Registration

Early registration fees apply if postmarked by 9/1/15. The fees include all lecture sessions, refreshments, printed materials, welcome reception, and daily lunches and dinners where applicable. There is an additional fee for all workshops and the 5K Fun Run/Walk. Daily rates are also available. Do not mail registration after 9/1/15. No refunds after 9/1/15. Refunds prior to that date are subject to a $50.00 administrative fee.

Name:_______________________________________________Male ( ) Female ( )
(as you would like it to appear on your name badge, including PA-C, PA-S, ect.)

Address:__________________________City:_______________State:_____Zip:_____

Phone (day):___________________________(evening):_________________________

Specialty:_____________________________

Email:__________________________________________________________________
(**All confirmations will be sent via email.**)

Entire Conference (single rate):
Until 8/1 Until 9/1 After 9/1
MAPA Member $450 $475 $520
Non-member $500 $550 $600
Student Member $225 $250 $275
Student Non-member $265 $280 $315

Special 2 Day Student Member Rate $165 $185

Daily Rate (indicate days below):
Until 9/1 After 9/1
MAPA Member $145 $155
Non-Member $175 $185
Student Member $100 $115
Student Non-member $115 $125

Days: Thursday Friday Saturday Sunday
*admission to Wednesday dinner lecture free with Thursday registration
Payment : (include check payable to MAPA or fill out credit card information below)

Registration Fees: $________
Additional Ticket Fees: $________
Membership Fees: $________ Add dues if joining, see below.
TOTAL ENCLOSED $________

_________________________________________ ___________________________________
Credit Card Number (MC/Visa/AMEX) Expiration Date
Signature
Name as it appears on card
Fellow: $125 for 1 yr
Affiliate: $125 for 1 yr
Associate: $75 for 1 yr
Student: $50 for 2 yrs

If joining please sign:

I am applying for membership in the Maryland Academy of Physician Assistants and I agree to uphold the PA profession’s Code of Ethics and to support the efforts of the Academy.

Signature:____________________________________ Date:_____________________________
Additional Tickets

Product Theater Dinner symposium: 9/09/15 6:30 pm – 8:00 pm
Will registrant attend: Yes ( ) No ( ) Free

Welcome reception: 9/10/15 6:30 pm – 9:30 pm
Will registrant attend: Yes ( ) No ( ) FREE
Adult Guests: ($15): #_______ $______
Children: (free): #_______

5K Fun Run/Walk: 9/12/15 6:30 am
Run/Walk on the beach in front of the Clarion. Please indicate t-shirt size
Sm ( ) Med ( ) Lge ( ) X-Lge ( )
$25 $_____

MAPA Celebration and Challenge Bowl: 9/12/15 6:30 pm
Will Registrant attend: Yes ( ) No ( ) Free
Adult Guest: ($25):#_____ $_____

Demystifying Emergency and Acute Care Medicine Workshop
9/09/15 9:00 am – 5:00 pm (Box Lunches Provided) (8 hour CAT 1 CME) Limited to 50 registrants, please register early
$199 $______

Reimbursement and Documentation Workshop: What You Need to Know
2 Self Assessment CAT 1 credits
9/09/15 10:00 am – 12:00 pm
Limited to 50 registrants, please register early
$50 $______

Patient Satisfaction Workshop: How to Improve Your Scores, Make Patients Happy, and Provide Good Medical Care (Performance Improvement Project included 20 PI CME credits)
09/09/15 12:00 pm - 2:00 pm
Limited to 50 registrants, please register early
$150 $______

Dermatology Procedures Workshop:
9/09/15 2:00 pm – 4:00 pm
Limited to 30 registrants, please register early
$65 $______

Urgent Care Procedures Workshop
9/09/15 2:00 pm – 4:00 pm
$65 $______

X-ray Review of Common Fractures Workshop: Is the Broken?
9/11/15 10:00 am – 12:00 pm
Limited to 40 registrants, please register early
$50 $______

Bedside Cardiac Diagnosis and Heart Sounds Workshop
9/11/15 2:00 pm – 4:00 pm
$50 $______

Patient Satisfaction Workshop: How to Improve Your Scores, Make Patients Happy, and Provide Good Medical Care (Performance Improvement Project included 20 PI CME credits)
09/11/15 2:00 pm - 4:00 pm
Limited to 50 registrants, please register early
$150 $______

Rapid Response Workshop: 9/12/15 10:00 am – 12:00 pm
Limited to 40 registrants, please register early
$50 $______

EKG Workshop for Students and New PAs
9/12/15 10:00 am – 12:00 pm
Limited to 30 registrants, please register early
$50 $______

Superficial Techniques for Superficial Wounds Workshop
9/12/14 2:00 pm – 5:00 pm
Limited to 30 registrants, please register early
$50 $______

Mastering the EKG Workshop
9/12/15 2:00 pm – 5:00 pm
Limited to 50 registrants, please register early
$50 $______

ACLS/BLS Initial Certification or Recertification: 9/12/15
Time varies, testing takes 45 min – 1 hour
BLS $65.00 $_____
ACLS $205.00 $_____