First Name* Last Name* Email address* Phone Number*Early Bird conference registration: Price: Early Bird conference registration options Individual: Couple: Member-in-training: Non Member: Physicians Couple Non Member: Conference registration after August 1st: Price: after august 1st options Individual: Couple: Friday, September 1rst Registration from 4:00 pm Welcome Buffet: (6:00pm to 9:00pm) Bohemian: (10:00pm to 11:30:pm) Adult: $55 Price: Quantity012345678910Non Member Adult: $70 Price: Quantity012345678910Children: 12 to 17: $25.00 Price: Quantity012345678910Children under 11 are free Price: Quantity012345678910Saturday, September 2nd 7:00pm to 10:00pm Kid's Night Out for children 4-12 years: $55 Price: Quantity012345678910Please specify bellow child's name and ageChildren NameAge Add Remove10:00pm to 12:00pm PAMA Rock Concert. Is an adult only event at no charge. Please note that their will be a prize for the best rock outfit.Will be attending? Yes No How many people*Sunday, September 3rd 7:00pm to 12:00pm Dinner and dance ( adults only) Cocktail attire: $125.00 Price: Quantity012345678910Non Member Cocktail attire: $140.00 Price: Quantity012345678910Other Activities Please indicate which activity you are going to participate and names of the participants.Golf (Saturday 7:45 am to 11:30 am)NameName Add RemoveTennis (Saturday 8:00 am to 11:00 am)NameName Add RemoveCycling (Saturday 7:30 am)NameName Add RemoveSoccer (Saturday 5:00pm to 6:00pm)NameName Add RemoveZumba Class (Saturday 12:00 to 1:00pm)NameName Add RemoveVolleyball (Sunday 3:00pm to 5:00pm)NameName Add RemoveSpecify any food allergies and the name of the guest Total Options Other Amount HiddenSection BreakPhysician Name* Phone*Payment Reason* Amount*
