AATS International Coronary Congress: State-of-the-Art Surgical Coronary Revascularization August 21-23, 2015 New York Marriot Marquis, Times Square, New York, NY Early Bird Registration Deadline: Friday, July 31, 2015 ATTENDEE INFORMATION__ __________________________________________________________________________ __ Name: _____________________________________________________________________________________________________ Institution: _________________________________________________________________________________________________ Address: ___________________________________________________________________________________________________ City: _________________________________ State: ___________ Zip: ___________________ Country______________________ Phone: ________________________________________________ Fax: ______________________________________________ E-mail (required for confirmation): ______________________________________________________________________________ REGISTRATION FEES__ ____________________________________________________________________________ Early Bird (thru 7/31) Meeting A.______ B. _____ AC. _____ D. _____ E. _____ ‘ Physicians and Surgeons APACVS Member Non-Member PA/SFA Nurse/Allied Health Resident/Fellow __ Regular (8/1-onsite) $ 700 $ 300 $ 350 $ 250 $ 150 $ 750 $ 350 $400 $ 300 $ 175 ___________ ___________ ___________ ___________ ___________ ADD HANDS-ON SESSION FOR SURGICAL FIRST ASSISTANTS - (please circle) 1. Conduit Course (PA, SFA) $ 100 $ 150 2. Chest Course (PA, SFA) $ 100 $ 150 ___________ ___________ TOTAL AMOUNT DUE: $______________________ METHOD OF PAYMENT____________________________________________________________ __ ____ _- Please charge my registration fees to the following credit card: Name As It Appears on Credit Card: _______________________________________________________________________________ Billing Address of Card Holder: Same as Above o r________________________________________________________________ City: ___________________________________________State: ___________Zip: _________________ Country: _________________ Credit Card #: ____________________________________________________________ ____ Expiration Date: _________ /________ Security Code: ___________________ (See card images below) Where is your Card Security Code? Your credit card’s security code is a 3- or 4- digit number located on its front or back of your credit card Signature: ______________________________________________________________ I would like to pay by check (enclosed). Please make checks payable to: American Association for Thoracic Surgery 500 Cummings Center Suite 4550 Beverly, Massachusetts 01915 Phone: 978-927-8330 Fax: 978-524-0461 All requests for cancellations must be received in writing. If a cancellation is received at the AATS Administrative Office prior to Friday, July 31, 2015, the registration fee, less a $50.00 administrative fee, will be refunded after the meeting. Refund requests received after July 31st will be assessed on a case by case basis.