Registration

2017 Spring Meeting & Pediatric Update

Register at right for the Spring Meeting.  Please note that those who are not enrolled in MOC CAN get CME for the Self-Assessment Workshop on Friday.  

Please use correct capitalization. DO NOT use ALL CAPS completing this form,
Please use correct capitalization. DO NOT use ALL CAPS completing this form,
Credentials *
Please use correct capitalization. DO NOT use ALL CAPS completing this form,
Please use correct capitalization. DO NOT use ALL CAPS completing this form,
Please use correct capitalization. DO NOT use ALL CAPS completing this form,
Phone *
Phone
Will you be participating in the Grand Pediatric Pentathlon? *
Fri./Sat. at your leisure, $50 donation to participate
Please indicate: 1) Adult shirt size (Small - 3XL) 2) Male or Female cut/style. (example: 1 large male cut, 1 Medium female cut, 1 small female cut)
Please indicate the 1) Youth shirt size (Small - Large) (example: 1 Large youth, 1 Medium youth, 1 Small youth
Will you be participating in the Good4Growth MOC Part 2 Workshop? *
Friday 1:30 p.m. Those who ARE NOT enrolled in MOC CAN get CME, offered through the Chapter.
Enrolled in MOC?
Will you be participating in the Saturday night reception & dinner? *
6:00 p.m., included in registration. Guests require additional fees
Please use correct capitalization. DO NOT use ALL CAPS completing this form,
Registration Fees *
Additional Adult tickets for Sat. night reception/dinner/dessert *
($60 per additional Adult guest)
Additional Child tickets for Sat. night reception/dinner/dessert *
($20 per child guest)
$20 per child
$50 per shirt for Adult and Youth
Tax-deductible donation
$

Please click submit above BEFORE paying.