SMA Assembly Cancellation/Registration Refund Policy - Southern ...

Return Form With
Payment to:
Registration
Southern Medical Assn.
PO Box 190088
Birmingham, AL
35219-0088
PLEASE PRINT OR TYPE
Fax:
205.945.1548
Full Name: _________________________________________________________ Degree: __________
DOB: __________ Gender: ______ Practice/Company Name: ________________________________
Address: ________________________________________________________________ ___ Home __Office
City: ________________________________________ State: ___________ Zip:___________________
Telephone: ________________________________ Fax: ____________________________________
Home Phone: ___________________________ E-mail address: ______________________________
Institution Awarding Your Degree:___________________________________________________
Specialty or Area of Certification:____________________________________________________
Spouse/Guest Name (if registering – see fees below): __________________________________
Assembly Registration Fees
Mark Category Category On/before Sept. 10, 2013 After Sept 10, 2013
Non-mbr Physician/ Healthcare Professional $795 $895
SMA Member $695 $795
Med Student/Resident/Fellow $300 $300
Military Physician/Healthcare Professional $300 $300
One Day Rate (indicate day):
Friday, December 13
Saturday, December 14
Sunday, December 15
Required for Assembly Notices
$350 $350
Total amount enclosed or to be charged: $__________
Method of Payment: __ Check Enclosed (Payable to SMA) __ VISA __ MC __ DISCOVER __AMEX
Card Number________________________________________________________Exp Date_______________
Security Code (required to process)___________________________________________________________
Name on Card_____________________________________________________________________________
Billing Address (include zip) ____ same as above OR ___________________________________________
_________________________________________________________________________________________
Signature_________________________________________________________________________________

Westin New York at Times Square - Booking Your Reservation
SMA’s group reservation deadline is: Thursday, November 21, 2013, at 5:00 pm EST. After this date,
reservations will be accepted by the hotel at its discretion and subject to prevailing rates and
availability. Note: You should book as early as possible as the group block and rate may sell out prior to
the hotel’s reservation deadline stated above. Refer to your hotel confirmation for cancellation policies.
Room Rates and Types – Westin New York at Times Square:
Single/Double Occupancy
$379 per night, plus taxes
A Triple Occupancy will have a surcharge of $30 and a Quad occupancy will have a surcharge of $60
applied to the rate.
Taxes and Fees: The room rate does NOT include taxes, which are currently 14.75%; $2.00 occupancy tax, and
a $1.50 convention center tax. Taxes and fees are subject to change without notice.
Come Early/Stay Late: The above rates will be honored for our group three (3) prior to the event and three
days post event – based on availability.
Call
By Phone: Call 1-888-627-7149 from U.S. and Canada; all other regions call 1-508-324-0500 and
reference SMA 2013 Medical Dilemmas Conference New York City to receive the group rate. In
addition, have the following information ready: Name, mailing address, email address, requested
room type and check-in and check-out dates, and a credit card to guarantee your reservation. Any
requests for special room arrangements must be made at the time of this call.
Reservation Deposit and Cancellation Policy
When your reservations are made, the hotel will require a deposit to guarantee your room. Upon receipt of your
confirmation, please carefully review the Hotel’s cancellation policy for your specific reservation.
SMA Assembly Cancellation/Registration Refund Policy
SMA’s Conferences are subject to cancellation. SMA will not refund travel costs if this Conference is
cancelled. Refunds are not given for inclement weather. Registration fee refund requests must be in writing.
A refund of your registration fee, minus a $125 administration processing fee, will be granted if notice is
received by November 28, 2013. After this time, no refunds will be granted.
Registrant with Disability
Call SMA to request assistance for special needs. Most requests received at least two weeks prior to the
Conference can be accommodated.
Conference Website: sma.org/medical-dilemmas