- American Association for Thoracic Surgery

AMERICAN ASSOCIATION
FOR THORACIC SURGERY
We Model Excellence
95 th ANNUAL MEETING REGISTRATION FORM
Washington State Convention Center | Seattle, WA | April 26-29, 2015
3 WAYS TO REGISTER
1) Online at www.aats.org
You may register for the meeting and book your hotel reservation simultaneously when registering online. Credit cards are the only accepted payment method when
registration is completed online. Registration will be available online throughout the duration of the meeting.
2) Call the AATS/Experient Customer Service Desk 800-424-5249 - Toll-free within the USA
847-996-5829 - International
3) Mail/Fax Meeting registration and hotel reservation form along with check or credit card information to:
Mail: AATS/Experient, 5202 Presidents court, G100, Frederick, MD 21705 Fax: 301-694-5124 (fax requires credit card information)
Annual Meeting Program Phone: 978-927-8330 Email: meetings@aats.org
PROFILE
First Name
Middle Initial
Last Name
Suffix
DegreeInstitution/Company
Telephone
Fax Email
Address
Address
City
State/Province
Country
Emergency Contact Name
Emergency Contact Phone Number
Postal/Zip Code
NPI# (National Provider Identifier Number, U.S. attendees only)
S- Guest/Spouse Registration is complimentary
Only two complimentary guests allowed per registered attendee. Guest badges are intended for use for Non-Physicians and may not be allowed to claim any CME/CE credits for the meeting.
Guest One Name for Badge(s) Guest Two Name for Badge(s)
Specialty (Check all that apply):
Other Areas of Interest (Check all that apply):
What best describes your practice? (Check one):
q A - Adult Cardiac Surgery
q B - Congenital Heart Surgery
q C - General Thoracic Surgery
q D - Vascular Surgery
q E - Cardiology
q F - Other (please specify):___________________
q A - Anesthesiology q B - Critical Care q C - Endovascular
q D - General Surgery q E - Pulmonary Medicine
q A - Private Practice
q B - Academia
q C - Private Hospital
q D - Academic Hospital
q E - Other (please specify): ________________________
AATS WEEK
q F - Robotic Surgery
q G - Oncology
q H - Transplantation
q I - Management/Administration
q J - Other (please specify):
__________________________
Includes the Mitral Conclave and 95th Annual Meeting
Years in Practice
How many years in practice? _______________________
REGISTRATION DEADLINE
Register for AATS Week 2015 and receive a $100 discount! *
Advance Registration Pricing Deadline: March 18, 2015
Mitral Conclave April 23-24, 2015, New York, NY
95th Annual Meeting April 25-29, 2015, Seattle, WA
After this date, all registration fees will increase. A credit card valid through May 2015 is
required to confirm meeting registration and hotel accommodations. Forms received
without a valid credit card and expiration date will not be processed. Housing may be
reserved by providing a valid credit card number even if you are paying for the Annual
Meeting registration by check.
q Yes, I plan to register for Mitral Conclave in addition to Annual Meeting
By registering for both events I will receive a $100 discount off the Mitral Conclave registration fee.
Registration for the 2015 AATS Mitral Conclave meeting is available at www.aats.org/mitral
*Discount does not apply to Residents/Fellows or Medical Students.
REGISTRATION PACKAGES
q Resident/Fellows & Medical Students
Resident/Fellows and Medical Students are able to register for the Saturday courses and
Sunday symposia at no charge. After March 18, 2015, Registration will be $100 each
course/symposium.**
ANNUAL MEETING FEES
Monday, April 27, 2015 – Wednesday, April 28, 2015 Only
On or Before 3/18/15
On or After 3/19/15
q A Member
No Charge
No Charge
q B Non Member Presenting Author
No Charge
No Charge
q C Non-Member Physician
$399
$499
q D Allied Health**
$299
$399
All Registrants must select a PRIMARY COURSE/SYMPOSIA for Saturday and Sunday.
q E Resident/Fellow**
No Charge
$100
**All Residents/Fellows, Medical Students and Allied Health professionals must provide
contact information for their Surgical Chief/Dean/Nurse Director for verification purposes.
q M Medical Student**
No Charge
$100
q G Expo Fee – Exhibit Hall
$100 per day
Name/Title
q K Non-Exhibiting Industry
$1,000 Exhibit Hall & Scientific Sessions
q Allied Health Package
Allied Health professionals who pre-register for the Annual Meeting are eligible for a discount
for the Saturday courses and Sunday symposia. Registration before March 18, 2015 for both
Saturday courses and Sunday symposia are only $350 and on or after March 19, 2015 is $450. **
Phone
Email
q Monday q Tuesday
Schedule
EXHIBITORS ONLY
Saturday April 25, 2015
Courses - 8:00 am-3:30 pm
Register for a Saturday course and you will have access to all other courses taking place
that same day. You must select a primary course.
PRIMARY COURSE: Choose One
q
q
q
q
q
q
LTE -Cardiothoracic Transplant & Mechanical Circulatory Support of Heart & Lung Failure
SSA - Adult Cardiac Skills
SSG - General Thoracic Skills
SSC - Congenital Skills
PRF - Allied Health Personnel Symposium
SURC - Surgical Ethics Course
On or Before 3/18/15
On or After 3/19/15
q Saturday Course for Physicians
q Saturday Course for Allied Health
q Saturday Course for Residents/Fellows
$225
$125
No Charge
$325
$225
$100
q Monday Lunch Ticket $30 q Tuesday Lunch Ticket $30
HOUSING ACCOMMODATIONS
The AATS recognizes that you have a number of options when securing hotel
accommodations for the 2015 AATS Annual Meeting. The city of Seattle and hotel
community have made a major commitment to AATS for competitive rates in quality hotels. If you require a room in Seattle, we encourage you to review the list below
and reserve your room at one of these official hotels within the AATS block.
HOUSING DEADLINE: March 18, 2015
The AATS Housing Bureau will be responsible for processing ALL housing requests for the
2015 AATS Annual Meeting. The hotel reservation cut-off date is Wednesday, March 18, 2015.
Book early as hotel inventory cannot be guaranteed after this date. If you are interested in
booking a suite, please contact the Housing Bureau at AATS@experient-inc.com.
Hotel Selection
Arrival Date: _______________ Departure Date: ________________
A block of rooms has been reserved at the following hotels: Choose One
Hands-On Sessions -4:00-6:00 pm Choose One
$75 each
q AHO - Adult
q CHO - Congenital
GHO - General Thoracic ( q Esophageal Disease OR q Pulmonary Disease )
q THO - Transplant
q Sheraton Seattle Standard Room $225
q Grand Hyatt Seattle Standard Room $204
Headquarter Hotel, less than 1 block from the Convention Center
1 block from the Convention Center
Medical students, General Surgery Residents, & up to third year integrated CT residents (I-6) only
Pre-registration required. Free of charge.
q Hyatt Olive 8 Standard Room $194
Sunday April 26, 2015
q Westin Seattle Standard Room $195
Additional Guests at Westin Additional Guests at other hotels
q Member for a Day - 6:30- 8:30 pm
Symposia - 8:00 am - 5:00 pm
Register for a Sunday symposium and you will have access to all other symposia taking place
that same day. You must select a primary course.
2 blocks from the Convention Center
q The Fairmont Olympic Hotel in Seattle Deluxe King $205 or Executive Suite $235
3 blocks from the Convention Center
5 blocks from the Convention Center
q $30.00/night x ____ nights = $____
q $25.00/night x ____ nights = $____
SPECIAL REQUESTS: Check all that apply
q Non-Smoking q Smoking (Not available at all hotels)
PRIMARY SYMPOSIUM: Choose One
q ACS - Adult Cardiac Surgery
q GEN - General Thoracic Surgery
q CHS - Congenital Heart Disease
On or Before 3/18/15
On or After 3/19/15
q Sunday Symposium for Physicians
q Sunday Symposium for Allied Health
q Sunday Symposium for Resident/Fellows
$225
$125
No Charge
$325
$225
$100
q One Bed
q Double Beds
q Other: ___________________________
Pursuant to the Americans with Disabilities Act
q I do not require specific aids or services during my visit
q I require specific aids or services during my visit
Please Specify: q Audio
Comments: _____________________________________________________________
Pre-Registration Required. Free of charge.
My Fees: Cardiothoracic Residents’ Luncheon “Preparing for an Academic Career”- 12:30-2:00 pm
Residents/Fellows, Medical Students Only
Pre-Registration Required. Free of charge.
q CLC - Cardiac
q CLG - General Thoracic
q MED - Medical Student
Total Annual Meeting fee: __________
Total Course, Symposium and Luncheon fees where applicable: __________
Total Social Programs and Tour fee: __________
Total Hotel fee: __________
Total Amount Due for 2015 Annual Meeting: __________
Monday April 27, 2015
Should a physician inform an innocent contact about HIV exposure, against state law?
Pre-Registration Required - $25.
q TCT- Transcatheter Therapy and Collaboration - 5:00-6:30 pm
Pre-Registration Required. Free of charge.
q Lillehei Forum - 5:00–6:30 pm.
Pre-Registration Required. Free of charge.
SOCIAL PROGRAMS AND TOURS
Woodinville Wine Excursion Tour - Sunday, April 26 from 12:30 – 4:30 pm
q $77.00 x ____ tickets = $ ____
Boeing and Future of Flight Tour - Monday, April 27 from 9:00 am – 1:00 pm
q $57.00 x ____ tickets = $ ____
Tastes of Pike Place Market Tour - Tuesday, April 28 from 9:15 am – 1:15 pm
q $78.00 x ____ tickets = $ ____
Attendee Reception at the Museum of Flight - Tuesday, April 28 from 7:30 – 10:00 pm
q $85.00 x ____ tickets = $ ____
q Mobile
q Other: _______________
PAYMENT q MOC Information Session Breakfast - 6:30-7:30 am
q EL- Ethics Forum Luncheon - 12:30- 2:00 pm
q Visual
Total Registration Package fee: __________
My Payment Method:
q
q
q
q
Credit Card #
Name on Card
Expiration Date (credit card must not expire before May 2015)
Billing Address
Check #____________ Make checks are payable to AATS.
Cash (US Dollars)
Travelers Check
Credit Card Card Type q MasterCard q Visa q American Express
Signature
POLICIES AND PROCEDURES
Registration and Cancellation Policy: Written requests for cancellations and refunds for registration must be received by April 15, 2015. Refunds will be subject to a $50 administrative fee and will be processed after the
meeting. Refunds are not available after April 15, 2015. Requests can be faxed to (301)-694-5124 or aats@experient-inc.com.
Housing Cancellation Policy: Reservations made via the web, fax, or mail will require a credit card (American Express, VISA or MasterCard) for guarantee purposes only. The credit card will guarantee your room for late arrival
for the day of scheduled arrival only. Please note that the hotel may charge your card upon receipt of the rooming list on or after March 18, 2015. Any deposit the hotel charges to your card will be applied as a credit to your
room folio. The hotel will also charge your card if you fail to cancel within the hotel’s cancellation policy or if you do not arrive (Please check with hotel directly regarding their cancellation policy). Please be aware that early
departure fees may also apply should the hotel not be notified of these changes in advance of their policy dates. It is the guest’s responsibility to notify the hotels after April 15, 2015 if any changes to an existing reservation.
Acknowledgements: Meeting registration and housing accommodation acknowledgments will be sent within three to five business days of receipt of form. If an acknowledgment is not received within two weeks, contact AATS/
Experient Customer Service at 800-424-5249 toll-free within the USA or 847-996-5829 International.