonary Rehabilitation¨ 43 Pulmonary Vascular Diseases, Other¨ 44 Rare Lung Diseases¨ 45 Respiratory Failure/Injury¨ 46 Restless Leg Syndrome¨ 47 Sarcoidosis¨ 48 Scleroderma¨ 49 Sepsis¨ 50 Shock¨ 51 Sickle Cell Disease¨ 52 Sleep-Related and Neuromuscular

Breathing Disorders, Other¨ 53 Systemic Diseases Affecting the

Respiratory System¨ 54 Transplantation¨ 55 Tuberculosis

The information collected below is to aid the ATS in the planning of future International Conferences.

REGISTRANT PROFILE2 * Required information

FIRST/GIVEN NAME* MI* LAST/FAMILY NAME*

ATS 2018 SAN DIEGO REGISTRATION FORM PAGE C

+Those registering in this category must supply the following:Program Director’s Name _______________________________________________________________________________________________________________________

Program Director’s Email Address ________________________________________________________________________________________________________________

University/Institution ___________________________________________________________________________________________________________________________

Program Start Date _____________________________________________ (mm/dd/yyyy) Program End Date ______________________________________ (mm/dd/yyyy)

NON-CREDIT CATEGORIES Those registering in these categories are NOT eligible to receive Continuing Medical Education credits, Nursing Contact Hours, or apply for MOC points.¨ I Spouse/Partner/Guest** $150 $150 $150** Includes admission to the Opening Ceremony, Awards Session, Plenary Session and Exhibit Hall only. If you do not want to attend these events,

you do not need to pay this fee. Children under the age of 12 are not permitted in the Exhibit Hall.¨ J Research Administrator/Association Executive# $150 $150 $150#May not register for seminars or workshops.¨ K Clinical Research Coordinator° $150 $150 $150°Those registering in this category must provide the following:

Institution Name ___________________________________________________________________________________________________________________________

Supervisor’s Name ______________________________________________________ Supervisor’s Email Address __________________________________________

TOTAL PART 3 FEES $

Member Registration Fees. If you are a member of the American Thoracic Society, check one category in the Members section.You must be an ATS member at the time of registration to be eligible for the member fee.Non-Member Registration Fees. If you are not a member of the ATS, check one category in the non-members section. Pre-registration fees received by March 21 are discounted. See below.

GENERAL REGISTRATION FEE3 * Required information

ATS MEMBERS¨ A Full Member $785 $845 $945¨ B Affiliate Member 920 955 1,020¨ C In-Training Member 295 330 395¨ D Senior/Emeritus Member 295 330 395¨ E One Day Only 250 300 350¨ Sun ¨ Mon ¨ Tue ¨ Wed

NON-MEMBERS¨ F Non-Member $1,180 $1,230 $1,320¨ G In-Training Non-Member+ 375 410 475¨ H One Day Only 350 400 450¨ Sun ¨ Mon ¨ Tue ¨ Wed

EARLY BIRD LATE ADVANCE ONSITE CHECK APPROPRIATE REGISTRATION CATEGORY* (THROUGH MARCH 21) (MARCH 22-MAY 17) (MAY 18-23)

FIRST/GIVEN NAME* MI* LAST/FAMILY NAME*

F. Please indicate which of the following organizations you are a member (check all that apply):¨ 01 AAAAI¨ 11 ERS

¨ 02 AAP¨ 12 FASEB

¨ 03 AARC¨ 13 JRS

¨ 04 AASM¨ 14 PATS

¨ 05 ACCP¨ 15 SCCM

¨ 06 ACP ¨ 07 ALAT ¨ 08 APSR ¨ 09 CTS ¨ 10 EB

G. Diversity and InclusionThe ATS is committed to fostering diversity and inclusion across all ATS activities and events. This information helps ATS evaluate current practice and determine areas for improvement. Please indicate with which of the following groups you identify (check all that apply):¨ 01 Non-U.S. Citizen and Non-Permanent Resident¨ 02 Respectfully decline to answer

¨ 03 American Indian or Alaska Native¨ 04 Asian¨ 05 Black or African-American

¨ 06 Hispanic, Latino, or of Spanish Origin¨ 07 Lesbian, Gay, Bisexual, Transgender, or Questioning

¨ 08 Native Hawaiian or Other Pacific Islander¨ 09 White¨ 10 Other

REGISTRANT PROFILE 2 continued

¨ L Postgraduate Course Only (Fri/Sat).Individual course fees vary. An additional fee of $50 will be added to respective course fees for Postgraduate Course Only registrants.

ATS 2018 SAN DIEGO REGISTRATION FORM PAGE D

FIRST/GIVEN NAME* MI* LAST/FAMILY NAME*

Reserved Seating Unreserved Access¨ Visionary Package (access for 25) $25,000¨ Champion Package (access for 15) $10,000 ¨ Supporter (access for 1) $350 Quantity: _____¨ Patron Package (access for 12) $5,000 ¨ ATS In-Training Attendee (access for 1) $50¨ Sustainer Package (access for 10) $3,500 ¨ Founder (access for 2) $1,000 Quantity: _____Please check the Foundation website at foundation.thoracic.org for amenities offered with each of the ticket levels above.¨ Underwrite an In-Training Attendee to the Benefit $100 Quantity: _____

ATS will contact you for the names of your In-Training Attendees.

Special Gift to Funds for the Future¨ Contribute to the ATS Funds for the Future $_________________

For Non-Corporate Sponsorship, contact Ally Felix, afelix@thoracic.org For Corporate Sponsorship, contact Lara Endreszl, lendreszl@thoracic.org

SUB TOTAL: ATS Foundation Research Program Benefit $

TICKETED SESSIONS AND EVENTS5

¨ quad (4 persons/2 beds) ¨ 1 bedroom suite (on request) ¨ 2 bedroom suite (on request)

ARRIVAL DAY/DATE: ______________________________________________ DEPARTURE DAY/DATE: __________________________________________________

Name(s) of person(s) sharing my room (other than spouse/partner/guest written in Part 1): _________________________________________________Hotel Special Request (subject to availability): ¨ Concierge Level ¨ Frequent Stay Program:

Name: ______________________________________________________ ID Number: ___________________________________________________

Hotel rooms are limited. If none of your choices are available, please indicate your preference below: ¨ Do not assign me a room ¨ Assign me a room at a hotel with similar rate¨ Assign me a room at any other hotel ¨ Assign me a room at hotel in similar locationIn order to confirm your hotel room or suite reservation, you must include a credit card with an expiration date valid through June of 2018. A hotel reservation will not be made if a valid credit card is not supplied on page A.All hotels servicing the ATS International Conference are proud to support the Foundation of the ATS. $5 per night from your room rate will support research for lung disease. Book your housing through Experient, the official ATS housing vendor. Beware of predatory housing companies.

4 HOTEL RESERVATION

Check here only if housing is not required: ¨ local resident ¨ staying with friends/relatives ¨ other: _______________________________________ See ATS website for hotel details. Please indicate your hotel choices below. You must register for the conference in order to secure a hotel reservation. Hotel choice based primarily on: ¨ rate ¨ location ¨ hotel1st choice hotel name __________________________________________ 2nd choice hotel name __________________________________________3rd choice hotel name __________________________________________

Room Type: ¨ single (1 person/1 bed) ¨ double (2 persons/1 bed) ¨ twin (2 persons/2 beds) ¨ triple (3 persons/2 beds)

Tenth Annual ATS Foundation Research Program Benefit Honoring James F. Donohue, MDSaturday, May 19, 7 p.m.

A.

• Registration required• Additional Fees May Apply

ATS 2018 SAN DIEGO REGISTRATION FORM PAGE E

FIRST/GIVEN NAME* MI* LAST/FAMILY NAME*

Section 5 Continued

B. Postgraduate Courses. Go to http://conference.thoracic.org/attendees/registration/fees-categories.php for course fees. If you are only attending a Postgraduate Course and do not plan to attend the Conference, please also check “Postgraduate Course Only” under Part 3 General Registration Fee. An additional fee of $50.00 will be charged. .Registrants for all courses must bring a laptop to the session to view the material.Please indicate course(s) you wish to register for below:Fri, May 18 ¨ PG1A/PG1B* ¨ PG2 ¨ PG3 ¨ PG4 ¨ PG5 ¨ PG6 ¨ PG7 ¨ PG8 ¨ PG9 ¨ PG10

¨ PG11Sat, May 19 ¨ PG16 ¨ PG17 ¨ PG18 ¨ PG19

¨ PG27 ¨ PG28 ¨ PG29¨ PG20 ¨ PG21 ¨ PG22 ¨ PG23 ¨ PG24 ¨ PG25

¨ PG12 ¨ PG13 ¨ PG14 ¨ PG15

¨ PG26*PG1A/PG1B is a 2-day course. Part 1 is on Friday, May 18 and Part 2 is on Saturday, May 19.Those registering for this course will be registered for both days.

SUB TOTAL: Postgraduate Courses $

C. Sunrise Seminars. Fee: $50 each. 7-8 a.m. Indicate choices by SS number.Go to http://conference.thoracic.org/program/session-information for the seminar titles.Mon, May 21 1st Choice SS ___________ 2nd Choice SS ___________ 3rd Choice SS ___________Tue, May 22 1st Choice SS ___________ 2nd Choice SS ___________ 3rd Choice SS ___________Wed, May 23 1st Choice SS ___________ 2nd Choice SS ___________ 3rd Choice SS ___________SUB TOTAL: Sunrise Seminars $

D. Meet the Professor Seminars. Fee: $70 each. 12:15-1:15 p.m. Indicate choices by MP number. Go to http://conference.thoracic.org/program/session-information for the seminar titles.Sun, May 20 1st Choice MP ___________ 2nd Choice MP ___________ 3rd Choice MP ___________Mon, May 21 1st Choice MP ___________ 2nd Choice MP ___________ 3rd Choice MP ___________Tue, May 22 1st Choice MP ___________ 2nd Choice MP ___________ 3rd Choice MP ___________SUB TOTAL: Meet the Professor Seminars $

E. Thematic Seminar Series. Fee $140. 12:15-1:15 p.m.Go to http://conference.thoracic.org/program/session-information for the series title.¨ TSS1, Sunday, May 20, Monday, May 23, Tuesday, May 22SUB TOTAL: Thematic Seminar Series $

Monday, May 21Tuesday, May 22Wednesday, May 23

¨ WS3¨ WS5¨ WS7

F. Workshops. Fee: $75 each. 11:45 a.m.-1:15 p.m.Go to http://conference.thoracic.org/program/session-information for the workshop titles.Sunday, May 20 ¨ WS1 ¨ WS2

¨ WS4¨ WS6¨ WS8

SUB TOTAL: Workshops $

G. Faculty Development Seminars. No Fee . 7-8 a.m.Go to http://conference.thoracic.org/program/session-information for the seminar titles.

¨Monday, May 21¨Tuesday, May 22¨Wednesday, May 23

FD1FD2FD3

SUB TOTAL: Faculty Development Seminars $

Section 5 Continued

H. Medical Education Seminars. Fee: $70 each. 12:15 -1:15 p.m.Go to http://conference.thoracic.org/program/session-information for the seminar titles.

¨Sunday, May 20 .¨Monday, May 21¨Tuesday, May 22

ME1ME2ME3

SUB TOTAL: Medical Education Seminars

I. Assembly Dinner/Receptions. Go to http://conference.thoracic.org/program/events/assembly-events.php for information about these events. Go to http://conference.thoracic.org/attendees/registration/fees-categories.php for dinner/reception fees.¨ Assembly on Pediatrics Dinner, Sunday, May 20, 7-10 p.m. .¨ Assemblies on Allergy, Inflammation & Immunology and Respiratory Cell & Molecular Biology Joint Reception, Monday, May 21, 7-10 p.m. ¨ Assembly on Sleep & Respiratory Neurobiology Reception, Monday, May 21, 7-10 p.m.SUB TOTAL: Assembly Dinner/Receptions $

TOTAL PART 5 FEES $

ATS 2018 SAN DIEGO REGISTRATION FORM PAGE F

FIRST/GIVEN NAME* MI* LAST/FAMILY NAME*

NON-TICKETED EVENTS6• Registration Required• No Additional Fees

A. Special Interest Programs No Fee.Go to the websites below for information about these events.¨ Networking Exchange for Early Career Professionals, Sat, May 19, 5:30 - 6:30 p.m. http://conference.thoracic.org/program/early-career-professionals/index.php¨ Diversity Forum, Sun, May 20, 11:45 a.m. - 1:15 p.m. http://conference.thoracic.org/program/events/diversity-forum.php¨ Women’s Forum, Mon, May 21, 11:45 a.m. - 1:15 p.m. http://conference.thoracic.org/program/events/womens-forum.php