Credentials *

MD

DO

RN

CRNP

DMD

PA

CPC

NP

Other

Phone *

(###)

###

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Will you be participating in the Grand Pediatric Pentathlon? *

Fri./Sat. at your leisure, donation to participate: $50/adult, $50/child

Yes

No

Will you be participating in the Saturday night reception/dinner? *

5:45 p.m., included in registration. Guests require additional fees

Yes

No

FIRST-TIME CHAPTER MEMBER ATTENDEES

FIRST-TIME CHAPTER MEMBER ATTENDEES: Enjoy a $50 rebate! This amount will be refunded to you after the conference. Check the “first-time attendee” box below and we will verify attendance records.

yes

Registration Fees *

$455-Chapter Members (Alabama or other AAP chapter) - AFTER May 4, 2023

$575-Non-Chapter Member Physicians

$295-Senior Physician (over age 70, fully retired), Chapter Affiliate NP/PA Member, PMA member or Nurse

$395-Non-Member NP/PA, (includes AL-AAP Chapter Dues!)

$0-Pediatric Resident/House Staff/Medical Student (waived, value of $395 valid only if you stay within our AL-AAP room block)

Pentathlon only

Additional Adult tickets for Saturday night reception/dinner? *

0

1

2

3

4

Additional Child tickets for Saturday reception/dinner? *

($25 per child guest)

0

1

2

3

4