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                     We wanted to remind you that the deadlines to register for the ACOG District VII,
                     VIII, IX and XI Annual District Meeting as well as the hotels are fast approaching.
                     We would hate for you to miss out on such a great meeting.

                     Below are the deadlines.
                     September 21st: Deadline for hotel registration at the Wailea Beach Marriott
                     (overflow hotel)
                     Reserve by phone: 1-800-266-9432

                     September 23rd: Deadline for hotel registration at the Grand Wailea (main hotel)
                     Reserve by phone: 1-800-888-6100

                     September 23rd: Deadline for pre-conference registration.
                     Please be aware that after September 23rd on-site fees will apply.
                     $100 will be added to each on-site registration category.

                     For more information about this ADM please visit

Hawaii fun facts:

l   The Hawaiian alphabet consists of only twelve letters. The five vowels are A, E, I, O, U.
    And the seven consonants are H, K, L, M, N, P, W.
l   Hawaii has the highest life expectancy in the United States.
l   Life expectancy for males is 75, for females 80 years.
l   Hawaii is the only U.S. state whose land area is increasing–from volcanic eruptions.
l   Pink is the official color of the Island of Maui.
Meeting Registration Form
The American Congress of Obstetricians and Gynecologists
Districts VII, VIII, IX & XI Annual Meeting
October 14-16, 2010
Maui, Hawaii

Please PRINT and COMPLETE all appropriate information to avoid delay in processing your registration
Name: _________________________________________________________________________________________________________________
                              First                                   Middle                                    Last
Address: ________________________________________________________________________________________________________________
                              Street                                                            City                                    State/Zip Code
Contact Information: _______________________________________________________________________________________________________
                                      Daytime Phone #                     Fax Phone #                        E-mail

   Please check if you require special assistance during the meeting (i.e., transportation, aids for hearing or vision)
Specify: _____________________________________________________________________________________________________________________________

REGISTRATION FEES (Please check and complete all appropriate information) A er September 23 onsite fees will apply.
ACOG Membership 9-digit ID No: ___ ___ ___ ___ ___ ___ ___ ___ ___ (Your membership status will be veri ed upon processing and appropriate fee will be applied)
Please indicate your District ________________
   ACOG Fellow/Junior Fellow in Practice                          $595                             Associate Members                                     $575
   ACOG Junior Fellow in Training                                 $125                             Non-ACOG Physician                                    $800
   ACOG Life Fellow/Fellow Senior Status                          $375                             Non-ACOG Residents                                    $375
   ACOG Educational A liate                                       $375                             Other-Non Health Care/Nurse                           $375
   Central American/Mexican Fellow                                $300                             Invited Faculty                                       N/C
   Central American/Mexican Junior Fellow in Practice             $175                             Junior Fellow with Accepted Poster                    N/C
   Central American/Mexican Junior Fellow in Training             $125                             Medical Students                                      N/C

   Spouse/Guest $150 Spouse/Guest Badge name(s) _______________________________________________________________________________________
*Please note: In order to participate in any social events, you must be a registered professional attendee or spouse/guest.

TICKETED SESSIONS - Please check the appropriate box
10:00   Selective 1 – Couples Communication        Selective 2 – Patient Safety    Selective 3 – Vulvovaginal Challenge
11:00   Selective 1 – Many Talents, Many Choices       Selective 2 – Contraception      Selective 3 – Lonnie Burnett Film Festival
11:45   Selective 1 – Cesarean on Demand       Selective 2 – Testosterone Replacement
10:00    Selective 1 – Building Your Practice      Selective 2 – IUDs and Implants       Selective 3 – Your Financial APGAR
10:45    Selective 1 – Fetal Heart Rate Monitoring       Selective 2 – Avoiding Complications
11:30    Selective 1 – Should a Robot be in Your Life?       Selective 2 – A Lighting Round Challenge
10:00   Selective 1 – Glen Hayden Memorial Lecture       Selective 2 – Making Chronic Pain Less Painful
11:00   Selective 1 – Staying Right w/the Board    Selective 2 – Case Studies in Financial Planning
  Young Physician’s Luncheon — $25 (ticket required)

If you are currently an ACOG District or Section o cer, please check the appropriate box:
    Fellow District O cer    Fellow Section O cer         Jr Fellow District O cer       Jr Fellow Section O cer

Registration Fees: $ ________________________________________               Total Amount Due: $ ________________________________________

Credit Card #: ____________________________________________                Expiration Date: ____________________________ CVN #: _________

   Check Payable to ACOG DISTRICT VII, VIII, IX & XI              VISA         MasterCard        American Express

Signature: ____________________________________________________________________                        Date: ________________________________

PAYMENT: Payment must be received in full in order to process your registration. Payment can only be in the form of a check, Visa, MasterCard, or American
Express. Mail payment and completed registration form to: ACOG Registrar, PO Box 96920, Washington, DC 20090-6920. Credit Card registrations can be faxed to:
(202) 488-0787. Registration cannot be taken by telephone. Registration inquiries: (202) 863-2540.
CUT-OFF DATE: To receive a printed name badge, your registration form and payment must be received at ACOG by SEPTEMBER 23, 2010. Forms received a er
the cut-o date will not be guaranteed advance registration.
CANCELLATION POLICY: Cancellations must be in writing and received in ACOG’s Registrar’s O ce no later than SEPTEMBER 23, 2010. A $50 administrative
fee will be charged for all cancellations. No refunds will be issued a er the deadline. ACOG DISTRICT VII, VIII, IX & XI reserve the right to cancel the program and
provide a refund should conditions warrant.

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