APMA News - October 2011 - (Page 57)
ADVANCE REGISTRATION
n
Scientific Program & Special Sessions
Registrants will be provided with a final registration form which will include an opportunity to indicate planned attendance at specific scientific sessions and special sessions (including breakfast symposia and the PICA Risk Management program).
About Your Information: All communication concerning the Annual Meeting originating from APMA or supplier vendors who purchase our meeting registrant data will be directed to the contact information below.
AUGUST 16 - 19, 2012 • WASHINGTON, D.C. MARRIOTT WARDMAN PARK HOTEL
n
Your Information
Last Name Formal First Name Nickname (or first name) for badge
APMA Member Number Address
City/State/Zip Code or Province/Country/Postal Code Daytime Telephone n Fax Number E-mail Address
Your Guest’s Information (If you have additional guests, please attach a separate sheet.)
Formal First Name Nickname (or first name) for badge
Last Name n
Additional Information Please Note:
n Educational topics are subject to change as the program schedule develops. n All registration fees must be paid in advance. n Payment must be received with your registration form. Registrations without complete payment will not be processed. n Registration for the APMA Annual Scientific Meeting includes educational sessions (unless otherwise noted), exhibit hall entry, and refreshment breaks. n A confirmation of registration will be sent to you by fax, mail, or e-mail. n Written requests for registration refunds must be postmarked on or before July 15, 2012. Registration fees are refunded less a $50 processing fee. All refunds will be issued after the meeting has occurred. n No refunds will be made after July 15, 2012. Refunds are not granted to no-shows.
q Check here if you have a disability and may require accommodations to participate fully. APMA will contact you. n Annual Meeting Registration & Fees
(circle appropriate amounts) q APMA Member q APMA Life Member q Non-APMA Member q Health Professional: RN, PT, PA, MD, DO, CPed, Chiropodist, ATC
Until April 27, 2012
$295.00 $95.00 $795.00 $795.00
Until July 29, 2012
$495.00 $295.00 $795.00 $795.00
After July 29, 2012
$595.00 $295.00 $795.00 $795.00
Complimentary Registration (check one) q DPM: Student q DPM: Resident/Fellow/Postgraduate APMA Member q Speaker q Other (Please explain; include name of authorizing organization and individual:
__________________________________________________________) n
Payment
Payment type (check one). Registration will not be processed unless accompanied by full payment. q Check enclosed (payable to APMA, Inc.) q Mastercard q Visa q American Express q Discover
Credit Card Number (please print clearly) Name on Card (please print) Authorized Signature Day Phone of Cardholder Date Expiration Date
Registration Amount ————
Mail your completed registration form to:
American Podiatric Medical Association Annual Meeting Office 9312 Old Georgetown Road Bethesda, MD 20814-1621 or fax to: 301-530-2752
WWW.APMA.ORG/THENATIONAL
PDF-NEWS
as of 7/1/2011
http://WWW.APMA.ORG/THENATIONAL
http://WWW.APMA.ORG/THENATIONAL
Table of Contents for the Digital Edition of APMA News - October 2011
APMA News - October 2011
President’s Message
Contents
ICD-10 in Practice: Coding for Fifth Metatarsal Injury
ICD-10 Benchmarks and Timeline
Team APMA Runs Away with the Show
Medical Mission to Costa Rica: Identifying Fungal Infections of the Foot
Federal Advocacy Forum
Resolutions Submissions
IT Consultant
Can They Really Do That?
Reimbursement
Members Who Know Media
Technofile
Young Voices
Small Business 101
APMAPAC Chair Report
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
List of Affiliated Organizations
Insurance Advisor
New Members
Death Notices
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
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