APMA News - March/April 2019 - 32

ANNUAL MEETING REGISTRATION FEES
ANNUAL
MEETING
(Circle
appropriate
amount) REGISTRATION FEES
(Circle appropriate amount)

APMA Member
APMA Member
APMA Life Member
APMA Life Member
DPM (Non-APMA Member)
DPM (Non-APMA Member)
Health-Care Professional
Health-Care Professional
APMA Student/Resident/Fellow Member
APMA Student/Resident/Fellow Member
APMA Member
APMA Member
Young
Physician

March 2-
After
June 17
June
March
2-
After17
June 17
June 17
$499
$599
$499
$599
$299
$299
$299
$299
$799
$799
$799
$799
$799
$799
$799
$799
Complimentary
Complimentary
$299
$299
$299
$299

Young Physician
APMA Member
APMA Member
Residency
Director

$299
$299

$299
$299

Residency Director
APMA Member
APMA Member
Federal
Services or Active Duty Military
Federal
Services
Active
Duty Military
This
rate is
availableor
only
to members
of the

$299
$299

$299
$299

(Circle appropriate amounts)

Workshop 1: Wound Care
Workshop
1: Wound
Care
Friday,
July 12,
2019
Friday, July
12, 2019
1:30-3:30
p.m.
1:30-3:30top.m.
Limited
24 attendees

$249
$249

Limited to 24 attendees
Workshop 2: Ultrasound
Workshop
2: 2019
Ultrasound
Friday,
July 12,

$249
$249

Friday, Julyp.m.
12, 2019
3:30-5:30
3:30-5:30
Limited
top.m.
24 attendees
Limited to 24 attendees
Workshop 3: Ankle Arthroscopy
WorkshopJuly
3: Ankle
Arthroscopy
Saturday,
13, 2019
Saturday, July
1:00-4:00
p.m.13, 2019

$349
$349

1:00-4:00
Limited
to p.m.
16 attendees
Limited to 16 attendees

accompanied by full payment.

Check enclosed in US dollars
Check enclosed
in US
dollars
(payable
to APMA,
Inc.)
(payable to APMA, Inc.) VISA
MasterCard
MasterCard
American
Express
American Express

VISA
Discover
Discover

Credit Card Number (please print clearly)
Credit Card Number (please print clearly)
Expiration Date
Expiration Date

Security Code
Security Code

Date
Date
Day Phone of Cardholder
Day Phone of Cardholder

ADDITIONAL INFORMATION
ADDITIONAL
INFORMATION
Per the Americans With Disabilities Act of 1990,
Per thehere
Americans
Witha Disabilities
Actmay
of 1990,
check
if you have
disability and
check here
if you have a disability
and may
require
accommodations
to participate
fully.
require accommodations to participate fully.
Please describe:
Please describe:

PLEASE NOTE:
NOTE:
*PLEASE
Educational
topics are subject to change as the
schedule
* program
Educational
topics develops.
are subject to change as the
program
schedule
* All
registration
feesdevelops.
must be paid in advance.

ADDITIONAL EVENT
ADDITIONAL EVENT

$
$

Registration will
processed unless
accompanied
by not
full be
payment.

Authorized Signature
Authorized Signature

HANDS-ON WORKSHOPS
HANDS-ON
(Circle
appropriateWORKSHOPS
amounts)

TOTAL
TOTAL

TOTAL REGISTRATION AMOUNT
TOTAL REGISTRATION AMOUNT
$
$
Payment type (check one):
Payment type
one):
Registration
will (check
not be processed
unless

Name on Card (please print clearly)
Name on Card (please print clearly)

Federal
component
society. of the
This rateServices
is available
only to members
Federal Services component society.

Podiatry Management Hall of Fame Luncheon
Podiatry Management
Hall of
Fame Luncheon
Saturday,
July 13, 12:00-1:00
p.m.
Saturday,ofJuly
13, 12:00-1:00 p.m.
Number
tickets:
at $75 each
Number of tickets:
at $75 each

PAYMENT
PAYMENT

$
$

All registration
fees
must bewith
paidyour
in advance.
* Payment
must be
received
registration form.
complete
will not be
* Registrations
Payment mustwithout
be received
with payment
your registration
form.
processed.
Registrations without complete payment will not be
processed. for The National includes educational
* Registration
(unless
otherwise
noted),
exhibit
hall entry, and
* sessions
Registration
for The
National
includes
educational
refreshment
breaks.
sessions (unless
otherwise noted), exhibit hall entry, and
refreshment
breaks.
*A
confirmation
of registration will be sent to you by fax,
or email. of registration will be sent to you by fax,
* mail,
A confirmation
mail, or email.
* Written
requests for registration refunds must be
on orfor
before
June 17,refunds
2019. Registration
* postmarked
Written requests
registration
must be
fees
are refunded
a $50
processing
fee. All refunds
postmarked
on or less
before
June
17, 2019. Registration
will
afterless
theameeting
has occurred.
feesbe
areissued
refunded
$50 processing
fee. All refunds
will refunds
be issued
the meeting
has 17,
occurred.
* No
willafter
be made
after June
2019. Refunds
not granted
to made
no-shows.
* are
No refunds
will be
after June 17, 2019. Refunds
are not granted to no-shows.

Mail, email, or fax your completed registration to:
Mail, email,
fax yourOffice
completed
to:
American Podiatric Medical Association,
AnnualorMeeting
| 9312registration
Old Georgetown
Road, Bethesda, MD 20814-1621
American Podiatric Medical Association,
Annual |Meeting
Office | 9312 Old Georgetown Road, Bethesda, MD 20814-1621
Fax: 301-530-2752
Email: membership_ask_apma@apma.org
Fax: 301-530-2752 | Email: membership_ask_apma@apma.org

32 APMA News March/April 2019
APMA News - March/April 2019

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