PODIATRIC PHYSICIAN REGISTRATION FORM ABOUT YOUR INFORMATION: All correspondence concerning The National originating from APMA or supplier vendors who purchase our registrant mailing list will be sent to the address provided below. Please print all information clearly. Your Information Non-CECH Lunch and Dinner Symposia These optional events are made possible at no charge, thanks APMA Member Number to the corporate sponsors noted below. Select a maximum of one lunch per day. Space is limited, so register early for these Last Name popular events. Note: Thursday's lunch symposia are the only APMA-provided lunches on that day. On Friday and Saturday, lunch will also be available in the exhibit hall (separate Formal First Name registration not required). Nickname (or First Name) for Badge THURSDAY / JULY 23 Non-CECH Lunch Symposium 1: Your Communication Solution (Weave) 12:00-1:00 p.m. City/State or Province/Country Non-CECH Lunch Symposium 2: Micro-Vascular Assessment (Modulim) 12:00-1:00 p.m. Zip Code or Postal Code Non-CECH Lunch Symposium 3: Treating Onychomycosis and Tinea Infections (Ortho Dermatologics) 12:00-1:00 p.m. Non-CECH Lunch Symposium 4: Topic-Wound Care (Organogenesis Inc.) 12:00-1:00 p.m. Address Daytime Telephone Fax Number Email Address NPI Number (Note: Physicians' NPI numbers are publicly available. APMA collects this information so that it can be used as needed, e.g., to satisfy Open Payment reporting requirements.) Your Guest's Information (If you have additional guests, please attach a separate sheet.) Last Name Formal First Name Nickname (or First Name) for Badge 6:00-7:00 p.m. Non-CECH Dinner Symposium: Topic- TBD (Janssen Pharmaceutical Companies) FRIDAY / JULY 24 Non-CECH Lunch Symposium 1: Regenerative Wound Healing (Polarity TE) 12:00-1:00 p.m. Non-CECH Lunch Symposium 2: Treating Uncontrolled Gout (Horizon Therapeutics USA, Inc.) 12:00-1:00 p.m. Non-CECH Dinner Symposium: Postoperative Pain Management (Heron Therapeutics, Inc.) 6:00-7:00 p.m. SATURDAY / JULY 25 Non-CECH Lunch Symposium: Topic-Wound Care (LifeNet Health) 12:00-1:00 p.m. PDF_PRELIM As of 3/10/2020 APMA News March/April 2020 29