APMA News - March/April 2019 - 31

PODIATRIC PHYSICIAN
PHYSICIAN
PODIATRIC
REGISTRATION FORM
FORM
REGISTRATION
ABOUT YOUR INFORMATION: All correspondence concerning The
ABOUT
INFORMATION:
Allsupplier
correspondence
concerning
The
National YOUR
originating
from APMA or
vendors who
purchase
our
National
APMA
vendors
who purchase
our
registrantoriginating
mailing listfrom
will be
sentor
tosupplier
the address
provided
below. Industry
registrant
mailing
listwish
will be
to the
the meeting
address should
provided
below.APMA's
Industry
representatives
who
to sent
attend
contact
representatives
who wish to attend
the meeting
should
APMA's
department of Development
and Corporate
Relations
atcontact
301-581-9200.
department of Development and Corporate Relations at 301-581-9200.

YOUR INFORMATION
YOUR INFORMATION
APMA Member Number
APMA Member Number

EDUCATIONAL PROGRAM AND SPECIAL SESSIONS
EDUCATIONAL PROGRAM AND SPECIAL SESSIONS
Check all of the sessions you will attend; all programs on this page
Check
all of the
youwith
willthe
attend;
all programs
on this
page
are included
freesessions
of charge
registration
fee. (See
reverse
are
included free of charge with the registration fee. (See reverse
for workshops.)
for workshops.)

THURSDAY / JULY 11, 2019
THURSDAY / JULY 11, 2019

Last Name
Last Name

General Lectures: Morning Sessions
General Lectures: Morning Sessions
General Lectures: Afternoon Sessions
General Lectures: Afternoon Sessions
Breakfast Symposium
Breakfast Symposium
Non-CECH Lunch Symposium 1 =: Non-Opioid
Non-CECH
Lunch Symposium
1 =: Non-Opioid
Pain Management
(Recro Pharma,
Inc.)
Pain Management (Recro Pharma, Inc.)
Non-CECH Lunch Symposium 2=:
Non-CECH
Lunch(Horizon
Symposium
2=: Inc.)
Refractory Gout
Pharma,
Refractory Gout (Horizon Pharma, Inc.)

Formal First Name
Formal First Name
Nickname (or First Name) for Badge
Nickname (or First Name) for Badge
Address
Address
City/State or Province/Country
City/State or Province/Country

7:00-8:30 a.m.
7:00-8:30 a.m.
12:00-1:00 p.m.
12:00-1:00 p.m.
12:00-1:00 p.m.
12:00-1:00 p.m.

FRIDAY / JULY 12, 2019
FRIDAY / JULY 12, 2019

Zip Code or Postal Code
Zip Code or Postal Code

General Lectures: Morning Sessions
General Lectures: Morning Sessions
Participating Organizations Track (Afternoon)
Participating Organizations Track (Afternoon)
7:00-8:30 a.m.
Breakfast Symposium
7:00-8:30 a.m.
Breakfast Symposium
12:00-1:00 p.m.
Non-CECH Lunch Symposium 1 =: TBD
12:00-1:00 p.m.
Non-CECH Lunch Symposium 1 =: TBD
12:00-1:00 p.m.
Non-CECH Lunch Symposium 2=:
12:00-1:00 p.m.
Non-CECH
Lunch
Symposium
2=:
Onychomycosis
and
Tinea Infections
Onychomycosis
and Tinea Infections
(Ortho Dermatologics)
(Ortho Dermatologics)

Daytime Telephone
Daytime Telephone
Fax Number
Fax Number
Email Address
Email Address
NPI Number
NPI Number
(Note: Physicians' NPI numbers are publicly available.
(Note:
numbers so
arethat
publicly
APMA Physicians'
collects thisNPI
information
it canavailable.
be used
APMA
collects
information
that it can
be used
as needed,
e.g.,this
to satisfy
Openso
Payment
reporting
as
needed, e.g., to satisfy Open Payment reporting
requirements.)
requirements.)

SATURDAY / JULY 13, 2019
SATURDAY / JULY 13, 2019

General Lectures: Morning Sessions
General Lectures: Morning Sessions
General Lectures: Afternoon Sessions
General Lectures: Afternoon Sessions
Breakfast Symposium
Breakfast Symposium
Students' and Residents' Program
Students' and Residents' Program
Non-CECH Lunch Symposium 1 =: TBD
Non-CECH Lunch Symposium 1 =: TBD
Non-CECH Lunch Symposium 2=: TBD
Non-CECH Lunch Symposium 2=: TBD
Poster Abstracts Symposium
Poster Abstracts Symposium

YOUR GUEST'S INFORMATION
YOUR GUEST'S INFORMATION

(If you have additional guests, please attach a
(If
you have
additional guests, please attach a
separate
sheet.)
separate sheet.)
Last Name
Last Name

7:30-9:30 a.m.
7:30-9:30 a.m.
10:00 a.m.-12:00 p.m.
10:00 a.m.-12:00 p.m.
12:00-1:00 p.m.
12:00-1:00 p.m.
12:00-1:00 p.m.
12:00-1:00 p.m.
1:00-2:00 p.m.
1:00-2:00 p.m.

SUNDAY / JULY 14, 2019
SUNDAY / JULY 14, 2019

Formal First Name
Formal First Name

General Lectures: Morning Sessions
General Lectures: Morning Sessions
General Lectures: Afternoon Sessions
General Lectures: Afternoon Sessions
Breakfast Symposium
Breakfast Symposium

Nickname (or First Name) for Badge
Nickname (or First Name) for Badge

7:00-8:30 a.m.
7:00-8:30 a.m.

Non-CECH Lunch Symposia are ticketed events limited to 100 participants each.
Non-CECH Lunch Symposia are ticketed events limited to 100 participants
each.
As of 2/22/2019

=
=

PDF_PRELIM As of 2/22/2019
PDF_PRELIM As of 2/22/2019

APMA News March/April 2019

31
APMA News - March/April 2019

Table of Contents for the Digital Edition of APMA News - March/April 2019
