Credentials *

MD

DO

RN

CRNP

DMD

PA

CPC

NP

Other

Phone *

(###)

###

####

Will you be participating in the Grand Pediatric Pentathlon? *

Fri./Sat. at your leisure, (early bird) donation to participate: $65/adult, $40/child under 12

Yes

No

Will you participate in Sandcastle University?

Select your first choice. Please note that space is limited to 15 people per class and on a first-come, first-served basis. If your first choice is no longer available, we will move you to the other class automatically.

Friday, April 19, 2 p.m. - 3 p.m.

Friday, April 19, 3:30 p.m. - 4:30 p.m.

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 March 28, 2024

$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