DEAPA Winter Conference

You may register through the mail by dowloading and printing this form 2012 Registration Brochure (PDF) or you may also register online below:

On-line Conference Registration

Instructions:

Complete the form below.
Items with a * are Mandatory.
Hit Submit at the bottom of the page.
The page will direct you to the Checkout page
You may add more conference registrations before checkout.
Questions? Contact Us. 207-620-7577 or email info@deapa.com

Registration info:

Registration Date: 05-18-2012

First Name:* Middle Name: Last Name:*

Title:* Other Title:(If title not listed to left enter title here.)

Address: *

Address:

Town:* State:* Zip:*

Phone:* Fax: Email:*

Email is used for conference purposes only to confirm your participation and notify you when the speaker presentations at www.deapa.com website prior to the conference

Additional Guests:

Number attending the Friday Evening Banquet $40 a person*

Selection for breakout sessions for Thursday February 2 at 7:45 a.m.

Breakout I - Splinting & Casting (Limit 20-25)
Breakout II - Evidence Based Updates in the Treatment of Atrial Fibrillation & A Review of the Evidence Based Treatments for Adult Type 2 Diabetes
No Breakout Group

Early Registration Conference fees:*

DEAPA Member $425
Other State Constituent Member $425
Non-Member $525
PA Student DEAPA Member $20
PA Student DEAPA Non-Member $50

After submitting you will be taken to the Payment Screen to complete your registration

Cancellation/Refunds

If you must cancel, please notify by phone or fax. Conference registration fee, minus a $50 administrative fee, will be refunded if notice of cancellation is received prior to January 16, 2012. No refunds will be granted after January 16th.