A PA's Guide to the Musculoskeletal Galaxy - American Academy of ...

A PA’s Guide to the Musculoskeletal Galaxy
April 18-21, 2013*Sheraton St. Louis Center City Hotel* St Louis, MO
Offline Registration Form
(offline registrations will only be accepted until January 18, 2013)
CONTACT INFORMATION
First Name Last Name Credential (limit two)
Work Address
Home Address
Contact Number (1) Contact Number (2)
E-Mail Address (1) E-Mail Address (2)
DEMOGRAPHIC INFORMATION
Years In Practice
_______(0-5) _______(6-8) _____(9-12) ___(13 or more)
Practice Setting
______(solo practitioner) ______(group practice) ______(hospital setting) ______(clinic )
AAPA Fellow Membership #___________________________
Food Allergies ______________________________________
Special Diet Requests_________________________________
1

A PA’s Guide to the Musculoskeletal Galaxy
April 18-21, 2013 *Sheraton St. Louis Center City Hotel* St Louis, MO
REGISTRATION INFORMATION
Reimbursement for the PA in Orthopeadics Thursday April 18
AAPA Fellow Member $275
Non-Member $400
Fifth Annual PA’s Guide to the Musculoskeletal Galaxy (includes continental breakfasts, all
breaks, one lunch, welcome reception on Feb 7 6-8pm, course materials on USB delivered at course sign-in)
AAPA Fellow Member $650
Non-Member $950
BREAK-OUT SESSIONS (Please select ONE break-out per session.)
Session One Friday April 19 10:30am-12:30pm
______ Weekend Warrior
______ Sideline Sports Medicine
______ Rheumatology Primer
______ Malignant/Benign Bone and Soft Tissue Tumors
Session Two Saturday April 20 1:30-3:30pm
______ Weekend Warrior
______ Sideline Sports Medicine
2

______ Rheumatology Primer
______ Malignant/Benign Bone and Soft Tissue Tumors
Session Three Saturday April 20 2:30-3:30pm (80 per session)
______ Weekend Warrior
______ Sideline Sports Medicine
______ Rheumatology Primer
______ Malignant/Benign Bone and Soft Tissue Tumors
PAYMENT METHOD (SELECT ONE)
________(CHECK)
CARD NUMBER
_____(VISA) ______(MASTER CARD) ______(AM EX)
EXPIRATION DATE
CARD HOLDER’S NAME (PRINT)
CARD HOLDER’S SIGNATURE
Please make your check payable to American Academy of Physician Assistants
Send your registration and payment BEFORE February 14, 2013 to:
AAPA Finance Department Send a secure fax to :
Attn: Galaxy 2013 OR 571-319-4414
2318 Mill Road, Suite 1300 Attn: Galaxy 2013
Alexandria, VA 22314
Cancellation/Refund Policy /Disclaimer
1) For cancellations received by AAPA by Feb 14, 2013, a full refund, less 25% processing
fee will be provided to the registrant.
2) For cancellations received between Feb 15, 2013 and March 8, 2013, a 50% refund is
given.
3) No refunds or credits will be provided for no-shows or cancellations received after
March 9, 2013.
Lodging
A housing block has been secured for conference attendees at the Sheraton St. Louis City
Center at a room rate of $89.00 (plus tax) for single/double rate. All attendees will receive free
WIFI in their guest room. There is NO WIFI in the lecture rooms.
Please make your reservations online at:
https://www.starwoodmeeting.com/StarGroupsWeb/res?id=1207255621&key=46DC or by calling the
3

hotel directly at 314-231-5007 or Central Reservation Office at 1-888-627-8096 and ask for PAs
Guide to the Musculoskeletal Galaxy room block. Rooms at this rate will be held until 5pm
March 22 , 2013.
4