amily octor - Louisiana Academy of Family Physicians
amily octor - Louisiana Academy of Family Physicians
amily octor - Louisiana Academy of Family Physicians
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REGISTRATION FEES (Registration fee covers CME <strong>of</strong>ferings, syllabus, daily continental<br />
breakfasts and warming huts, and one ticket to the Mardi Gras party.<br />
AMOUNT<br />
TOTAL<br />
LAFP/AAFP MEMBER<br />
Member ID # $325 $<br />
LAFP/AAFP FAMILY PRACTICE RESIDENT *<br />
Member ID # $175 $<br />
LAFP LIFE MEMBERS<br />
Member ID # $175 $<br />
ALLIED HEALTH/PHYSICIAN ASSISTANTS<br />
Copy <strong>of</strong> License must be attached $375 $<br />
NON-MEMBER PHYSICIAN<br />
Please indicated specialty: $375 $<br />
LATE REGISTRATION FEE* - If your registration is postmarked AFTER<br />
January 15, 2003, ADD $50 to your registration fee. (F<strong>amily</strong> Practice Residents are exempt*)<br />
SPECIAL REGISTRATIONS & EXTRA TICKETS<br />
LIFT TICKETS (Note: Lift<br />
tickets will not be available for pickup<br />
until 6:00 am on Saturday, March 1.<br />
Tickets will not be available prior to that<br />
time.)<br />
Adult<br />
(13-64)<br />
Child<br />
(5-12)<br />
Ticket Type Quantity Quantity<br />
1 Day $65 X $25 X $<br />
2 <strong>of</strong> 3 days $120 X $45 X $<br />
3 <strong>of</strong> 5 days $150 X $60 X $<br />
4 <strong>of</strong> 6 days $185 X $80 X $<br />
5 days $220 X $100 X $<br />
6 days $265 X $120 X $<br />
Senior (Age 65-69) No group rate<br />
Senior tickets available.<br />
Add<br />
+ $50<br />
After 1/15/03<br />
Spouse/Guest Registration<br />
(Includes daily continental breakfasts and warming huts and one ticket to the Mardi Gras party) $65 $<br />
Mardi Gras Party (Tuesday, March 4) Adult Ticket $40 $<br />
Mardi Gras Party (Tuesday, March 4) Child (Age 6-16) Ticket $20 $<br />
Mardi Gras Party (Tuesday, March 4) Child (Age 5 and under) Ticket N/C #<br />
Please Indicate #<br />
EXTENDED<br />
COST<br />
Purchase directly from resort $ –NA–<br />
$<br />
___ I have enclosed a check payable to LAFP<br />
PAYMENT MODE<br />
LIFT TICKET TOTAL $<br />
TOTAL AMOUNT DUE LAFP<br />
$<br />
OR ___ I will use my credit card: ___Visa/MasterCard ___ Discover ___American Express<br />
Card Number: _________________________________________ Expiration Date: ________<br />
Card Holder’s Name: ______________________________________ Signature: ________________________________________<br />
NOTE: Refunds, less a $75 administrative charge, will be given on receipt <strong>of</strong> written cancellations received prior to February 1, 2003. No refunds<br />
will be given after that date. LAFP student members are invited to attend CME activities at no charge, but must pay a $25 fee to cover<br />
admittance to the Mardi Gras Party.<br />
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