APMA News - July/August 2020 - 17

Registration Form
Weekend 1: August 8-9, 2020 | Weekend 2: August 15-16, 2020
ABOUT YOUR INFORMATION:
All correspondence concerning the APMA Online
CECH Summer Series 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
APMA Member Number

REGISTRATION FEES
Please check the appropriate
registration fee below.

BOTH
WEEKENDS

August 8-9 &
August 15-16

WEEKEND 2
ONLY

August 8-9

August 15-16

APMA Member

$399

$249

APMA Life Member

$199

$149

DPM (Non-APMA Member)

$799

$549

Health-Care Professional

$799

$549

APMA Student/Resident/Fellow Member

Last Name

WEEKEND 1
ONLY

Complimentary

APMA Young Physician Member

$299

$199

Formal First Name

APMA Residency Director Member

$299

$199

APMA Federal Services or Active Duty
Military Member

$299

$199

Address

$99

$59

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

City/State or Province/Country

Daytime Telephone

Zip/Postal Code

Fax Number

Email Address

Podiatric Medical Assistant

NON-CECH EVENTS
Spend the lunch hour or a quick break with one of our corporate supporters and learn
the latest from them during these non-CECH events. Space is limited. Details available
in the coming weeks.

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.)
PLEASE NOTE:
* The APMA Online CECH Summer Series is a virtual
event, and to participate, attendees must have a valid
email address as well as a computer/mobile device
with an internet connection.
* Educational topics are subject to change as the
program schedule develops.
* All registration fees must be paid in advance.
* Payment must be received with your registration form.
Registrations without complete payment will not be
processed.
* A confirmation of registration will be sent to you by
mail or email.
* Cancellation policy: Cancellation requests must be
made in writing. Cancellations received by July 31 will
receive a refund minus a $100 fee. No refunds available
for no-shows or cancellations received after July 31.
Refunds will be processed after the event.

WEEKEND 1

WEEKEND 2

Saturday, August 15
Saturday, August 8
Non-CECH Lunchtime With a Sponsor
Non-CECH Lunchtime With a Sponsor
1:00-2:00 p.m.
1:00-2:00 p.m.
Non-CECH Quick Break With a Sponsor
4:00-4:30 p.m.
Sunday, August 9
Non-CECH Quick Break With a Sponsor
1:00-1:30 p.m.

Sunday, August 16
Non-CECH Quick Break With a Sponsor
1:00-1:30 p.m.

PAYMENT
TOTAL REGISTRATION AMOUNT

Payment type (check one) Registration will not be processed unless accompanied by full payment.
Check enclosed in US dollars (payable to APMA, Inc.)
MasterCard

VISA

American Express

Credit Card Number (please print clearly)

Discover

Expiration Date

Security Code

MAIL, EMAIL, OR FAX YOUR COMPLETED
REGISTRATION TO:
American Podiatric Medical Association
9312 Old Georgetown Road
Bethesda, MD 20814-1621
Fax: 301-530-2752
Email: registration@apma.org

Name on Card (please print clearly)

Authorized Signature

Date

Day Phone of Cardholder
As of 6/22/2020

APMA News - July/August 2020

Table of Contents for the Digital Edition of APMA News - July/August 2020