March-April 2013 - The Society for Academic Emergency Medicine

Registration Form
2013 SAEM Annual Meeting - Atlanta, GA
Registration Form
Early Bird Preregistration On-site
2013 Nonmember SAEM Registration Annual Meeting - Atlanta, until 3/15 GA until 5/3 5/14 - 5/18
Physician (MD, DO) 775.00 800.00 850.00
Physician (MD, DO) – Annual Meeting with one-day Junior Faculty Forum Early 875.00 Bird Preregistration 925.00 975.00 On-site
(Reflects $125.00 discount off Annual Nonmember Meeting registration) Registration
until 3/15 until 5/3 5/14 - 5/18
Physician (MD, DO) – Annual Meeting with two-day Senior Leadership Faculty Forum 950.00 1,000.00 1,100.00
Physician (MD, DO) 775.00 800.00 850.00
(Reflects $50.00 discount off Annual Meeting registration)
Physician (MD, DO) – Annual Meeting with one-day Junior Faculty Forum 875.00 925.00 975.00
EMT/Paramedic/Nurse/Physician Asst/NP (Associate) 310.00 330.00 350.00
(Reflects $125.00 discount off Annual Meeting registration)
Administrator 525.00 550.00 575.00
Physician (MD, DO) – Annual Meeting with two-day Senior Leadership Faculty Forum 950.00 1,000.00 1,100.00
Resident/Fellow 275.00 300.00 350.00
(Reflects $50.00 discount off Annual Meeting registration)
EMT/Paramedic/Nurse/Physician
Resident with Resident Leadership
Asst/NP
Forum
(Associate) 310.00
400.00
330.00
425.00
350.00
475.00
(with networking lunch, reflects $50.00 discount off Annual Meeting registration)
Administrator 525.00 550.00 575.00
Medical Student or Undergraduate 100.00 125.00 175.00
Resident/Fellow 275.00 300.00 350.00
Research Coordinator (Non-MD) 200.00 225.00 275.00
Resident with Resident Leadership Forum 400.00 425.00 475.00
Residency Coordinator (Non-MD) 275.00 300.00 350.00
(with networking lunch, reflects $50.00 discount off Annual Meeting registration)
International
Medical Student
Member
or Undergraduate 100.00 125.00 175.00
Research Coordinator (Non-MD) 200.00 225.00 275.00
Residency Coordinator (Non-MD) Special Sessions (Nonmembers)
275.00 300.00 350.00
International Tuesday, May 14 Member & Wednesday, May 15, 2013
Two-day Senior Leadership Faculty Forum
Wednesday, May 15, 2013
Special Sessions (Nonmembers)
AEM Consensus Conference
Tuesday, May 14 & Wednesday, May 15, 2013
Grant Writing Workshop
Two-day Thursday, Senior Leadership May 16, 2013 Faculty Forum
Wednesday, May 15, 2013
Resident Leadership Forum
AEM Consensus Friday, May Conference 17, 2013
Grant
Medical
Writing
Student
Workshop
Symposium
Thursday, May 16, 2013
One-day Junior Faculty Forum
Resident
AWAEM Luncheon
Leadership Forum
Friday, May 17, 2013
Medical Student Symposium
One-day Junior Faculty Forum
AWAEM Luncheon
Method of Payment: Check Credit Card (VS, MC, DC, AX)
Name as it appears on Card:
Credit Method Card of Number: Payment: Check Credit Card (VS, MC, DC, AX) Expiration Date: Security Code:
Name Billing as Address: it appears on Card:
Credit City, State: Card Number: Expiration Date: Security Zip: Code:
Billing Signature: Address:
City, State:
Cancellations: Cancellations submitted by email to events@saem.org (subject line: CANCEL) and received on or before April 30, 2013, will receive a refund, less a
$50 Signature:
cancellation fee. Cancellations received after April 30, 2013, will be assessed a $100 cancellation fee. No telephone cancellations will be accepted. No refunds will
be made for cancellation requests after May 10, 2013.
Cancellations: Cancellations submitted by email to events@saem.org (subject line: CANCEL) and received on or before April 30, 2013, will receive a refund, less a
$50 cancellation fee. Cancellations received after April 30, 2013, will be assessed a $100 cancellation fee. No telephone cancellations will be accepted. No refunds will
be made for cancellation requests after May 10, 2013.
Zip:
Please submit registration application to SAEM • By mail: SAEM 2340 S. River Road, Suite 208, Des Plaines, IL 60018 • By email: events@saem.org • By Fax: 847-813-5450.
Please submit registration application to SAEM • By mail: SAEM 2340 S. River Road, Suite 208, Des Plaines, IL 60018 • By email: events@saem.org • By Fax: 847-813-5450.
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