AAAP 2008 Attendee Registration

Personal Information

First Name:

Last Name:

Degree(s):

Organization/Company:

Address 1:

Address 2:

City:

State:

Zip/Postal Code:

Country:

Web Site:

Primary Phone:

Fax:

E-mail (required):

Emergency Contact Phone:

Ethnicity:

African-American Hispanic Asian

Native American Caucasian Other

Please check this box if you require special accommodations to participate

or if you have special dietary needs. AAAP will contact you for further details

Yes No

AAAP will be providing a list of attendees including contact information to all meeting attendees. May we include you on this list?

Yes No

Are you a first time attendee to an AAAP Annual Meeting & Symposium?

AAAP Member?

Yes No

New AAAP Member? (Since December 2007)

Yes No

Not an AAAP member?

Join now!

Would you like to join AAAP and receive a discount on your registration?

For more information and to apply for membership, please visit to

www.aaap.org/membership/membership.htm. Get started today!

REGISTRATION FEES

Please check the

appropriate box.

Please Note:

Member status will be

verified by the AAAP Office.

For questions about your membership status, please call the AAAP Office at (401) 524-3076.

By Oct. 22

After Oct. 22

AAAP Member

   $465

     $515

Non Member

   $575

     $625

Resident / Med Student

   $225

     $275

Related Health Professional

   $225

     $275

* Spouse of AAAP Member

   $200

     $250

* Spouse* of Non-Member

   $225

     $275

* Spouse name:

* Separate registration and fees are required for spouse/partner attending sessions and other conference functions. This registration does not include pre-conference or post-conference events.

Check this box ONLY if you are an EXHIBITOR.

Please indicate which functions you plan on attending:

Opening Reception, Thursday, December 4th, 7:00- 9:00 pm

Area Meetings Luncheon, Friday, December 5th, 1:15 - 2:15 pm

*Lunch with the Experts, Saturday, December 6th, 11:30 am-12:30 pm

*For Lunch with the Experts, please select the topic you wish to attend from the

following options:

Pain & Addiction

Marijuana Dependence

Dual Diagnoses

Prescription Drug Dependence

Addiction and Criminal Justice

Pharmacotherapy

Smoking Cessation

12 Step Program

Methamphetamine

Working with Professionals (impaired, athletes, etc)

Optional

PRE-Conference

Event

The Buprenorphine Training Session on Wednesday, Dec. 3, 2008. AAAP Member or Non-Member registration is separate from the 19th Annual Meeting. Registration and can be completed online at:

www.docoptin.com/Physician/courseDetails.aspx?CourseID=282

Optional

POST-Conference

Event

The 2008 AAAP Review Course will be held in conjunction with the 19th Annual Meeting & Symposium on Dec. 6-7, 2008. This event requires separate registration. More information can be found at: www.aaap.org/reviewcourse.htm

Registration for the 2008 AAAP Review Course can be completed at: www.aaap.org/meetings/2008RC/2008RCreg.html

AAAP MENTOR/MENTEE Program (Optional)

MUST be an AAAP Member.

CHOOSE ONLY ONE OPTION: either MENTOR

or MENTEE.

I would like to serve as a MENTOR for a:

New AAAP Member

Resident

Medical Student

I am interested in:

I am a MENTEE. I would like to be assigned a mentor. I am a:

New AAAP Member

Resident

Medical Student

I am interested in:

How did you hear about the AAAP Annual Meeting?

AAAP Web Site

AAAP Newsletter

AAAP Mailing

AAAP Email Blast

Colleague

Advertisement

Other

AAAP Conference

LIVE Auction

to benefit the

AAAP Trainee Fund

Thursday, December 4, 2008 from 7-9 pm

I would like to donate an item to the 19th Annual Meeting & Symposium LIVE Auction to benefit the AAAP Trainee Fund. This auction will be held during the Opening Reception on Thursday, December 4th from 7 -9 pm. HAVE FUN WITH YOUR DONATION! DONATIONS ARE TAX DEDUCTIBLE. All contributors will be recognized in the Annual Meeting Final Program and AAAP Newsletter. Please call Meredith at (401) 524-3076 with any questions.

Items to consider include a week's stay at vacation homes, artwork,

sports or performance tickets, jewelry, copies of published books, gift

certificates, gift baskets, artisan goods - any donation is appreciated!

ITEM Description:

Approximate VALUE:

Please bring your item with you to the conference.

Billing Information

Click here if billing information is the same as your contact information above.

Billing First Name:

Billing Last Name:

Billing Address 1:

Billing Address 2:

Billing City:

Billing State:

Billing Zip:

Billing Country:

Payment

(American Express, Visa, MasterCard)

Card Number:

Expiration Date:

CSV Code:

On the back of your credit card, you should see

three digits that are not part of your credit card number.

These three digits are your Card Security Verification (CSV) number.