Please total each section on both sides of this registration form.
Grand Total: $____________
Payment in full must accompany registration in order for it to be processed. Payment may be in the form of a check drawn on a U.S. bank or MasterCard/Visa/American Express.
Registrations will be returned unprocessed if proper payment is not provided or form is incomplete. A $50 administrative fee will be withheld on cancellations postmarked on or
before Monday, May 12, 2014. No refunds are possible after this date. The final date to pre-register is Monday, May 19, 2014. Registration forms received after this date will be
processed on site at the on-site registration desk. Registration confirmations will be emailed approximately 2 business days after the receipt of your registration.
By submitting this registration form, the registrant/payer agrees to abide by the terms and conditions listed in the preliminary program.
Monday, June 2
q
L01: Should People Suffering from Sleep Disorders have their Driver's Licenses
Revoked?
Tuesday, June 3
q
L02: Is APAP as Good as an In-lab Titration?
Wednesday, June 4
q
L03: Does Objective Measuring of Compliance Improve Outcome?
Section V - Lunch Debate Registration -
Fee per session: $40 Member, $50 Nonmember
Section V Total:
$____________
SLEEP 2014 Credits
Member Nonmember
AAST 36 th Annual Meeting Credits
Nonmember
q
Continuing Medical Education (CME)
Credit for Physicians
$25
$40
q
Continuing Education Credits (CEC) for
Technologists attending AAST 36 th Annual Meeting*
$20
q
Continuing Education (CE) Credit for
Psychologists
$45
$45
*CEC fee is included in the General Registration for
AAST members only.
q
Continuing Education (CE) Contact Hours
for Nurse Practitioners
$25
$40
q
Letter of Attendance for Others
$25
$40
Section VI - Credits
Section VI Total:
$____________
Payment Method
q
Check: Make payable to APSS
q
Credit Card
(check one)
:
q
MasterCard
q
Visa
q
American Express
Card#:_____________________________ Exp. Date: _____/_____ Validation Code*:__________ Cardholder Name:____________________
Address: _________________________________ City: _____________________ State: _____ Zip: _________ Country: ________________
Signature: _____________________________________________ Date: _____/_____/__________
Please choose ONE of the following methods to submit a registration form (registrations are not accepted by phone):
Mail
(check or credit card)
:
APSS, Attn: Meeting Department
2510 North Frontage Road
Darien, IL 60561
Fax
(credit card only)
:
(630) 737-9789
Online
(credit card only)
:
Section VIII
Total:
Shirts ______
$__________
Section VIII - Shirt Order -
Shirts will be available for pickup at the SLEEP 2014 Society Booth at the Minneapolis Convention Center from May 31 - June 4, 2014
S – $45 M – $45 L – $45 XL – $45 2XL – $50 3XL – $55 Total # of
Shirts
Grand
Total $
Men's Polo
(Enter quantity under size)
Women's Polo
(Enter quantity under size)
q
Individual Ticket $50 x ________ = $_________
Section IX - PAC Breakfast (AASM Members Only)
Section IX Total: $____________
q
Individual Ticket
$50 x _______ = $________
q
If you would like to make an additional donation to the ASMF or SRSF,
check here and indicate amount and society to the right.
q
ASMF $_________
q
SRSF $_________
Section VII - Pizza with a Purpose Welcome Reception
Section VII Total:
$____________
For questions, contact the APSS Meeting Department
at (630) 737-9770 or visit
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