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Or register online at www.aapainmanage.org
Register now for the Academy’s 2006 Clinical Meeting in Orlando:
Beyond Boundaries: Forging New Alliances in Pain Management.
Name
Profession
Address
City State Zip
Daytime Phone/Email (required) /
Pre-meeting, Meeting Registration (Thursday) Amount Amount Paid
Member* $ 185
Non-Member $ 225
*Employees of Pain Program Accredited Facilities may register at Member rate
Clinical Meeting Registration (Fri., Sat., Sun.) Early Bird After 7/1 On-Site Amount Paid
Member* $ 375 $ 420 $ 475
Non-Member $ 550 $ 585 $ 640
Full-Time Student Member ** $ 50 $ 60 $ 70
Full-Time Student Non-Member ** $ 85 $ 95 $ 125
One Day $ 250 $ 260 $ 280
Awards Luncheon (Saturday 12:35 - 2:00 pm) $ 35 $ 35 $ 35
You must register and pay for luncheon prior to conference, cannot sign up on-site
*Employees of Pain Program Accredited Facilities may register at Member rate
Membership
Individual Membership $ 195 $195 $195
Amount Paid
Student Membership** $ 50 $ 50 $ 50
**Must provide proof of student status
Total Payment $
Method of payment Visa Mastercard Discover Check Enclosed (US Funds Only)
Credit Card #
Expiration Date Verification Number Signature
Please mail or fax completed Registration Form to:
For AAPM Office Use Only
American Academy of Pain Management
13947 Mono Way #A
Sonora, CA 95370
Phone 209-533-9744
Fax 209-533-9750
Bring
a guest!
The Academy is offering complimentary guest badges for the Exhibit Hall on Friday and Saturday. Badges will be
available at the registration desk.
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