GAPA



General Information


Registration includes breakfasts & refreshments, commemorative attendee tote bag, and access to sessions and exhibits. Registration badges will be required for admission to all events. Payment is due with the registration form and must be submitted by the dates below to qualify for the corresponding rate. Materials can only be guaranteed to pre-registered attendees - be sure to register early.

GEORGIA PAs - If you wish to become a member of GAPA ($175), please check the checkbox on this form or complete our online form.

Please complete and submit the registration form below. One registration form per person. If you prefer, you may print this form with your browser and fax or mail to GAPA.


Date:
Note that items marked with an "*" are required fields.
PERSONAL INFORMATION
*First Name:
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*Last Name:
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*Email Address:
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*Please Select: PA-C    ARNP    PA Student    FNP
Other:
(Please specify if Other)
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*Specialty:
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GAPA Membership #:
*NPI #:
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*How did you learn about the conference:
(Check all that apply.)
AAPA CME Calendar
Conference Brochure
GAPA Website
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HealthJobsNationwide.com Banner
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REGISTRATION CATEGORY INFORMATION
SELECT CATEGORY ON/BEFORE
Jan 15
ON/BEFORE
March 1
ON/BEFORE
July 1
AFTER
July 1
GAPA PA Fellow Member $695 $795 $845 $895
Retiree/Military
      (10% discount!)
$625 $715 $760.50 $805.50
GA PA Non-Members/ Other Professional $870 $970 $1,020 $1,070
Live streaming (Full conference general sessions � Includes complimentary Board Review course) $499
Spouse/Guest**
-- no CME credits awarded
$220 $235 $250 $265
Spouse/Guest Name:
**Full guest registrations include the same items as a full conference registration except a CME certificate and select product theater meals. Product theater meals are healthcare provider attendance specific only.
One Day Registration:
Sunday
Monday
Tuesday
Wednesday
$290 $330 $350 $370
Student Track Only:
Saturday
$50 $50 $50 $50
*If student, please list:
  o PA Program
  o Graduation Year: 4 digit year value only.  The entered year is less than the minimum allowed.  The entered year is greater than the maximum allowed.
Registration Fees Subtotal $
New GAPA PA Member Discount $
Registration Fees Total $
MEMBERSHIP DUES
CURRENT GAPA MEMBERS:  Check this box to add additional $175 for your membership renewal dues

GA PA NON-MEMBERS:  Check this box to join GAPA. $175 will be deducted from your registration fee (giving you the GAPA Member rate) and $175 will be added for your Membership Dues. You will be granted fellow member status for the balance of the current membership period (January 1, 2020–December 31, 2020).
Membership Fees Subtotal $


WORKSHOPS

**Please see the event schedule before selecting your workshops. Some workshop times will overlap.


SATURDAY
  Board Review (Gilboy). Will be held online. (8:00 AM - 12:00 PM, 1:30 PM - 5:30 PM)
       (only available for Full Conference registrants)
FREE
  Suturing Workshop (Gordon) (7:00 AM - 11:30 AM) $95
  Abdominal Ultrasound (Treworgy) (8:00 AM - 12:00 PM) $95
  ACLS/BLS (Fullard). Will be held online. (12:00 PM � 5:00 PM) $175
  Ortho Exams: Knee, Ankle & Upper Extremities (Vacala) (3:15 PM � 5:45 PM) $95
SUNDAY
  Joint Injections (Vacala) (2:15 PM - 5:15 PM) $95
MONDAY
  Basic Fractures & Splinting in the Acute Care Setting (Vacala) (2:00 PM - 4:00 PM) $95
TUESDAY
  PALS/BCLS (Fullard). Will be held online. (2:00 PM - 5:00 PM) $175
 
Workshop Fees Total $

GENERAL SESSIONS

Please select one track per day


SUNDAY SESSION
 Cardiology
  None
MONDAY SESSIONS
  Orthopedics
  Women's Health
  None
TUESDAY SESSIONS
 Dermatology
 Pediatrics
 Diabetes
  None
WEDNESDAY SESSIONS
 Urgent Care / Emergency Medicine
  None

ADDITIONAL EVENTS
 5K Fun Run Walk (Wednesday, 6:30 am)
$25 $
   5K T shirt size:  S:    M:    L:    XL:   
Event Fees Subtotal $

PAC DONATIONS
A Chance To Protect And Promote Our Profession.
Your Generous Contribution Helps!

(Suggested minimum $25-$50)
Amount You Would Like To Donate: $

GRAND TOTAL $

REFERRAL INFORMATION


  Referrer's Name:  Referrer's GAPA ID:

PAYMENT INFORMATION
* Please complete all fields in this section.
Visa   MasterCard  Discover  American Express 

Please make a selection.

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"Self-Care" Guarantee:  Register now for our 2020 event, and should you need to change your plans for ANY reason, you�ll be offered a FULL REFUND for notice provided up to 7 days before the event starts. After that, you�re welcome to transfer your registration to our 2021 conference, or we�ll provide a refund less a $75 administrative fee.

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MAIL OR FAX INSTRUCTIONS


Complete form and mail to: GAPA
1905 Woodstock Road, Suite 2150
Roswell, GA 30075
Complete form and fax to: 770-640-1095
Payment is due with registration form. If faxing, please include credit card number. To avoid duplicate charges, do not mail registration form if you have already faxed it or submitted it via this webform.
Make checks payable to GAPA (GAPA'S Tax ID#: 58-1296375)
In accordance with the Americans With Disabilities Act, please call the GAPA office if you have any special needs.


Stay Connected to GAPA! GAPA Goes Green

GAPA GREENIn an effort to lower our environmental impact and preserve our natural resources, GAPA has elected to Go Green! Please look for our Green logo to learn more about GAPA's Green Initiatives.