Personal Information

First Name:

Last Name:

Degree(s):

Organization/Company:

Address 1:

Address 2:

City:

State:

Country:

Zip/Postal Code:

Web Site:

Primary Phone:

Fax:

E-mail (required):

Emergency Contact & Phone:

Ethnicity:

African-American                  Hispanic                         Asian

Native American                     Caucasian                      Other

Yes               No

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

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

AAAP Member?  

     Yes                 No

New AAAP Member?   (Since December 2008)

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/member-center.  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.  

* 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.

Please indicate which functions you plan on attending:

     Opening Reception, Thursday, December 3rd, 7:00- 9:00 pm

     Area Meetings Luncheon, Friday, December 4th, 12:30 - 1:30  pm

     "Share the Vision" Luncheon with the Experts* & Live Auction, Sat., Dec. 5th, 11:15 am-1:15 pm

*Have a topic for discussion at the Share the Vision Luncheon? Please submit your ideas - we need your help!

 

TOPIC:       

Optional 

POST-Conference 

Review Course Event

The 2009 AAAP Review Course will be held in conjunction with the 20th Annual Meeting & Symposium on Dec. 5-6, 2009.  This event requires separate registration.  More information can be found at:  www.aaap.org/meetings-and-events/review-course

Registration for the 2009 AAAP Review Course can be completed at:  https://aaap.org/reviewcourse09/2009RCreg_new.html

How did you hear about the AAAP Annual Meeting?

AAAP Web Site

AAAP Newsletter

AAAP Mailing

AAAP Email Blast

AAAP Member

Advertisement   (Please list location of ad)

Other   (Please list)

(The AAAP Trainee Fund helps support initiatives like travel, annual events and the Trainee Scholarships and Awards.)

  I would like to donate an item to the 20th Annual Meeting & Symposium Auction to benefit the AAAP Trainee Fund.  HAVE FUN WITH YOUR DONATION!  DONATIONS MAY BE TAX DEDUCTIBLE.  All contributors will be recognized in the Annual Meeting Final Program and AAAP Newsletter.   Please call Linda 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:

01 - January 02 - February 03 - March 04 - April 05 - May 06 - June 07 - July 08 - August 09 - September 10 - October 11 - November 12 - December 2009 2010 2011 2012 2013 2014 2015

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.