APMA News - May/June 2019 - 38

ANNUAL MEETING REGISTRATION FEES
ANNUAL
MEETING REGISTRATION FEES
(Circle appropriate amount)
(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
Young Member
Physician
Young Physician
APMA Member
APMA
Member
Residency
Director
Residency Director
APMA Member
APMA
FederalMember
Services or Active Duty Military
Federal
Active
Duty Military
This rate Services
is availableor
only
to members
of the

March 2-
After
March
2-
After
June 17
June
17
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
$299
$299

$299
$299

$299
$299

$299
$299

(Circle appropriate amounts)

Workshop 1: Wound Care
Workshop
Care
Friday, July 1:
12,Wound
2019
Friday,
July
12,
2019
1:30-3:30 p.m.
1:30-3:30 p.m.
Limited to 24 attendees
Limited to 24 attendees
Workshop 2: Ultrasound
Workshop
2: Ultrasound
Friday, July 12,
2019
Friday,
Julyp.m.
12, 2019
3:30-5:30
3:30-5:30 p.m.
Limited to 24 attendees
Limited to 24 attendees
Workshop 3: Ankle Arthroscopy
Workshop
3: Ankle
Arthroscopy
Saturday, July
13, 2019
Saturday,
1:00-4:00July
p.m.13, 2019

$249
$249

$249
$249

$349
$349

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

Registration will
be processed unless
accompanied
by not
full payment.
accompanied by full payment.

Check enclosed in US dollars
Check enclosed
in US
dollars
(payable
to APMA,
Inc.)
(payable to APMA, Inc.)
MasterCard
VISA
MasterCard
VISA
American
Express
Discover
American Express
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
With
Actmay
of 1990,
check
if you have
a Disabilities
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
topicsdevelops.
are subject to change as the
program
schedule
* All
registration
feesdevelops.
must be paid in advance.

ADDITIONAL EVENT
ADDITIONAL EVENT

All registration
fees
must be
paid
in advance.
** Payment
must be
received
with
your
registration form.
complete
will not be
* Registrations
Payment mustwithout
be received
withpayment
your registration
form.
processed.
Registrations without complete payment will not be

Podiatry Management Hall of Fame Luncheon
Podiatry
Hall ofp.m.
Fame Luncheon
Saturday,Management
July 13, 12:00-1:00

$
$

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

Authorized Signature
Authorized Signature

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

TOTAL
TOTAL

TOTAL REGISTRATION AMOUNT
TOTAL REGISTRATION AMOUNT

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.

Saturday,
July
13, 12:00-1:00 p.m.
Number of
tickets:
at $75 each
Number of tickets:
at $75 each

PAYMENT
PAYMENT

$
$

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 requests
email.
* Written
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 orless
before
June
17, 2019. Registration
will
afterless
the ameeting
has occurred.
feesbe
areissued
refunded
$50 processing
fee. All refunds
willrefunds
be issued
the meeting
has17,
occurred.
* No
willafter
be made
after June
2019. Refunds
granted
to no-shows.
* are
No not
refunds
will be
made 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: Road, Bethesda, MD 20814-1621
American Podiatric Medical Association,
AnnualorMeeting
| 9312registration
Old Georgetown
Fax: 301-530-2752
Email: membership_ask_apma@apma.org
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

38 APMA News May/June 2019
APMA News - May/June 2019

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