Challenges in Endoscopy in - American Society for Gastrointestinal ...

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Accommodations The American College of Gastroenterology (ACG) has contracted discounted rates with the following hotel: Gaylord National Resort and Convention Center 201 Waterfront Street National Harbor, MD 20745 Reservations: Call 301-965-4000 or book online at www.gaylordhotels.com/gaylord-national ACG has arranged a room block for this event at $299 per night plus applicable tax. When making your hotel reservation, identify yourself as an attendee of ACG’s Annual Scientific Meeting and provide the group code: A-ACG11 to receive the special rate. Continuing Medical Education The American Society for Gastrointestinal Endoscopy (ASGE) is accredited by the Accredited Council for Continuing Medical Education to provide continuing medical education for physicians. ASGE designates this live activity for a maximum of 8.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Americans with Disabilities Act (ADA) If you need any auxiliary aids or services identified in the ADA (e.g., assistive listening devices or Braille materials), please contact: American Society for Gastrointestinal Endoscopy (ASGE) 1520 Kensington Road, Suite 202 Oak Brook, IL 60523; Telephone: 630-573-0600 Cancellation Policy Written notice of cancellation and requests for refunds must be received by ACG’s office by October 7, 2011. After this day, no refunds will be possible. Registration cancellations are not accepted by telephone. An explanation must be provided in writing. There will be a $50 administrative fee assessed for cancellation of any paid event. Refunds will be issued after the meeting. This new program is designed to recognize and reward endoscopists who are dedicated to their own professional development and furthering their ability to provide the most effective patient care. Participants in this program will receive discounts on ASGE courses and products, as well as a Certificate of Achievement in Endoscopy Education. For additional information on the criteria and application process, please visit the Training and Education web page at www.asge.org.
Challenges in Endoscopy in 2011: A Practical Approach Held in Conjunction with the American College of Gastroenterology 76 th Annual Scientific Meeting Registration All registration is handled through the American College of Gastroenterology. The Pre-registration deadline is Friday, October 7, 2011. You may register for this event in one of three ways: 1. Online: You may register online at ACG’s secure website, www.acgmeetings.org 2. Fax: You may fax your completed registration form (with credit card information) to ACG at 301-263-9025 3. Mail: You may mail your completed registration form to: American College of Gastroenterology 6400 Goldsboro Road, Suite 450 Bethesda, MD 20817-5846 On-Site Registration After October 7, 2011, registration will only be available on-site at the ACG Registration Desk at the Gaylord National Resort and Conference Center and will be on a space available basis only. Pre-registration is strongly recommended. Please print legibly or type. Do not register more than one person for the course on this form. This form may be duplicated or additional forms are available on the ASGE web site at www.asge.org. Date_____/_____/_____ Registration Fees (Check one) ASGE or ACG Member Non-Member Physician $395 $495 Trainee $200 $250 Allied Health Professional $200 $250 Practice Manager $200 (ASGE only) $250 Total Amount Due $_________ Name Academic Degree(s) Institution Address City REGISTRATION FORM METHOD OF PAYMENT Payable in U.S. dollars (Check one): 1. I’ve enclosed a check for $ _______________ made payable to: American College of Gastroenterology 6400 Goldsboro Road, Suite 450 Bethesda, MD 20817-5846 2. Credit Card: Visa MasterCard American Express State Phone Fax The above information is my: Home Work Zip Cardholder Name Card Number Expiration Date E-mail ASGE Member? Yes No ACG Member? Yes No Signature 3. You may also fax this form directly to ACG at 301-263-9025 Photography Waiver ASGE periodically takes photographs and/or video during our educational courses and events, and reproduces them in ASGE educational, news or promotional material, whether in print, electronic or other media, including the ASGE website. By participating in this course, you grant the right to use your name and photograph for such purposes to ASGE. All postings become the property of ASGE.
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