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REGISTRATION FORM
Register using ONE of the following options:
• Online: shop.aap.org/live-activities
• Phone: 866/THE -AAP1 (866/843-2271)
Outside the United States and Canada, call 630/626-6000, option 3
• Mail (form and payment to):
American Academy of Pediatrics/Registration
PO Box 776442
Chicago, IL 60677-6442
• Fax (form and payment info to): 847/228-5059
REGISTRANT INFORMATION
NAME
ADDRESS 1
ADDRESS 2
STATE/ COUNTRY,
CITY PROVINCE ZIP IF NOT U.S.
REGISTRATION FEE
METHOD OF PAYMENT
CREDIT CARD: MasterCard Visa American Express Discover
CARD NUMBER: __________________________________________________ EXPIRATION DATE: __________/____________
PRINT NAME AS IT APPEARS ON CARD: _________________________________________________
CHECK (Payable to “American Academy of Pediatrics”)
ADVANCED REGISTRATION DEADLINE: August 21, 2019. Any requests received after the deadline will be accepted on a
space-available basis and will be charged at the higher rate.
CANCELLATION, REFUND POLICY: Cancellations must be received by September 6, 2019, to receive a refund. An
administrative charge of $50 will be deducted. No refunds will be issued for requests received after that date.
Please contact the Academy registration office if you do not receive a confirmation within 7 days. The AAP recommends that you do not make travel or hotel
reservations that cannot be changed or cancelled without penalty until you receive your confirmation, as the AAP cannot be responsible for expenses incurred
by an individual who is not confirmed and for whom space is not available at this course. Costs incurred, such as airline or hotel penalties, are the
responsibility of the individual. The AAP reserves the right to cancel this activity due to unforeseen circumstances or to limit enrollments, should attendance
exceed capacity. Course educational sessions are open only to registered attendees.