APMA News - May/June 2019 - 37

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

YOUR
YOUR INFORMATION
INFORMATION
APMA
APMA Member
Member Number
Number

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

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

Last
Last Name
Name

General
General Lectures:
Lectures: Morning
Morning Sessions
Sessions
Formal
Formal First
First Name
Name

General
General Lectures:
Lectures: Afternoon
Afternoon Sessions
Sessions

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

Breakfast
Breakfast Symposium
Symposium

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

Non-CECH
Non-CECH Lunch
Lunch Symposium
Symposium 11==
(Organogenesis
(Organogenesis Inc.)
Inc.)

12:00-1:00
12:00-1:00 p.m.
p.m.

Non-CECH
Non-CECH Lunch
Lunch Symposium
Symposium 22==
(Horizon
(Horizon Therapeutics)
Therapeutics)

12:00-1:00
12:00-1:00 p.m.
p.m.

FRIDAY
FRIDAY // JULY
JULY 12,
12, 2019
2019
General
General Lectures:
Lectures: Morning
Morning Sessions
Sessions

Zip
Zip Code
Code or
or Postal
Postal Code
Code

Participating
Participating Organizations
Organizations Track
Track (Afternoon)
(Afternoon)
7:00-8:30
7:00-8:30 a.m.
a.m.

Breakfast
Breakfast Symposium
Symposium

Daytime
Daytime Telephone
Telephone

Non-CECH
Non-CECH Lunch
Lunch Symposium
Symposium 11
(Janssen
(Janssen Pharmaceuticals,
Pharmaceuticals, Inc.)
Inc.)

12:00-1:00
12:00-1:00 p.m.
p.m.

Non-CECH
Non-CECH Lunch
Lunch Symposium
Symposium 22==
(Ortho
(Ortho Dermatologics)
Dermatologics)

12:00-1:00
12:00-1:00 p.m.
p.m.

==

Fax
Fax Number
Number
Email
Email Address
Address

SATURDAY
SATURDAY // JULY
JULY 13,
13, 2019
2019
NPI
NPI Number
Number

General
General Lectures:
Lectures: Morning
Morning Sessions
Sessions

(Note:
(Note: Physicians'
Physicians' NPI
NPI numbers
numbers are
are publicly
publicly available.
available.
APMA
APMA collects
collects this
this information
information so
so that
that itit can
can be
be used
used
as
as needed,
needed, e.g.,
e.g., to
to satisfy
satisfy Open
Open Payment
Payment reporting
reporting
requirements.)
requirements.)

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

7:30-9:30
7:30-9:30 a.m.
a.m.

Students'
Students' and
and Residents'
Residents' Program
Program

10:00
10:00 a.m.-12:00
a.m.-12:00 p.m.
p.m.

YOUR
YOUR GUEST'S
GUEST'S INFORMATION
INFORMATION

Non-CECH
Non-CECH Lunch
Lunch Symposium
Symposium 11==
(Siren)
(Siren)

12:00-1:00
12:00-1:00 p.m.
p.m.

(If
(If you
you have
have additional
additional guests,
guests, please
please attach
attach aa
separate
separate sheet.)
sheet.)

Non-CECH
Non-CECH Lunch
Lunch Symposium
Symposium 22==
(Wright
(Wright Medical
Medical Group
Group N.V.)
N.V.)

12:00-1:00
12:00-1:00 p.m.
p.m.

Poster
Poster Abstracts
Abstracts Symposium
Symposium

1:00-2:00
1:00-2:00 p.m.
p.m.

Non-CECH
Non-CECH Dinner
Dinner Symposium
Symposium
(Olaregen
(Olaregen Therapeutix
Therapeutix Inc.)
Inc.)

6:00-7:00
6:00-7:00 p.m.
p.m.

Last
Last Name
Name

==

Formal
Formal First
First Name
Name

SUNDAY
SUNDAY // JULY
JULY 14,
14, 2019
2019
General
General Lectures:
Lectures: Morning
Morning Sessions
Sessions

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

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

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

Non-CECH
Non-CECH Symposia
Symposia are
are ticketed
ticketed events
events limited
limited to
to 100
100 participants
participants each.
each.

==

As of 5/22/2019
As
As of
of 5/22/2019
5/22/2019

APMA News May/June 2019

37
APMA News - May/June 2019

Table of Contents for the Digital Edition of APMA News - May/June 2019
