Annual Meeting – Registration Annual Meeting 2018 Packages and Sessions Are you, or is the individual for whom you are registering, a current Ohio AAP member? * Yes - $0 No - $170 N/A - I am not a physician - $0 Senior Member* - $100 *Senior Members are good standing members who have reached the age of 70 … OR ...Members age 65 or older and no longer derive income from professional employment. If you are unsure about current Ohio AAP membership status, please contact Teresa Kerr (email@example.com). For individuals who are not current members of one of the listed organizations, Annual Meeting fees will include $170 membership fee. This $170 membership fee applies only to physicians. Please select the 2018 Annual Meeting Package(s) for which you would like to register: * Superhero (two-day) Package - $260 Friday Only - $200 Saturday Only - $100 Friday Luncheon Only Superhero Package – Friday Luncheon, Friday MOC/CME Tracks, Friday Awards Ceremony, Saturday Breakfast, Saturday Sessions Friday Only - Luncheon, MOC/CME Tracks, Awards Ceremony Saturday Only - Saturday Breakfast and Saturday Sessions Friday Luncheon Only - Pricing below For the Friday Luncheon only, please choose your number of tickets. * 1 ticket - $20 2 tickets - $40 4 tickets - $80 Table of 8 - $500 Please select your preferred session for Friday from 1:00 - 2:00pm * MOC Part II - Brief Resolved Unexplained Events (BRUE) Early Onset Neonatal Sepsis MOC Part II - Ohio AAP Advocacy Treasure Hunt MOC Part II - The Role of the Physician in Bullying: Identification, Screening, and Education and Anticipatory Guidance Please select your preferred session for Friday from 2:30 - 3:30pm * MOC Part II - Newborn Board Medicine: Neonatal Abstinence Syndrome (NAS) Breastfeeding MOC Part II - Ohio Advocacy Update MOC Part II - Social Determinates of Health Resources Please select your preferred session for Friday from 4:00 - 5:30pm * Shark Tank Event-Best New Program Wins! (CME) MOC Part II - Adolescent Panel and Adolescent 101/Making the Most of the Adolescent Well Visit On Saturday morning, do you plan to attend the breakfast meeting from 8:30 - 10:00am? * Yes No Please select your preferred track for Saturday from 10:15am - 12:45pm * MOC Part II - Smoking Cessation in the Pediatric Setting, What the Literature Says MOC Part II - All About Nutrition! MOC Part II - Best Practices In Adolescent Immunizations Your Annual Meeting Package includes the 2018 Ohio AAP Awards Reception, which will take place on Friday Evening from 5:30-7:00pm. Would you like to register any additional guests for the reception? * Yes No How many additional guest would you like to register for the Awards Reception? * ----- 1 - $15 2 - $30 3 - $45 4 - $60 5 - $75 6 - $90 7 - $105 8 - $120 9 - $135 10 - $150 Name(s) of Awards Reception Attendees On Friday, Sept. 21, 2018 from 7:00-10:00pm, the Ohio AAP Foundation will be hosting its Game Night Fundraiser. Would you like to purchase tickets for this event? * Yes No How many Game Night Tickets would you like to purchase? * ----- One - $30 Two - $60 Four - $100 Your ticket purchase includes 2 drink tickets per person, as well as chips for the event. Name(s) of Game Night Attendees I would like to make an additional donation of ________ to the Ohio AAP Foundation. Subtotal: Discounts Did you participate in one of the Ohio AAP's Quality Improvement (QI) Projects during 2017/2018? * Yes - Discount of $25 No Name of QI Project ---- Building Mental Wellness LC EASE - Hospitalist Safe Sleep LC Injury Prevention/Safe Sleep LC Injury Prevention/SEEK LC HPV Quality Improvement LC Ohio QI2U - Adolescent Health Program Ohio QI2U - MenB Program Parenting at Mealtime and Playtime LC Smoke Free Families LC TALK Adolescent LC TRAIN LC New Fellows? Yes - 50% Discount - $85 Other Available Discounts * First Time Attendee: $25 New Member: $25 Poster Presenter: $25 Peds on Call Member: $50 None of the above discounts are applicable Only one discount per attendee ($25 discount for QI Project participants can be combined with one of the above discounts) Attendee Information Name * First Last Name and Credentials * Last, Credentials Organization/Practice * Street Address * Street Address 2 City * State * Ohio Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip * Phone Number * Email Address * Name for Badge * Please include any credentials that you would like to have on your badge (MD, DO, FAAP, MPH, etc.). What made you register for the meeting? (Check all that apply) * Interesting Topics Need for MOC Part II Credit Networking with Colleagues Shark Tank Other Men B Summit How did you hear about the meeting? (Check all that apply) * Email Blast Ohio AAP Today Ohio Pediatrics Ohio AAP Website Personal Referral/Colleague Postcard in Mail Practice Recruitment Visit Other Total Due ($): You will receive information on hotel accommodations in the email confirmation you receive after payment. You may also CLICK HERE to gain access to the Ohio AAP room block at the Crowne Plaza Dublin.