Credit card authorization form

    Please fill in the following information and e-sign below

    Each additional badge is $750
    Please list the extra badge names below or email the names to Wim Libby,

    Credit Card Information

    VisaMasterCardAmerican ExpressDiscover

    This authorization is being provided to:

    Matt Van Wie,

    Manager, Corporate and Educational Support

    (804) 550-2312

    By signing via electronic signature, I agree to the credit card provided being charged the amount indicated above, on the date signed, and for the purpose stated above.
    Orthopaedic Summit (OSET, Inc.)

    • 31 River Rd, Suite 100
    • Cos Cob, CT, 06807
    • Matt Van Wie
    • P: (804) 550-2312
    • F: (804) 550-0695

    Orthopaedic Summit

    35 Mayflower Avenue
    Unit B
    Stamford, CT 06906
    Phone +1 (212) 987-OSET (6738)



    Follow Us

    For the latest news and announcements follow the Orthopaedic Summit social media pages.


    13th Orthopaedic Summit 2023
    Boston Marriott Copley Place
    Wednesday, September 19 – Saturday, September 23, 2023

    Please click here if you need to reset your password.