Just a reminder! 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) https://resweb.passkey.com/Resweb.do?mode=welcome_ei_new&eventID=2589427 Reserve by phone: 1-800-266-9432 September 23rd: Deadline for hotel registration at the Grand Wailea (main hotel) http://www.adm2010maui.com/id2.html 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. http://www.adm2010maui.com/id3.html For more information about this ADM please visit http://www.adm2010maui.com/index.html 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 THURSDAY, OCTOBER 14 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 FRIDAY, OCTOBER 15 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 SATURDAY, OCTOBER 16 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 FRIDAY, OCTOBER 15 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.