Annual Meeting – Registration 2017 Ohio AAP Annual Meeting #OhioAAPAM! 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 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 2017 Annual Meeting Package(s) that you would like to register for: * Advocate (two-day) Package - $230 Friday Only - $170 Saturday Only - $100 Hospitalist Medicine Track - $175 Advocate Package – Friday Keynote, Friday MOC/CME Tracks, Friday Awards Ceremony, Saturday Breakfast, Saturday Sessions Friday Only - Keynote, MOC/CME Tracks, Awards Ceremony Saturday Only - Saturday Breakfast and Saturday Sessions Keynote Only - FREE Please select your preferred session for Friday from 2:10 - 4:00pm * MOC Part II - Child Abuse Payment Reform Panel Please select your preferred track for Saturday from 10:00am - 12:30pm * MOC Part II - Obesity MOC Part II - Injury Prevention: Birth to 4 and Adolescent MOC Part II - Mental Health Issues On Saturday morning, I plan to attend (check all that apply): * Breakfast with the AAP Incoming President and District V Chair (8:30-9:30am) General Session: Introducing Solids to Baby: The Pros and Cons of Modern Feeding (9:30-10:00am) Senior Section Meeting (9:30-10:30am) Your Annual Meeting Package includes the 2017 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, October 27, 2017 from 7:00-10:00pm, the Ohio AAP Foundation will be hosting its 7th Annual Casino Night Fundraiser. Would you like to purchase tickets for this event? * Yes No How many Casino Night Tickets would you like to purchase? * ----- One - $60 Two - $100 Three - $160 Four - $200 Five - $260 Six - $300 Seven - $360 Eight - $400 Nine - $460 Ten - $500 Your ticket purchase includes 2 drink tickets per person, as well as chips for the event. Name(s) of Casino Night Attendees Saturday registration includes participation in a MOC Part IV Kick Off Session for the Self-Paced Online QI Project at 10:00am-12:00pm. Select a program: Injury Prevention Obesity Prevention Total: Did you participate in one of the Ohio AAP's Quality Improvement (QI) Projects during 2016/2017? * Yes - Discount of $25 Yes - I would like to donate my discount to the Ohio AAP Foundation - Discount of $0 No Name of QI Project ---- Building Mental Wellness LC CQN ADHD LC EASE - Hospitalist Safe Sleep LC Good4Growth LC Injury Prevention/Safe Sleep LC Injury Prevention/SEEK LC HPV Quality Improvement LC Ohio QI2U - MenB LC Parenting at Mealtime and Playtime LC Preschool Vision Screening LC Smoke Free Families LC TALK - Adolescent LC Other Available Discounts * First Time Attendee: $25 Poster Presenter: $25 Early Bird (deadline Aug. 1, 2017): $10 None of the above discounts are applicable. I am a First Time Attendee and/or Poster Presenter - Please donate my discount to the Ohio AAP Foundation - Discount of $0 I am an Early Bird Registration - Please donate my discount to the Ohio AAP Foundation - Discount of $0 Smoke Free Families QI Program Participant: $50 Only one discount per attendee ($25 discount for QI Project participants can be combined with one of the above discounts) I would like to make an additional donation of ________ to the Ohio AAP Foundation. Name * First Last Name and Credentials * Last, Credentials Organization/Practice * Street Address * Street Address 2 City * State * Ohio Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming Zip * Phone Number * Email Address * Name for Badge * Please include any credentials that you would like to have on your badge (MD, DO, FAAP, MPH, etc.). What made you register for the meeting? (Check all that apply) * Interesting Topics Need for MOC Part II Credit Networking with Colleagues Shark Tank Other How did you hear about the meeting? (Check all that apply) * Email Blast Ohio AAP Today Ohio Pediatrics Ohio AAP Website Personal Referral/Colleague Postcard in Mail Other Total Due ($): 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.