Alabama Society of PAs : Continuing Medical Education

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Member Benefits Include:

• Annual CME Meetings
• Legislative &
Reimbursment Information
• Networking Opportunities
much more...

CONTINUING MEDICAL EDUCATION (CME)

ASPA CME Annual Conference
February 16-19, 2012

Highland Conference Center, Birmingham, Alabama

Schedule of Events | Registration by Credit Card

REGISTRATION BY MAIL

Fill in the registration form below, your info will be emailed to us and you must send your check or call to make credit card payment over the phone
OR - DOWNLOAD the PDF! and mail to us with your check to the address below.

Please use this form if you wish to pay by check!
For purchasing registration by credit card - go here.

Name:

Phone:

Address:

City:

State:

Zip:

Email Address*:

Member Type:

PA Student Other:

If you would like to join ASPA, click here to join!

	ASPA Member PA	ASPA Non-Member PA
Early Registration (Before February 1)	$325	$475
PA Student Member	$20	$30
One Day Rate	$200	$275
Drug Course Only	$125	$175

The Drug Course will be offered on Sunday, February 20, 2012. You must pre-register by February 1 to take this course!*

Payment Method:

Mailing a Check, Check Number:

Call me for Payment - Phone Number:

Best Time to Call Me:

Please make checks payable to and mail to:
Alabama Society of Physician Assistants, PO Box 1900, Montgomery, AL 36102-1900

For credit card payments - please use this form to pay via PayPal.

For more information call 334-315-6112 or email questions to aspa@knology.net.

Please note: In the event you are unable to attend, please contact the ASPA office for a refund, minus a $50 cancellation fee. Refunds will not be given after February 1.

Comments:

*Privacy Statement: ASPA values the privacy of your personal information and at no time will share your email address with any other company or agency. Your email address will be used soley as a means of communication between ASPA and yourself. Your email address will not be shared or sold. Your information will be kept strictly confidential.

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Schedule of Events