PODIATRIC PHYSICIAN MEETING REGISTRATION FORM Use this form to register for The National, or register online at www.apma.org/thenational. The meeting is being provided in-person only. 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. YOUR INFORMATION Non-CECH Lunch Symposium 1 (Organogenesis) APMA Member Number Last Name Formal First Name Nickname (or First Name) for Badge Address City/State or Province/Country Zip Code or Postal Code Daytime Telephone Fax Email 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 Last Name Formal First Name Nickname (or First Name) for Badge Non-CECH Lunch Symposium 2 (Horizon Therapeutics) Non-CECH Lunch Symposium 3 (TBD) Non-CECH Lunch Symposium 4 (Heron Therapeutics) Non-CECH Dinner Symposium 1 (TBD) Non-CECH Dinner Symposium 2 (TBD) FRIDAY / JULY 14 Non-CECH Lunch Symposium 1 (Averitas Pharma) Non-CECH Lunch Symposium 2 (Ortho Dermatologics) Non-CECH Dinner Symposium 1 (TBD) Non-CECH Dinner Symposium 2 (TBD) SATURDAY / JULY 15 Non-CECH Lunch Symposium 1 (TBD) Non-CECH Lunch Symposium 2 (TBD) Non-CECH Dinner Symposium (TBD) 12:00-1:00 p.m. 12:00-1:00 p.m. 6:30-7:30 p.m. 12:00-1:00 p.m. 12:00-1:00 p.m. 6:30-7:30 p.m. 6:30-7:30 p.m. 12:00-1:00 p.m. 12:00-1:00 p.m. 12:00-1:00 p.m. 12:00-1:00 p.m. 6:00-7:00 p.m. 6:00-7:00 p.m. NON-CECH LUNCH AND DINNER SYMPOSIA These optional events are made possible at no charge, thanks to the corporate sponsors noted below. Select a maximum of one lunch and one dinner per day. Space is limited, so register early for these popular events. THURSDAY / JULY 13 As of 3/16/2023http://www.apma.org/thenational