How to Register Canceled or Closed Programs Step 1: Personal Information Education programs may be canceled or closed due to capacity or insufficient enrollment. If any selections are canceled or closed and payment was made by credit card, the amount charged will include only the available programs. If paid by check, a full refund will be issued for affected programs. Allow four to six weeks after the Annual Meeting for processing refunds. Remove the mailing label on the back of this book and affix it to the Personal Information box on the registration form. If the information on the label is incorrect, make corrections on the label or in the space provided. Cancellations/Refunds of Registration Indicate your Primary Focus of Practice: Alzheimer’s Disease, Amyotrophic Lateral Sclerosis, Attention Deficit-Hyperactivity Disorder, Autism, Back Pain, Behavioral Neurology, Brain Tumors, Carpel Tunnel Syndrome, Cerebral Palsy, Child Neurology, Chronic Pain, Coma, Dementia, Dystonias, Epilepsy, Fibromyalgia, Headache, Lyme Disease, Migraine, Movement Disorders, Muscular Dystrophy, Multiple Sclerosis, Myasthenia Gravis, Neuropathy, Neuroimaging, Parkinson’s Disease, Restless Legs Syndrome, Shingles, Sleep Disorders, Spinal Cord Injury, Sports Concussion, Stroke, Sweat disorders, Tinnitus, Tourette Syndrome, Traumatic Brain Injury, or currently not in practice. Until March 16, 2011 . . . Refund less $50 administrative fee March 17–April 1, 2011 . . Refund less $100 administrative fee After April 1, 2011 . . . . . No refund ■■ ■■ ■■ ■■ ■■ ■■ ■■ All cancellations must be submitted in writing to [email protected] or fax to (415) 293-4071. No-shows will not receive a refund. Name substitutions are not permitted. No refunds will be processed for amounts of $20 or less. Credit card refunds will be processed 4–6 weeks after request. Check refunds will be processed 4–6 weeks after Annual Meeting. Programs are subject to cancellation if enrollment is insufficient. In the event of cancellation, registration for the cancelled course will be fully refunded. The AAN is not responsible for airfare, hotel, or other costs incurred by participants in the event of program or registration cancellation. Special Accommodations Deadline: March 16 The Hawaii Convention Center and the AAN are in compliance with the Americans with Disabilities Act or Human Rights Code and strive to accommodate all visitors. Information booths, designated parking, and assisted listening devices are available. If you require special accommodation to attend the Annual Meeting, contact Lori Strachota no later than March 16, 2011, at [email protected] or (651) 695-2706. Note: Kosher meals can be provided at any breakfast or lunch, and must be arranged on or before March 16, 2011, by contacting AAN Registration/CMR at [email protected], (800) 676-4226, or (415) 979-2283. There is a $25 surcharge per meal. On-site requests cannot be accommodated. Save Up to $600* in Annual Meeting Registration! Only an AAN membership can save you up to $600*on 2011 Annual Meeting registration and course fees—that’s nearly the cost of your AAN membership dues alone! Plus you’ll get all of the other benefits throughout the year that only an AAN membership can afford. Visit www.aan.com/dues today. *Based on Active member status and early registration vs. on-site registration. Note: It is important that this information be current. A confirmation letter will be emailed or faxed. Name badge, tickets, and CME transcripts will be mailed to the address provided. Step 2: Education Programs and Specialists in Focus Shade the boxes corresponding to the Education Program type you wish to register and enter the program number on the line. Step 3: Fees Box A: General Registration Fee: Select the appropriate fee. See page 124 for fee inclusion details. Box B: Education Program Fees: Calculate the total fees using the Education Program Fee Schedule. Box C and Box D: Virtual Annual Meeting and Additional Activities (optional): Select a Syllabi on CD, Webcast-On-Demand, and/or Practice CD. Price includes applicable sales tax. If you do not pick up your CD at the AAN Store during the Annual Meeting, there will be an additional $15 shipping and handling charge. Step 4: Commercial Mailings Registrant’s mailing and email addresses will be used for AANgenerated hard copy mailings and emails related to the Annual Meeting and provided to commercial entities. Check the box if you do not wish to receive hard copy mailings, invitations, and emails from commercial entities. Step 5: Payment Indicate method of payment. Note: Government credit cards are not accepted for advance registration, as they cannot be processed without the actual credit card. Government credit cards may be used on-site. Deadline: March 16 Registrations will be processed according to the date of receipt. Registrations received after March 16, 2011, will be processed at a higher rate. On-site registration opens Friday, April 8, 2011, at 3:00 p.m. at the Hawaii Convention Center. Questions: US/Canada International Email (800) 676-4226 (415) 979-2283 [email protected] 125 Registration Worksheets Education Program Fee Schedule Use this table to calculate the fees for the number of registered programs. Tally the number of each type of program. Multiply the amount by the fee for your membership type. Transfer the total amount to Box B on the registration form. Note: Do not use this schedule for on-site registration. Neurologist member and nonmember fees increase $20.00 per program on-site. Program Type: Junior and Non-Neurologist Member: Member Neurologist: Nonmember: (Honorary, Senior, Fellow, Active, Associate) (Junior, Intern, Research Scientist, Non-neurologist Clinician, Business Administrators, Students) Corresponds with “2.0 Education Program” on registration page 127 AC/PC (Half-Day Course) x $45 = x $115 = x $145 = CS (Case Studies Program) x $75 = x $110 = x $150 = EP* (Directors Conference) x $125 = x $255 = x $385 = ES (Extended Seminar) x $75 = x $110 = x $150 = FC (Full-Day Course) x $90 = x $225 = x $280 = KP (Kick-Off Program) x $50 = x $80 = x $105 = MR (Morning Report) x $60 = x $85 = x $115 = NF (Neuro Flash) x $60 = x $85 = x $115 = NP (Neurology Skills Pavilion) x $180 = x $235 = x $315 = PM*** (Post Meeting Neuroimaging Conference) x $235 = x $440 = x $525 = PW (PM Skills Workshop) x $180 = x $235 = x $315 = SC** (Science Conference) x $100 = x $155 = x $210 = SM (Seminar) x $60 = x $85 = x $115 = SW (Skills Workshop) x $350 = x $460 = x $615 = Corresponds with “2.1 Specialists in Focus Tracks” on registration page 127 Specialists in Focus: Aging/Dementia/Degenerative Disease x $85 = x $220 = x $280 = Specialists in Focus: Cerebrovascular x $85 = x $220 = x $280 = Specialists in Focus: Child Neurology Specialists in Focus: Movement Disorders x $85 = x $220 = x $280 = x $85 = x $220 = x $280 = Total Education Program Fees (Enter in Box B on Registration Form): ______________________________ * If you are attending the Clerkship and Program Directors’ Conference (1EP.001) only and no other Annual Meeting events, the cost increases $50. ** If you are attending the Future of Neuroscience Conference (7SC.001) only, and no other Annual Meeting events, the cost increases $70 ($170 on-site) and includes Thursday and Friday Scientific events. Medical students and PhD candidates may attend at no charge but MUST register and receive a ticket. ***If you are attending the Post Meeting Neuroimaging Conference and no other Annual Meeting events, the cost increases $50. The cost increases $40 on or after March 17, 2011. Corresponds with “3. Fees” section, Box C on registration page 127 LD (Physician Leadership Program) x $90 = x $225 = x $280 = 2011 Virtual Annual Meeting Product Fees Use this table to calculate the fees for Virtual Annual Meeting products. Tally the number of each type of product. Multiply the amount by the fee for your membership type. Transfer the total amount to Box C on the registration form. Corresponds with “3. Fees” section, Box D on registration page 127 Program Type: Virtual Annual Meeting Three Pack (Webcast, Syllabi, and MP3) Virtual Annual Meeting Two-Pack (Webcast and Syllabi) 126 Junior and Non-Neurologist Member: Member Neurologist: Nonmember: After March 16 x $199 = x $299 = x $499 = x $1,099 = x $129 = x $199 = x $299 = x $849= Syllabi CD x $49= x $99 = x $149 = x $299= Practice CD x $39 = x $49 = x $59 = x $99= Webcast-On-Demand x $99 = x $149 = x $199 = x $599= MP3-On-Demand and DVD x $99 = x $149 = x $199 = x $299 = Total Product Fees (Enter in Box D on Registration Form): ___________________ AAN 63rd Annual Meeting Registration Form / Deadline: March 16, 2011 1. Personal Information AAN ID Number One form per registrant Primary Focus of Practice 2.1 Specialists in Focus Tracks (See page 17 for more information) Saturday, April 9-Sunday, April 10 Specialists In Focus: Attending _________ Aging/Dementia/Degenerative Disease (Includes 1PC.002, 2PC.006, and Integrated Neuroscience Session). Name (last, first, middle initial) and degree (MD, DO, PhD, RN) Address Sunday, April 10-Monday, April 11 City/State/Country ZIP/Postal Code Telephone Fax Specialists In Focus: Cerebrovascular Attending _________ (Includes 2AC.007, 3AC.006, and Integrated Neuroscience Session). Sunday, April 10- Monday, April 11 Specialists In Focus: Child Neurology Attending _________ (Includes 2PC.007, 3PC.007, and Integrated Neuroscience Session). Email 2.0 Education Programs There is a fee for each selected Education Program. Calculate the total in the Education Program Fee Schedule on page 126 and enter in Box B in the Fees section. To register for a program, shade the box and enter the complete number of the program on the line. Saturday, April 9, 2011 1AC. 1EP. 1FC. Sunday, April 10, 2011 2AC. 2ES. 2ES. 2FC. Monday, April 11, 2011 3AC. 3CS. 3CS. 3ES. Tuesday, April 12, 2011 4NP. 4PC. 1KP. 1NP. 1PC. I will be attending this day 1SM. 1SM. 1SM. 2NF. 2NP. 2PC. I will be attending this day 2PW. 2SM. 2SM. 3ES. 3FC. 3MR. 3NP. I will be attending this day 3PC. 3SM. 3SM. 3SW. 4SM. 4SM. Wednesday, April 13, 2011 5CS. 5NP. 5NF. 5PC. I will be attending this day 4SM. I will be attending this day 5SM. 5SW. Thursday, April 14, 2011 6NF. 6SM. 6PC. 6SM. I will be attending this day 6SM. Friday, April 15, 2011 7AC. 7CS. 7ES. 7ES. I will be attending this day 7SM. 7SM. 7SW. 7FC. 7NF. 7PC. 7SC. Saturday, April 16, 2011 8AC. 8SM. I will be attending this day 8PM. 001 (Post Meeting Neuroimaging Conference) Monday, April 11-Tuesday, April 12 Specialists In Focus: Movement Disorders Attending _________ (Includes 3AC.007, 4PC.004, and Integrated Neuroscience Session). 3. Fees BOX A: General Registration Fee Before March 16 After March 16 Student $0 $0 _ ________ Junior and Non-Neurologist Member $100 $130 _ ________ (Junior, Intern, Business Administrator, Non-Neurologist Clinician, Research Scientist) Member Neurologist $305 $420 _ ________ (Active, Associate, Fellow) Member Neurologist $0 $0 _ ________ (Senior, Honorary) Nonmember $610 $840 _ ________ BOX B: Education Program Fees Calculated in program fee schedule on page 126 �������� BOX C: Additional Opportunities (Check all that apply) Physician Leadership Program Monday Friday Celebration for Research Guest Tickets $50 ea. (one free ticket per registrant) Run/Walk for Brain Research $25 ea. AAN and AAN Foundation Awards Luncheon $50 ea. (Junior Members and Students free upon request) Support Research, Buy a Brain $5 ea. _ ________ _ ________ _ ________ _ ________ �������� BOX D: Virtual Annual Meeting (VAM) ____VAM 3-Pack ____VAM 2-Pack ____Syllabi CD ____Practice CD ____Webcast-On-Demand ____MP3-On-Demand & DVD Calculated in product fees on page 126 �������� Registrations received after March 16, 2011, will be processed at higher rates. TOTAL ��������� 4. Commercial Mailings I do not wish to receive hard copy mailings, invitations, and emails from commercial entities. 5. Payment Check/Money Order Payment must accompany registration. Make check payable to American Academy of Neurology (US funds only). A $25 charge will apply to checks returned for insufficient funds. Register: Online: www.aan.com/amrapreg VISA Master Card American Express Diner’s Club Fax: Card number: ����������������������������������������������� Mail: A AN Registration/CMR 33 New Montgomery, Suite 1100 San Francisco, CA 94105 Expiration date: / No government credit cards. (415) 293-4071 I authorize the AAN to charge my credit card the amount determined by the AAN as registration fees. Signature Fed ID# 41-0726167AAN
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