Or, fax or mail this form and payment to: Fax: 847/228-5059 (credit card payment is required) American Academy of Pediatrics/Registration 37925 Eagle Way, Chicago, IL 60678-1379 Register Online at AAPexperience.org/register For Office Use Only: D $ Payment Organization Address City Country (if other than USA) State/Province ZIP Code Office Telephone Number Cell Phone Number E-mail Address Your primary contact information will be included in the bar code that you may use in the Exhibit Hall. 2013 NATIONAL CONFERENCE REGISTRATION FORM Non-ticketed Programs There is no advance selection for specific educational sessions (excluding courses and workshops for which an additional fee is required.) Every professional attendee has the same opportunity to attend sessions on a first-come, first-served basis. Once the session has reached capacity, attendees will have to choose another session during that time frame. We are offering several repeated sessions, which will be posted near the meeting rooms. A PERSONAL INFORMATION AAP ID Number (AAP members only) First Name Last Name Degree Badges will be mailed to all advance registrants who register by September 13 and who live in the United States or Canada approximately two weeks prior to the conference. Your badge will be mailed to the primary membership address you have on file with the AAP or the address below if you are a nonmember. ☐ This is my first AAP National Conference & Exhibition. Emergency Contact Name Emergency Contact Phone ___-___- ____ Example 847/434-4000 (Please note this information will only be used in the event of an emergency on-site) Need assistance registering? Call us — we are here to help! 800/433-9016, option 3 [email protected]Indicate Twitter handle if you’d like to attend a tweet-up during the conference! Age ☐ 20–30 ☐ 31–40 ☐ 41–50 ☐ 51–60 ☐ 61–70 ☐ 71+ Gender ☐ Female ☐ Male Specialty/Sub-specialty ☐ Allergy & Immunology ☐ Cardiology/Cardiac Surgery ☐ Dermatology ☐ Development & Behavioral ☐ Emergency Medicine ☐ Endocrinology ☐ General Peds ☐ Neonatology/Perinatology ☐ Pulmonology ☐ Resident ☐ Surgery ☐ Urology ☐ Other __________________ Annual Volume of Products & Services Purchased ☐ $50,000 – $100,000 ☐ $100,000 – $250,000 ☐ $250,000 – $500,000 ☐ $500,000 – $1,000,000 ☐ over $1,000,000 Purchaser Profile ☐ General Pediatrician ☐ Pediatric Medical or Surgical Subspecialist ☐ Allied Health Professional ☐ Practice Manager ☐ Pediatric Resident or Fellow ☐ Family Physician ☐ Medical Student ☐ Other The Department of Education showcases many tools and resources in the AAP Resource Center at the conference. Please check if you are interested in receiving email alerts about the following ☐ eNews from the AAP National Conference & Exhibition ☐ Live AAP CME Activities Notification ☐ Pediatrics Digest E-Alert ☐ AAP Education Newsletter ☐ AAP Journals & PREP Newsletter (user tips, etc) ☐ PedJobs Career Quarterly e-Newsletter ☐ PediaLink e-Newsletter ☐ Life Support Programs Orlando, FL Oct 26–29, 2013 Orange County Convention Center AAPexperience.org
Transcript
Or fax or mail this form and payment toFax 847228-5059 (credit card payment is required)
American Academy of PediatricsRegistration 37925 Eagle Way Chicago IL 60678-1379
Register Online at AAPexperienceorgregister For Office Use Only
D $ Payment
Organization
Address
City
Country (if other than USA) StateProvince ZIP Code
Office Telephone Number Cell Phone Number
E-mail Address
Your primary contact information will be included in the bar code that you may use in the Exhibit Hall
2013 NATIONAL CONFERENCE REGISTRATION FORM
Non-ticketed ProgramsThere is no advance selection for specific educational sessions (excluding courses and workshops for which an additional fee is required) Every professional attendee has the same opportunity to attend sessions on a first-come first-served basis Once the session has reached capacity attendees will have to choose another session during that time frame We are offering several repeated sessions which will be posted near the meeting rooms
A PERSONAL INFORMATION
AAP ID Number (AAP members only)
First Name
Last Name Degree
Badges will be mailed to all advance registrants who register by September 13 and who live in the United States or Canada approximately two weeks prior to the conference Your badge will be mailed to the primary membership address you have on file with the AAP or the address below if you are a nonmember
This is my first AAP National Conference amp Exhibition
Emergency Contact Name
Emergency Contact Phone ___-___-____ Example 847434-4000
(Please note this information will only be used in the event of an emergency on-site)
Need assistance registeringCall us mdash we are here to help800433-9016 option 3registrationaaporg
Indicate Twitter handle if yoursquod like to attend a tweet-up during the conference
Age 20ndash30 31ndash40 41ndash50 51ndash60 61ndash70 71+
Gender Female Male
SpecialtySub-specialty Allergy amp Immunology CardiologyCardiac Surgery Dermatology Development amp Behavioral Emergency Medicine Endocrinology General Peds NeonatologyPerinatology Pulmonology Resident Surgery Urology Other __________________
Purchaser Profile General Pediatrician Pediatric Medical or Surgical Subspecialist Allied Health Professional Practice Manager Pediatric Resident or Fellow Family Physician Medical Student Other
The Department of Education showcases many tools and resources in the AAP Resource Center at the conference Please check if you are interested in receiving email alerts about the following
eNews from the AAP National Conference amp Exhibition
Live AAP CME Activities Notification Pediatrics Digest E-Alert AAP Education Newsletter AAP Journals amp PREP Newsletter (user tips etc) PedJobs Career Quarterly e-Newsletter PediaLink e-Newsletter Life Support Programs
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
b TOTAL ATTENDEE REGISTRATION FEES $
D TOTAL SPECIAL EVENT AND FAMILY PROGRAM FEES $
NumBER of TiCkETsADuLT(s) CHiLD(REN)
(17 amp younger)pRiCE
fRiDAy oCToBER 25
V0014 adultV0014C child
AAP Community Cares Project (Children must be at least 5 years old) 1200 pm ndash 430 pm
______ ______Complimentary $0
V0020 adultV0020C child
AAP Kidsrsquo Camp 530pmndash830pm ______ ______
Complimentary $0
V0021 adultV0021C child
Welcome Reception 730pmndash930pm ______ ______
Complimentary $0
sATuRDAy oCToBER 26
V1136 adultV1136C child
Orlando Experience at Disneyrsquos Hollywood Studiosreg
715pmndash1100pm ______ ______
Complimentary $0
suNDAy oCToBER 27
V2116 adultchild
CPR Anytime In English 400pmndash530pm ______ ______
$25 total per family $25
V2149 adultV2149C child
Presidentrsquos Reception in the Exhibit Hall 530pmndash700pm ______ ______
Complimentary $0
moNDAy oCToBER 28 V3002 adult
V3002C child
Friends of Children Fund 5K Fun Run amp Walk
730amndash830am ______ ______
We recommend a minimum donation of $25 to the AAP
Friends of Children Fund Every participant will receive
a Fun Run t-shirt
$25 $75 $50 $100
Check your appropriate registration feeFull ConFerenCe PriCing
Please fill in the number of adult and child tickets requested for each event
C TOTAL FAMILY REGISTRATION FEES $
Last name __________________________________
You must be registered for the conference to attend any special events courses workshops or catered events
AAP Members save over $200 on registration
Join or renew at AAPorgjoin
lASt nAMe FirSt nAMe relAtiOnShiP Adultchild
(ages 17 amp under) Price1 $10
2 $10
3 $10
4 $10
5 $10
SUBTOTAL
The family registration is intended for the professional attendeersquos family members The family registration fee is $10 per person and grants admission into the following programs
AAP Community Cares Project Exhibit Hall Orlando Experience at Disneyrsquos Hollywood Studiosreg
C FAMILY REGISTRATION FEE
Welcome Reception and Kidsrsquo Camp Presidentrsquos Reception Plenary Sessions
Please fill in the information for each family member below
CHILD CAREOn-site child care is available at the conference and will be located at the Peabody Hotel Registration is handled directly by Kiddie Corp Sign up early as space is limited Please visit kiddiecorpcomaapkidshtm or call 800942-9947 to registerRegistered family members do not have access to any educational sessions except
for Plenary Sessions
To register for a tour or to purchase reduced-price theme park tickets visit AAPexperienceorgtours AAPexperienceorgticketsSee page 24 for a list of tours
AAP has partnered with Capitol Service Inc Florida to offer a wide variety of high-quality Orlando tours Many tours sell out in advance so register early
Tickets are available for purchase by conference registrants and registered family AAP may cancel any tour that does not meet minimum attendance requirements (with a full refund provided) All tours depart from the Orange County Convention Center
E COURSES AND WORKSHOPS
AAP TOURS AND THEME PARK TICKETS
Last name __________________________________
E TOTAL COURSES + WORKSHOPS FEES $
wOrkShOPSWorkshops sell out quickly Please indicate your first and second choice if there is more than one workshop offered in the same time period by placing a number 1 or 2 in the box before the workshop code Each workshop has a $65 material fee
F SESSION HANDOUTS ON FLASH DRIVE
All session handouts will be available online (free to registered attendees) beginning September 30th Complimentary wireless internet access will be available at the Orange County Convention Center to view session handouts on your mobile device
Session Handouts on USB flash drives can be purchased in advance and will be available for pick-up in West Hall C Lobby of the convention center
Session Handouts on USB Flashdrive FD1(limit 1 per registrant) $30
Flash drive includes handouts submitted for general sessions (Audience Response
Case Discussions Interactive Group Forums Selected Short Subjects Seminars and Workshops) Handouts may not be available for Meet-the-Expert Discussions Plenary Sessions Courses or SectionCouncil programs All presented oral and poster abstracts will be accessible on the flash drive
sATuRDAy oCToBER 26
830amndash1000am
W1050 Suturing Workshop (repeats as W1123)W1051 Asthma and Allergy Gadgets of Interest to Pediatricians (repeats as W2142)
$65 $ ______
200pmndash330pm W1091 Hands-on Rheumatology Workshop for the Pediatrician (repeats as W1124) $65 $ ______
400pmndash530pm
W1122 Hands-on Exam of Knee and Ankle (repeats as W2109)W1123 Suturing Workshop (repeats from W1050)W1124 Hands-on Rheumatology Workshop for the Pediatrician (repeats from W1091)
$65 $ ______
suNDAy oCToBER 27
830amndash1000am
W2058 Emergency Procedures in the Office Setting (repeats as W2108)W2059 Spirometry Workshop (repeats as W4035)
$65 $ ______
200pmndash330pm
W2108 Emergency Procedures in the Office Setting (repeats from W2058)W2109 Hands-on Exam of Knee and Ankle (repeats from W1122)
$65 $ ______
400pmndash530pm
W2141 Casting and Splinting Workshop (repeats as W3055)W2142 Asthma and Allergy Gadgets of Interest to Pediatricians (repeats from W1051)
$65 $ ______
moNDAy oCToBER 28 830amndash1000am
W3053 Eye Examination Skills Using the Ophthalmoscope (repeats as W3100)W3054 Otoscopy Workshop Important Observations and Diagnosis Using the Otoscope (repeats as W3133)W3055 Casting and Splinting Workshop (repeats from W2141)
$65 $ ______
200pmndash330pm
W3099 Simulation Lab for Recognition Stabilization and Evaluation of Abusive Head TraumaW3100 Eye Examination Skills Using the Ophthalmoscope (repeats from W3053)
$65 $ ______
400pmndash530pm W3133 Otoscopy Workshop Important Observations and Diagnosis Using the Otoscope (repeats from W3054) $65 $ ______
TuEsDAy oCToBER 29
830amndash1000am W4035 Spirometry Workshop (repeats from W2059) $65 $ ______
cOurSeS ToTAL
fRiDAy oCToBER 25
800amndash430pm C0001 NRP Current Issues Seminar ndash Itrsquos a Small World After All $85 $ ______
NRP Concurrent Sessions (Select one breakout for each time slot) 100pmndash230pm 245pmndash415pm
NRP Breakout 1 Case-Based Discussion on Neonatal Ethics wAudience Response System (ARS)
NRP Breakout 2 How to Perform the Performance and Integrated Skills StationsmdashMoving From Great to Excellent
NRP Breakout 3A Hands on Simulation Training Focused on Anomalies (Repeat of Breakout 3B)
NRP Breakout 3B Hands on Simulation Training Focused on Anomalies (Repeat of Breakout 3A)
NRP Breakout 4 Microsim Demonstration and Potential Future Applications within NRP
800amndash1130am C0016 Pediatric Practice Managers Program Enhance the Patient Experience Through Engagement and Get Paid for It Complimentary $0
800amndash1130am C0009 Millennium Development Goals (MDGs) 2015 and Beyond Complimentary $0
1130amndash530pm C0010 Peds 21 Promoting Early Brain and Child Development (EBCD) Building Brains Forging Futures Complimentary $0
sATuRDAy oCToBER 26
800amndash600pm C1012 APLS The Pediatric Emergency Medicine Course $275 $ ______
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
Please register online at AAPexperienceorgregister or mail or fax this form and payment to
American Academy of PediatricsRegistration37925 Eagle Way Chicago IL 60678-1379
Fax 847228-5059 (credit card payment is required)
Advance Registration Deadline september 13 2013 Cancellation Deadline for Registration september 13 2013
Note If the total payment is incorrect the necessary adjustments will be made and your credit card will be charged accordingly
METHOD OF PAYMENT
Check enclosed payable to the American Academy of Pediatrics (US Only) VISA MasterCard Discover American Express
Card Number Exp Date (MMYY)
Cardholder Zipcode
Name as it appears on card (please print)
Signature
Any special disability requirements for you or your family please describe
Advance registration will not be made without payment Registration confirmations will be sent by e-mail or standard mail
Photos or videos of conference attendees become property of the AAP and may appear in AAP conference publications To protect the privacy of minors full-face views are never used only sideback views of children unless parent permission is granted
G CATERED EVENTS tOtAL FEEs
TOTAL PAYMENT $
B TOTAL ATTENDEE REGiSTRATiON FEES $_______
C TOTAL FAMiLY REGiSTRATiON FEES $_______
D TOTAL SPECiAL EVENT AND FAMiLY PROGRAM FEES $_______
E TOTAL COURSES AND WORkShOPS FEES $_______
F TOTAL SESSiON hANDOUTS ON FLASh DRiVE FEES $_______
I Wersquoll Plant a Tree to Offset Your Carbon Footprint (TR1)
Qty ____ x $10 = $_______
Last name __________________________________
Need assistance registering Call us mdash we are here to help800433-9016 option 3 | registrationaaporg
CANCELLATION POLICY Cancellation requests must be sent in writing by September 13 to
AAP Registration141 Northwest Point BlvdElk Grove Village IL 60007
Fax 847228-5059Email registrationaaporg
Cancellation requests received by September 13 will receive a full refund less a $50 administrative fee Refunds will be processed one month following the close of the conference After September 13 all fees paid to the AAP for conference registration catered events special events courses and workshops are nonrefundable
fEE ToTAL
fRiDAy oCToBER 25
800am-1100am M01 Innovations in Obesity Prevention Assessment and Treatment Forum
Comp $0
sATuRDAy oCToBER 26
1130am-100pm
M02 Council on Children with DisabilitiesSection on Developmental and Behavioral Pediatrics Joint Program Lunch
$30 $30
1230pm-130pm
M03 Section on Administration and Practice Management Edward J Saltzman Luncheon
$35 $35
100pm-215pm M04 Section on Surgery Lunch amp Poster Session
$57 $57
700pm-1100pm M05 Section on Cardiology and Cardiac Surgery Banquet
______times $80 = tickets
$____
suNDAy oCToBER 27
700am-815am M06 District I Breakfast Comp $0
700am-815am M07 District II Breakfast Comp $0
700am-815am M08 District III Breakfast Comp $0
700am-815am M09 District IV Breakfast Comp $0
700am-815am M10 District V Breakfast Comp $0
700am-815am M11 District VI Breakfast Comp $0
700am-815am M12 District VII Breakfast Comp $0
700am-815am M13 District VIII Breakfast Comp $0
700am-815am M14 District IX Breakfast Comp $0
700am-815am M15 District X Breakfast Comp $0
1130am-130pm M16 Section on Surgery Luncheon and Clinical Problem Solving
$57 $57
1200pm-200pm M17 Council on Community Pediatrics Awards Luncheon
Comp $0
moNDAy oCToBER 28
1200pm-100pm
M18 Council on Foster Care Adoption and Kinship Care Luncheon (COFCAKC Members Only)
Comp $0
1230pm-130pm M19 Annual Business Luncheon (AAP Members)
Comp (Limit 1 Ticket)
$0
1230pm-130pm M20 Annual Business Luncheon (Non-members and Guests)
______times $60 = tickets
$____
G TOTAL CATERED EVENTS FEES $
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
b TOTAL ATTENDEE REGISTRATION FEES $
D TOTAL SPECIAL EVENT AND FAMILY PROGRAM FEES $
NumBER of TiCkETsADuLT(s) CHiLD(REN)
(17 amp younger)pRiCE
fRiDAy oCToBER 25
V0014 adultV0014C child
AAP Community Cares Project (Children must be at least 5 years old) 1200 pm ndash 430 pm
______ ______Complimentary $0
V0020 adultV0020C child
AAP Kidsrsquo Camp 530pmndash830pm ______ ______
Complimentary $0
V0021 adultV0021C child
Welcome Reception 730pmndash930pm ______ ______
Complimentary $0
sATuRDAy oCToBER 26
V1136 adultV1136C child
Orlando Experience at Disneyrsquos Hollywood Studiosreg
715pmndash1100pm ______ ______
Complimentary $0
suNDAy oCToBER 27
V2116 adultchild
CPR Anytime In English 400pmndash530pm ______ ______
$25 total per family $25
V2149 adultV2149C child
Presidentrsquos Reception in the Exhibit Hall 530pmndash700pm ______ ______
Complimentary $0
moNDAy oCToBER 28 V3002 adult
V3002C child
Friends of Children Fund 5K Fun Run amp Walk
730amndash830am ______ ______
We recommend a minimum donation of $25 to the AAP
Friends of Children Fund Every participant will receive
a Fun Run t-shirt
$25 $75 $50 $100
Check your appropriate registration feeFull ConFerenCe PriCing
Please fill in the number of adult and child tickets requested for each event
C TOTAL FAMILY REGISTRATION FEES $
Last name __________________________________
You must be registered for the conference to attend any special events courses workshops or catered events
AAP Members save over $200 on registration
Join or renew at AAPorgjoin
lASt nAMe FirSt nAMe relAtiOnShiP Adultchild
(ages 17 amp under) Price1 $10
2 $10
3 $10
4 $10
5 $10
SUBTOTAL
The family registration is intended for the professional attendeersquos family members The family registration fee is $10 per person and grants admission into the following programs
AAP Community Cares Project Exhibit Hall Orlando Experience at Disneyrsquos Hollywood Studiosreg
C FAMILY REGISTRATION FEE
Welcome Reception and Kidsrsquo Camp Presidentrsquos Reception Plenary Sessions
Please fill in the information for each family member below
CHILD CAREOn-site child care is available at the conference and will be located at the Peabody Hotel Registration is handled directly by Kiddie Corp Sign up early as space is limited Please visit kiddiecorpcomaapkidshtm or call 800942-9947 to registerRegistered family members do not have access to any educational sessions except
for Plenary Sessions
To register for a tour or to purchase reduced-price theme park tickets visit AAPexperienceorgtours AAPexperienceorgticketsSee page 24 for a list of tours
AAP has partnered with Capitol Service Inc Florida to offer a wide variety of high-quality Orlando tours Many tours sell out in advance so register early
Tickets are available for purchase by conference registrants and registered family AAP may cancel any tour that does not meet minimum attendance requirements (with a full refund provided) All tours depart from the Orange County Convention Center
E COURSES AND WORKSHOPS
AAP TOURS AND THEME PARK TICKETS
Last name __________________________________
E TOTAL COURSES + WORKSHOPS FEES $
wOrkShOPSWorkshops sell out quickly Please indicate your first and second choice if there is more than one workshop offered in the same time period by placing a number 1 or 2 in the box before the workshop code Each workshop has a $65 material fee
F SESSION HANDOUTS ON FLASH DRIVE
All session handouts will be available online (free to registered attendees) beginning September 30th Complimentary wireless internet access will be available at the Orange County Convention Center to view session handouts on your mobile device
Session Handouts on USB flash drives can be purchased in advance and will be available for pick-up in West Hall C Lobby of the convention center
Session Handouts on USB Flashdrive FD1(limit 1 per registrant) $30
Flash drive includes handouts submitted for general sessions (Audience Response
Case Discussions Interactive Group Forums Selected Short Subjects Seminars and Workshops) Handouts may not be available for Meet-the-Expert Discussions Plenary Sessions Courses or SectionCouncil programs All presented oral and poster abstracts will be accessible on the flash drive
sATuRDAy oCToBER 26
830amndash1000am
W1050 Suturing Workshop (repeats as W1123)W1051 Asthma and Allergy Gadgets of Interest to Pediatricians (repeats as W2142)
$65 $ ______
200pmndash330pm W1091 Hands-on Rheumatology Workshop for the Pediatrician (repeats as W1124) $65 $ ______
400pmndash530pm
W1122 Hands-on Exam of Knee and Ankle (repeats as W2109)W1123 Suturing Workshop (repeats from W1050)W1124 Hands-on Rheumatology Workshop for the Pediatrician (repeats from W1091)
$65 $ ______
suNDAy oCToBER 27
830amndash1000am
W2058 Emergency Procedures in the Office Setting (repeats as W2108)W2059 Spirometry Workshop (repeats as W4035)
$65 $ ______
200pmndash330pm
W2108 Emergency Procedures in the Office Setting (repeats from W2058)W2109 Hands-on Exam of Knee and Ankle (repeats from W1122)
$65 $ ______
400pmndash530pm
W2141 Casting and Splinting Workshop (repeats as W3055)W2142 Asthma and Allergy Gadgets of Interest to Pediatricians (repeats from W1051)
$65 $ ______
moNDAy oCToBER 28 830amndash1000am
W3053 Eye Examination Skills Using the Ophthalmoscope (repeats as W3100)W3054 Otoscopy Workshop Important Observations and Diagnosis Using the Otoscope (repeats as W3133)W3055 Casting and Splinting Workshop (repeats from W2141)
$65 $ ______
200pmndash330pm
W3099 Simulation Lab for Recognition Stabilization and Evaluation of Abusive Head TraumaW3100 Eye Examination Skills Using the Ophthalmoscope (repeats from W3053)
$65 $ ______
400pmndash530pm W3133 Otoscopy Workshop Important Observations and Diagnosis Using the Otoscope (repeats from W3054) $65 $ ______
TuEsDAy oCToBER 29
830amndash1000am W4035 Spirometry Workshop (repeats from W2059) $65 $ ______
cOurSeS ToTAL
fRiDAy oCToBER 25
800amndash430pm C0001 NRP Current Issues Seminar ndash Itrsquos a Small World After All $85 $ ______
NRP Concurrent Sessions (Select one breakout for each time slot) 100pmndash230pm 245pmndash415pm
NRP Breakout 1 Case-Based Discussion on Neonatal Ethics wAudience Response System (ARS)
NRP Breakout 2 How to Perform the Performance and Integrated Skills StationsmdashMoving From Great to Excellent
NRP Breakout 3A Hands on Simulation Training Focused on Anomalies (Repeat of Breakout 3B)
NRP Breakout 3B Hands on Simulation Training Focused on Anomalies (Repeat of Breakout 3A)
NRP Breakout 4 Microsim Demonstration and Potential Future Applications within NRP
800amndash1130am C0016 Pediatric Practice Managers Program Enhance the Patient Experience Through Engagement and Get Paid for It Complimentary $0
800amndash1130am C0009 Millennium Development Goals (MDGs) 2015 and Beyond Complimentary $0
1130amndash530pm C0010 Peds 21 Promoting Early Brain and Child Development (EBCD) Building Brains Forging Futures Complimentary $0
sATuRDAy oCToBER 26
800amndash600pm C1012 APLS The Pediatric Emergency Medicine Course $275 $ ______
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
Please register online at AAPexperienceorgregister or mail or fax this form and payment to
American Academy of PediatricsRegistration37925 Eagle Way Chicago IL 60678-1379
Fax 847228-5059 (credit card payment is required)
Advance Registration Deadline september 13 2013 Cancellation Deadline for Registration september 13 2013
Note If the total payment is incorrect the necessary adjustments will be made and your credit card will be charged accordingly
METHOD OF PAYMENT
Check enclosed payable to the American Academy of Pediatrics (US Only) VISA MasterCard Discover American Express
Card Number Exp Date (MMYY)
Cardholder Zipcode
Name as it appears on card (please print)
Signature
Any special disability requirements for you or your family please describe
Advance registration will not be made without payment Registration confirmations will be sent by e-mail or standard mail
Photos or videos of conference attendees become property of the AAP and may appear in AAP conference publications To protect the privacy of minors full-face views are never used only sideback views of children unless parent permission is granted
G CATERED EVENTS tOtAL FEEs
TOTAL PAYMENT $
B TOTAL ATTENDEE REGiSTRATiON FEES $_______
C TOTAL FAMiLY REGiSTRATiON FEES $_______
D TOTAL SPECiAL EVENT AND FAMiLY PROGRAM FEES $_______
E TOTAL COURSES AND WORkShOPS FEES $_______
F TOTAL SESSiON hANDOUTS ON FLASh DRiVE FEES $_______
I Wersquoll Plant a Tree to Offset Your Carbon Footprint (TR1)
Qty ____ x $10 = $_______
Last name __________________________________
Need assistance registering Call us mdash we are here to help800433-9016 option 3 | registrationaaporg
CANCELLATION POLICY Cancellation requests must be sent in writing by September 13 to
AAP Registration141 Northwest Point BlvdElk Grove Village IL 60007
Fax 847228-5059Email registrationaaporg
Cancellation requests received by September 13 will receive a full refund less a $50 administrative fee Refunds will be processed one month following the close of the conference After September 13 all fees paid to the AAP for conference registration catered events special events courses and workshops are nonrefundable
fEE ToTAL
fRiDAy oCToBER 25
800am-1100am M01 Innovations in Obesity Prevention Assessment and Treatment Forum
Comp $0
sATuRDAy oCToBER 26
1130am-100pm
M02 Council on Children with DisabilitiesSection on Developmental and Behavioral Pediatrics Joint Program Lunch
$30 $30
1230pm-130pm
M03 Section on Administration and Practice Management Edward J Saltzman Luncheon
$35 $35
100pm-215pm M04 Section on Surgery Lunch amp Poster Session
$57 $57
700pm-1100pm M05 Section on Cardiology and Cardiac Surgery Banquet
______times $80 = tickets
$____
suNDAy oCToBER 27
700am-815am M06 District I Breakfast Comp $0
700am-815am M07 District II Breakfast Comp $0
700am-815am M08 District III Breakfast Comp $0
700am-815am M09 District IV Breakfast Comp $0
700am-815am M10 District V Breakfast Comp $0
700am-815am M11 District VI Breakfast Comp $0
700am-815am M12 District VII Breakfast Comp $0
700am-815am M13 District VIII Breakfast Comp $0
700am-815am M14 District IX Breakfast Comp $0
700am-815am M15 District X Breakfast Comp $0
1130am-130pm M16 Section on Surgery Luncheon and Clinical Problem Solving
$57 $57
1200pm-200pm M17 Council on Community Pediatrics Awards Luncheon
Comp $0
moNDAy oCToBER 28
1200pm-100pm
M18 Council on Foster Care Adoption and Kinship Care Luncheon (COFCAKC Members Only)
Comp $0
1230pm-130pm M19 Annual Business Luncheon (AAP Members)
Comp (Limit 1 Ticket)
$0
1230pm-130pm M20 Annual Business Luncheon (Non-members and Guests)
______times $60 = tickets
$____
G TOTAL CATERED EVENTS FEES $
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
To register for a tour or to purchase reduced-price theme park tickets visit AAPexperienceorgtours AAPexperienceorgticketsSee page 24 for a list of tours
AAP has partnered with Capitol Service Inc Florida to offer a wide variety of high-quality Orlando tours Many tours sell out in advance so register early
Tickets are available for purchase by conference registrants and registered family AAP may cancel any tour that does not meet minimum attendance requirements (with a full refund provided) All tours depart from the Orange County Convention Center
E COURSES AND WORKSHOPS
AAP TOURS AND THEME PARK TICKETS
Last name __________________________________
E TOTAL COURSES + WORKSHOPS FEES $
wOrkShOPSWorkshops sell out quickly Please indicate your first and second choice if there is more than one workshop offered in the same time period by placing a number 1 or 2 in the box before the workshop code Each workshop has a $65 material fee
F SESSION HANDOUTS ON FLASH DRIVE
All session handouts will be available online (free to registered attendees) beginning September 30th Complimentary wireless internet access will be available at the Orange County Convention Center to view session handouts on your mobile device
Session Handouts on USB flash drives can be purchased in advance and will be available for pick-up in West Hall C Lobby of the convention center
Session Handouts on USB Flashdrive FD1(limit 1 per registrant) $30
Flash drive includes handouts submitted for general sessions (Audience Response
Case Discussions Interactive Group Forums Selected Short Subjects Seminars and Workshops) Handouts may not be available for Meet-the-Expert Discussions Plenary Sessions Courses or SectionCouncil programs All presented oral and poster abstracts will be accessible on the flash drive
sATuRDAy oCToBER 26
830amndash1000am
W1050 Suturing Workshop (repeats as W1123)W1051 Asthma and Allergy Gadgets of Interest to Pediatricians (repeats as W2142)
$65 $ ______
200pmndash330pm W1091 Hands-on Rheumatology Workshop for the Pediatrician (repeats as W1124) $65 $ ______
400pmndash530pm
W1122 Hands-on Exam of Knee and Ankle (repeats as W2109)W1123 Suturing Workshop (repeats from W1050)W1124 Hands-on Rheumatology Workshop for the Pediatrician (repeats from W1091)
$65 $ ______
suNDAy oCToBER 27
830amndash1000am
W2058 Emergency Procedures in the Office Setting (repeats as W2108)W2059 Spirometry Workshop (repeats as W4035)
$65 $ ______
200pmndash330pm
W2108 Emergency Procedures in the Office Setting (repeats from W2058)W2109 Hands-on Exam of Knee and Ankle (repeats from W1122)
$65 $ ______
400pmndash530pm
W2141 Casting and Splinting Workshop (repeats as W3055)W2142 Asthma and Allergy Gadgets of Interest to Pediatricians (repeats from W1051)
$65 $ ______
moNDAy oCToBER 28 830amndash1000am
W3053 Eye Examination Skills Using the Ophthalmoscope (repeats as W3100)W3054 Otoscopy Workshop Important Observations and Diagnosis Using the Otoscope (repeats as W3133)W3055 Casting and Splinting Workshop (repeats from W2141)
$65 $ ______
200pmndash330pm
W3099 Simulation Lab for Recognition Stabilization and Evaluation of Abusive Head TraumaW3100 Eye Examination Skills Using the Ophthalmoscope (repeats from W3053)
$65 $ ______
400pmndash530pm W3133 Otoscopy Workshop Important Observations and Diagnosis Using the Otoscope (repeats from W3054) $65 $ ______
TuEsDAy oCToBER 29
830amndash1000am W4035 Spirometry Workshop (repeats from W2059) $65 $ ______
cOurSeS ToTAL
fRiDAy oCToBER 25
800amndash430pm C0001 NRP Current Issues Seminar ndash Itrsquos a Small World After All $85 $ ______
NRP Concurrent Sessions (Select one breakout for each time slot) 100pmndash230pm 245pmndash415pm
NRP Breakout 1 Case-Based Discussion on Neonatal Ethics wAudience Response System (ARS)
NRP Breakout 2 How to Perform the Performance and Integrated Skills StationsmdashMoving From Great to Excellent
NRP Breakout 3A Hands on Simulation Training Focused on Anomalies (Repeat of Breakout 3B)
NRP Breakout 3B Hands on Simulation Training Focused on Anomalies (Repeat of Breakout 3A)
NRP Breakout 4 Microsim Demonstration and Potential Future Applications within NRP
800amndash1130am C0016 Pediatric Practice Managers Program Enhance the Patient Experience Through Engagement and Get Paid for It Complimentary $0
800amndash1130am C0009 Millennium Development Goals (MDGs) 2015 and Beyond Complimentary $0
1130amndash530pm C0010 Peds 21 Promoting Early Brain and Child Development (EBCD) Building Brains Forging Futures Complimentary $0
sATuRDAy oCToBER 26
800amndash600pm C1012 APLS The Pediatric Emergency Medicine Course $275 $ ______
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
Please register online at AAPexperienceorgregister or mail or fax this form and payment to
American Academy of PediatricsRegistration37925 Eagle Way Chicago IL 60678-1379
Fax 847228-5059 (credit card payment is required)
Advance Registration Deadline september 13 2013 Cancellation Deadline for Registration september 13 2013
Note If the total payment is incorrect the necessary adjustments will be made and your credit card will be charged accordingly
METHOD OF PAYMENT
Check enclosed payable to the American Academy of Pediatrics (US Only) VISA MasterCard Discover American Express
Card Number Exp Date (MMYY)
Cardholder Zipcode
Name as it appears on card (please print)
Signature
Any special disability requirements for you or your family please describe
Advance registration will not be made without payment Registration confirmations will be sent by e-mail or standard mail
Photos or videos of conference attendees become property of the AAP and may appear in AAP conference publications To protect the privacy of minors full-face views are never used only sideback views of children unless parent permission is granted
G CATERED EVENTS tOtAL FEEs
TOTAL PAYMENT $
B TOTAL ATTENDEE REGiSTRATiON FEES $_______
C TOTAL FAMiLY REGiSTRATiON FEES $_______
D TOTAL SPECiAL EVENT AND FAMiLY PROGRAM FEES $_______
E TOTAL COURSES AND WORkShOPS FEES $_______
F TOTAL SESSiON hANDOUTS ON FLASh DRiVE FEES $_______
I Wersquoll Plant a Tree to Offset Your Carbon Footprint (TR1)
Qty ____ x $10 = $_______
Last name __________________________________
Need assistance registering Call us mdash we are here to help800433-9016 option 3 | registrationaaporg
CANCELLATION POLICY Cancellation requests must be sent in writing by September 13 to
AAP Registration141 Northwest Point BlvdElk Grove Village IL 60007
Fax 847228-5059Email registrationaaporg
Cancellation requests received by September 13 will receive a full refund less a $50 administrative fee Refunds will be processed one month following the close of the conference After September 13 all fees paid to the AAP for conference registration catered events special events courses and workshops are nonrefundable
fEE ToTAL
fRiDAy oCToBER 25
800am-1100am M01 Innovations in Obesity Prevention Assessment and Treatment Forum
Comp $0
sATuRDAy oCToBER 26
1130am-100pm
M02 Council on Children with DisabilitiesSection on Developmental and Behavioral Pediatrics Joint Program Lunch
$30 $30
1230pm-130pm
M03 Section on Administration and Practice Management Edward J Saltzman Luncheon
$35 $35
100pm-215pm M04 Section on Surgery Lunch amp Poster Session
$57 $57
700pm-1100pm M05 Section on Cardiology and Cardiac Surgery Banquet
______times $80 = tickets
$____
suNDAy oCToBER 27
700am-815am M06 District I Breakfast Comp $0
700am-815am M07 District II Breakfast Comp $0
700am-815am M08 District III Breakfast Comp $0
700am-815am M09 District IV Breakfast Comp $0
700am-815am M10 District V Breakfast Comp $0
700am-815am M11 District VI Breakfast Comp $0
700am-815am M12 District VII Breakfast Comp $0
700am-815am M13 District VIII Breakfast Comp $0
700am-815am M14 District IX Breakfast Comp $0
700am-815am M15 District X Breakfast Comp $0
1130am-130pm M16 Section on Surgery Luncheon and Clinical Problem Solving
$57 $57
1200pm-200pm M17 Council on Community Pediatrics Awards Luncheon
Comp $0
moNDAy oCToBER 28
1200pm-100pm
M18 Council on Foster Care Adoption and Kinship Care Luncheon (COFCAKC Members Only)
Comp $0
1230pm-130pm M19 Annual Business Luncheon (AAP Members)
Comp (Limit 1 Ticket)
$0
1230pm-130pm M20 Annual Business Luncheon (Non-members and Guests)
______times $60 = tickets
$____
G TOTAL CATERED EVENTS FEES $
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
Please register online at AAPexperienceorgregister or mail or fax this form and payment to
American Academy of PediatricsRegistration37925 Eagle Way Chicago IL 60678-1379
Fax 847228-5059 (credit card payment is required)
Advance Registration Deadline september 13 2013 Cancellation Deadline for Registration september 13 2013
Note If the total payment is incorrect the necessary adjustments will be made and your credit card will be charged accordingly
METHOD OF PAYMENT
Check enclosed payable to the American Academy of Pediatrics (US Only) VISA MasterCard Discover American Express
Card Number Exp Date (MMYY)
Cardholder Zipcode
Name as it appears on card (please print)
Signature
Any special disability requirements for you or your family please describe
Advance registration will not be made without payment Registration confirmations will be sent by e-mail or standard mail
Photos or videos of conference attendees become property of the AAP and may appear in AAP conference publications To protect the privacy of minors full-face views are never used only sideback views of children unless parent permission is granted
G CATERED EVENTS tOtAL FEEs
TOTAL PAYMENT $
B TOTAL ATTENDEE REGiSTRATiON FEES $_______
C TOTAL FAMiLY REGiSTRATiON FEES $_______
D TOTAL SPECiAL EVENT AND FAMiLY PROGRAM FEES $_______
E TOTAL COURSES AND WORkShOPS FEES $_______
F TOTAL SESSiON hANDOUTS ON FLASh DRiVE FEES $_______
I Wersquoll Plant a Tree to Offset Your Carbon Footprint (TR1)
Qty ____ x $10 = $_______
Last name __________________________________
Need assistance registering Call us mdash we are here to help800433-9016 option 3 | registrationaaporg
CANCELLATION POLICY Cancellation requests must be sent in writing by September 13 to
AAP Registration141 Northwest Point BlvdElk Grove Village IL 60007
Fax 847228-5059Email registrationaaporg
Cancellation requests received by September 13 will receive a full refund less a $50 administrative fee Refunds will be processed one month following the close of the conference After September 13 all fees paid to the AAP for conference registration catered events special events courses and workshops are nonrefundable
fEE ToTAL
fRiDAy oCToBER 25
800am-1100am M01 Innovations in Obesity Prevention Assessment and Treatment Forum
Comp $0
sATuRDAy oCToBER 26
1130am-100pm
M02 Council on Children with DisabilitiesSection on Developmental and Behavioral Pediatrics Joint Program Lunch
$30 $30
1230pm-130pm
M03 Section on Administration and Practice Management Edward J Saltzman Luncheon
$35 $35
100pm-215pm M04 Section on Surgery Lunch amp Poster Session
$57 $57
700pm-1100pm M05 Section on Cardiology and Cardiac Surgery Banquet
______times $80 = tickets
$____
suNDAy oCToBER 27
700am-815am M06 District I Breakfast Comp $0
700am-815am M07 District II Breakfast Comp $0
700am-815am M08 District III Breakfast Comp $0
700am-815am M09 District IV Breakfast Comp $0
700am-815am M10 District V Breakfast Comp $0
700am-815am M11 District VI Breakfast Comp $0
700am-815am M12 District VII Breakfast Comp $0
700am-815am M13 District VIII Breakfast Comp $0
700am-815am M14 District IX Breakfast Comp $0
700am-815am M15 District X Breakfast Comp $0
1130am-130pm M16 Section on Surgery Luncheon and Clinical Problem Solving
$57 $57
1200pm-200pm M17 Council on Community Pediatrics Awards Luncheon
Comp $0
moNDAy oCToBER 28
1200pm-100pm
M18 Council on Foster Care Adoption and Kinship Care Luncheon (COFCAKC Members Only)
Comp $0
1230pm-130pm M19 Annual Business Luncheon (AAP Members)
Comp (Limit 1 Ticket)
$0
1230pm-130pm M20 Annual Business Luncheon (Non-members and Guests)
______times $60 = tickets
$____
G TOTAL CATERED EVENTS FEES $
Orlando FL Oct 26ndash29 2013 Orange County Convention CenterAAPexperienceorg
