American Academy of Pediatrics
Dedicated to the Health of All Children


California Chapter 1

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Spring Annual Monterey Meeting

Event Brochure
Online Registration
May 24, 25, 26, 2008
at the Portola Plaza Hotel Monterey		 Disclaimer: This on-line registration forwards your request by e-mail directly to Beverly Busher, Chapter Executive Director. This communication is not encrypted but provides more protection than simple fax. It is your decision whether you prefer standard mail, electronic mail as this form allows, or standard fax. The fax document is available above with the Event Brochure.
 

Tab through the choices, using the Enter Key will submit your survey.
Name
Address
City
State
Zip Code
Telephone with area code
Fax (If you want confirmation by Fax)
E-mail (If you want conformation by E-mail)
Registrant Type
Payment Amount Total ($$)
Payment Method (Only Visa and MasterCard Users May Register Online)
Credit Card Number
Credit Card Expiration Date (If Applicable)
Attending Saturday Dinner and Dance (Important)
Three days continental breakfast $30 each child
(place number of kids in the box to the right)
Three days continental breakfast $60 each adult guest
(place number of adults in the box to the right)
Please include number of adults and number of children in the comments field below if you are attending Dinner and Dance
Comments (Include number and type of guests)