GAPA 2017 CME Conference
July 10 - 14, 2017
Hilton Head Island • South Carolina
Westin Hilton Head Island


GAPA is going GREEN!

General Information


Registration includes breakfasts, lunches, refreshment breaks, commemorative attendee tote bag, and access to sessions and exhibits. Registration badges will be required for admission to all events. Payment is due with registration form and must be submitted by the below dates to qualify for corresponding rate. Materials can only be guaranteed to pre-registered attendees - be sure to register early.

GEORGIA PAs - If you wish to become a member of GAPA ($175), please check the checkbox on this form or complete our online form.

Please complete and submit the registration form below. One registration form per person. If you prefer, you may print this form with your browser and fax or mail to GAPA.


Date:
Note that items marked with an "*" are required fields.
PERSONAL INFORMATION
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*Please Select: PA-C    ARNP    PA Student    FNP
Other:
(Please specify if Other)
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*Specialty:
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GAPA Membership #:
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*How did you learn about the conference:
(Check all that apply.)
AAPA CME Calendar
Conference Brochure
GAPA Website
Emails from GAPA Office
Emails from healthjobsnationwide.com
AdvancedPracticeJobs.com
Phone Calls from GAPA Headquarters
Fax Reminders from GAPA Headquarters
Facebook Ads
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Other (please specify)    

REGISTRATION CATEGORY INFORMATION
SELECT CATEGORY ON/BEFORE
Feb 15
ON/BEFORE
March 22
ON/BEFORE
May 15
AFTER
May 15
GAPA PA Fellow Member

$645

$745 $795 $845
Retiree/Military
      (25% discount!)
$485 $555 $595 $635
GA PA Non-Members/ Other Professional $820 $920 $970 $1,020
Spouse/Guest**
-- no CME credits awarded
$200 $215 $230 $245
Spouse/Guest Name:
**Full guest registrations include the same items as a full conference registration except a CME certificate and select product theater luncheons. Product theater luncheons are healthcare provider attendance specific only.
One Day Registration:
Monday
Tuesday
Wednesday
Thursday
Friday
$255 $295 $315 $335
Student Track Only:
Monday
$50 $50 $50 $50
*If student, please list:
  o PA Program
  o Graduation Year: 4 digit year value only.  The entered year is less than the minimum allowed.  The entered year is greater than the maximum allowed.
Registration Fees Subtotal $
Discount for New PA Member $
Registration Fees Total $
MEMBERSHIP DUES

CURRENT GAPA MEMBERS:  Check this box to add additional $175 for your membership renewal dues

GA PA NON-MEMBERS:  Check this box to join GAPA. $175 will be deducted from your registration fee (giving you the GAPA Member rate) and $175 will be added for your Membership Dues. You will be granted fellow member status for the balance of the current membership period (January 1, 2017–December 31, 2017).

Membership Fees Subtotal $


WORKSHOPS

**Please be sure to check workshop times to ensure there is no overlapping


  Board Review (Monday) $199
  Slit Lamp (Monday) $90
  Crash Course in Clinical Skills (Monday) Workshop Full $125
  Crash Course in Clinical Skills (Wednesday) $125
  ACLS (Monday) $145
  Joint Injections (Monday) $75
  Suturing & Wound Techniques (Monday) Workshop Full $125
  Suturing & Wound Techniques (Thursday) $125
  None -

GENERAL SESSIONS

Please select one track per day


TUESDAY SESSIONS
  Emergency Medicine
  None
WEDNESDAY SESSIONS
  Orthopedics/Sports Medicine
  Dermatology
  None
THURSDAY SESSIONS
  Cardiology
  Women's Health
  None
FRIDAY SESSIONS
  It's All in the Blood
  None
 
Workshop Fees Total $

ADDITIONAL EVENTS
5K Fun Run Walk
$25 $
     5K T shirt size:  S:    M:    L:    XL:   
Golf Tournament
$100 $
Event Fees Subtotal $

PAC DONATIONS
A Chance To Protect And Promote Our Profession.
Your Generous Contribution Helps!

(Suggested minimum $25-$50)
Amount You Would Like To Donate: $

NURSE PRACTITIONER DISCOUNT – 15% off
To qualify for this discount, print this completed form and mail or fax to GAPA office.
Do NOT submit online.
  Nurse Practitioner Discount
        Name of colleague:
$

GRAND TOTAL $

PAYMENT INFORMATION
* Please complete all fields in this section.


Visa  MasterCard  Discover  American Express 

Please make a selection.

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REFUNDS: Written notice of cancellation must be received by June 5, 2017. A $75 administrative fee will be retained.

 

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MAIL OR FAX INSTRUCTIONS


Complete form and mail to: GAPA
1905 Woodstock Road, Suite 2150
Roswell, GA 30075
Complete form and fax to: 770-640-1095
Payment is due with registration form. If faxing, please include credit card number. To avoid duplicate charges, do not mail registration form if you have already faxed it or submitted it via this webform.
Make checks payable to GAPA (GAPA'S Tax ID#: 58-1296375)
In accordance with the Americans With Disabilities Act, please call the GAPA office if you have any special needs.


Stay Connected to GAPA! GAPA Goes Green

GAPA GREENIn an effort to lower our environmental impact and preserve our natural resources, GAPA has elected to Go Green! Please look for our Green logo to learn more about GAPA's Green Initiatives.