Registration InstructionsRegistering for ACG 2014 is easy.You can register online, by fax or by mail.ONLINE: www.acgmeetings.gi.orgFAX: 301-263-9025MAIL:American College of Gastroenterology6400 Goldsboro Road, Suite 200Bethesda, MD 20817-5842Step 1 • Contact InformationProvide your contact information (including email address) on theRegistration Form.Step 2 • Course SelectionsTo register, choose one of the educational programs under your correspondingregistration category. You may also select one or more ofthe optional programs offered on Friday, October 17. Please circlethe Friday Program(s) you would like to attend.Note: If you select the 3-day Clinical Review, you do not need toregister for the GI Pathology and Imaging Course or the What’s Newin GI Pharmacology Course.Registrants of the Postgraduate Course and the Annual ScientificMeeting may choose to receive either a printed copy of the meetingsyllabus or a PDF of the syllabus on a USB drive. There is a separatecharge to purchase both the USB version and the printed version ofeither syllabus.Step 3 • Optional Learning Luncheons andBreakfast SessionsIf you’ve selected the Postgraduate Course, you have the optionof attending up to two of the 24 Postgraduate Course LearningLuncheons (one each day) to be offered. The cost is only $75 each.Learning Luncheons are offered on Saturday and Sunday, October18 and 19. You may choose one Learning Luncheon each day.Learning Luncheons are optional. Since Learning Luncheons fill upfast, please indicate your top five choices for each day by numberingthem 1-5. We will make every effort to accommodate your topchoice.handouts will be provided to attendees registered for any BreakfastSession. You may choose one Breakfast Session each day. BreakfastSessions are optional. Since Breakfast Sessions fill up fast, pleasechoose up to your top five choices for each day by numbering them1-5. We will make every effort to accommodate your top choice.Step 4 • Additional OfferingsACG offers additional programs or materials to certain attendees.• Fellows-in-training may sign up for one of the two Trainees’luncheons on Sunday, October 19. The cost for each luncheon is$35. This event is available only to GI fellows-in-training.• Online Self-Assessment Test. Postgraduate Course registrantsmay purchase the 2014 Online Self-Assessment Test for $75. Theadvance purchase option is available only to 2014 PostgraduateCourse registrants. The deadline for advance access purchaseis September 5, 2014. Check the box on the registration form ifyou would like to place an advance order for the Online Self-Assessment Test.• PG+MOC. Postgraduate Course registrants may purchase ACG'snew 10 point module exclusive for the 2014 Annual PostgraduateCourse. Members pay an additional $40; Non-members $50.The deadline for pre-registration is September 24, 2014. Checkthe box on the registration form if you would like to place an orderwhen you register.Step 5 • PaymentRegistration selections are now complete. If you choose to mail or faxthe registration form, please complete the payment information onthe form and sign the form.If you signed up for the Annual Scientific Meeting, you have theoption of attending up to three of the 17 Annual Scientific MeetingBreakfast Sessions offered on Monday, October 20, Tuesday,October 21, and Wednesday, October 22. The cost is only $60each. A syllabus on USB containing all ACG 2014 Breakfast SessionFor more information on ACG 2014 and to register, visit www.acgmeetings.gi.org.124
ACG 2014 Registration FormMail to: ACG, 6400 Goldsboro Road,Suite 200, Bethesda, MD 20817-5842Fax to: ACG at 301-263-9025.Fax with credit card number and signature.Web: Register online at www.acgmeetings.gi.org.Cancellation: Written notice of cancellationand requests for refunds must be received bythe College’s office by September 24, 2014.After this day, no refunds will be possible.Registration cancellations are not accepted bytelephone. An explanation must be provided inwriting. There will be a $50 administrative feeassessed for cancellation of any paid event.Refunds will be issued after the meeting. SeeCancellation Policy on page 121.ADA Compliance: Attendees of the ACGAnnual Meeting who need additionalreasonable accommodations or who havespecial needs should contact the ACG officeat 301-263-9000 no later than September 24.Please complete sections 1-5. Please print clearly.1. peRsonal InFoRmatIonFirst nameLast nameMUST circle all that apply: MD* DO* PhD Rn nP LPn PA PharmD Other *Please enter your 10-digit nPI number (required if U.S. physician)Look up your nPI number at npinumberlookup.org.Mailing Address Home address Work addressCity State/Province Zip / Postal Code CountryPhoneFaxEmail (required for meeting confirmation)I am bringing a mobile device or tablet: Yes no2. ReGIstRatIon FeesI am currently an ACG member.My application † for membership is attached.I have registered below at the member rates.(For membership information or to downloada membership application, visit www.gi.org.)†Registration will not be processed withoutmembership application.I am an ACG 2014 presenter: oral paper poster(includes FACG and MACG)Resident/Trainee/CandidateMember of ACGACG MemberASGE Practice Manager MemberPhysician / Exhibitor / Guest /Guest Physician / PharmDAllied Health Personnel(e.g. NP, RN, LPN, PA) orSpouse / Guest name, only if attending meetingResident/Trainee** (must attachletter from PD verifying status)Allied Health PersonnelCircle fee(s) based on attendee typePG Course and Annual Meeting, October 18–22PG Course Only, October 18–19Annual Meeting Only, October 20–223-day Clinical Review, October 17–19, includes PG Course,GI Pathology/Imaging, and GI Pharmacology3-day Clinical Review PLUS Annual Meeting, October 17–22aCG memBeRs$425 $0 $275$425 $0 $275$0 $0 $0$600 $200 $450$600 $200 $450(e.g. NP, RN, LPN, PA)Practice Managernon-memBeRs$750 $200 $575 $575$550 $200 $500 $500$300 $0 $150 $150$750 $425 $725 $725$850 $425 $800 $800Optional Friday Programs, October 17GI Pathology/Imaging; half-day/am (included in 3-Day Clinical)GI Pharmacology; half-day/pm (included in 3-Day Clinical)Practice Management; full dayGI Recertification; half-day/pmASGE Endoscopy Course; full day$200 $160 $175$200 $160 $175$275 $0 $200$150* $150* $150*$395 $200 $200$225 $225 $225 $225$225 $225 $225 $225$300 $300 $300 $200$175* $175* $175* $175*$495 $250 $250 $250*Recertification Course: Separate purchase of ACG’s module required.Boxed dinner provided. See page 14 for more details.**Your registration will not be processed without a letter from yourProgram Director verifying status.Postgraduate Course attendeesPlease indicate syllabus preference.Print version only ....... FREEUSB drive only ........... FREEPrint and USB ...............$302014PREAnnual Scientific Meeting attendeesPlease indicate syllabus preference.Print version only ....... FREEUSB drive only ........... FREEPrint and USB ...............$30125
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Featured LecturesDavid Sun LectureT
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