GSMA Annual Convention & Scientific Assembly

GSMA 2012 Annual Convention & Scientific Assembly

Program Agenda At-A-Glance*
Mail-In/Fax Registration Form*
Convention Advertisement Rates*

Hotel Accommodations

Register Online to receive special rates at the Omni Resort
Condo/Villa Reservation Form*

or

Contact  the Hilton Hotel at 1-800-843-6664 (Group Ref #: 060912GASTATEME). 
For Condo/Villa Rental contact the Palmetto Dunes Resort at 800-448-3408  (Group Reference #80).

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Advance Registation ends May 31, 2012 (10% discount).
After this date all registration must take place on site.

Information:
* First Name
  
* Last Name
  
* E-mail Address
  
* Address
(CME Certificate will be mailed to this address)
  
* City
  
* State
  
* Zip Code
  
* Telephone
  
Fax
  
Registering As:
Registering As:
  
Member
$150.00 $135.00		 2012 GSMA membership must be paid to qualify for this rate.
Non-Member Physician
$567.50 $510.00		  
New Member
$710.00 $639.50		  
NMA & Other Affiliate Medical Society Member
$150.00 $135.00		 Registrant must show proof of current membership in NMA or Affiliate Medical Society to be eligible for discounted rate
 
 
 
Events/Activities:
Please indicate number of persons attending
June 13:
 
Welcoming Reception (@ $0.00 No Charge)
 
Golf Tournament (@$100 - Participants MUST pre-register)
Tennis Tournament (@$50.00 - Participants MUST pre-register for tournament)
   
June 14:
 
Awards Dinner/Dance (@$65.00)
   
June 15:
 
Family Luncheon: Adult Ticket (@$35.00)
Family Luncheon: Child Ticket (@$15.00)
Additional Comments