American Association of Oral and Maxillofacial Surgeons in conjunction with the German Society of Oral and Maxillofacial Surgeons

AWNUAL MEETING REGISTRATION FORM September 29-October 3, 1993 Orlando, Florida

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Important Notes on Registration

Sectiou I: Registrants (Please print or type)

Deadline for receipt of AAOMS I’m-Re@ration is

August 24,893.

Sedan II: i4iAoms 1993 h Gewal Registration

Fees

Settim Ilk Professional adA Staff Prqpam

A separate registration form must be completed for each AAOMS/GSOMS member and for professional and allied staff. Spouses, guests and other individuals accompanying members should be included in the accompanying persons section below. Please mail registration form and check payable in U.S. dollars to AAOMS, Lockbox 71027, Chicago, IL 60694-1027.

Registrant #l Name

Badge Nickname

Address

City

Telephone ( ) -

State Zip

FAX Number ( ) -

If registrant is Professional and Allied Staff, enter member’s name here:

Accompanying Spouse/Guest/

Registrant # 2 Age if under 21_

Registrant # 3 Age if under 21_

Family Members Registrant # 4 Age if under 21_

AAOMSIGSOMS Fellow/Member/ Affiliate/Candidate/Applicant/Retired

AAOMS Life Fellow/Member

AAOMSIGSOMS Resident/Student

Non-Member Who Is Not An OMS

OMS Who Is Not A Member Of AAOMS/GSOMS

Spouse/Guest/Family Member (includes opening ceremony)

Professional and Allied Staff

Through 7-31-93

$ 350

S 0

$ 200

S 600

$1200

$ 0

s 0

8-l-93 through 8-24-93

After 8-24-93 and on-site

$ 400 $ 450

S 0 $ 0

$ 225 $ 225

$ 700 $ 800

$1400 $1500

$ 0 $ 0

$ 0 $ 0

Total ktioll II

Professional and Allied Staff Symposium: Aids Update Friday, October 1,8:30 am -12145 pm Attending: _yes _no

Note: Register for the Assistant mini-lectures by completing the scientific registration form on page 73. Do not send any fees for AMLs at this time. Upon confirmation of AML availability, AAOMS will submit an invoice to you for payment,

Section IV: Foundation Benefit

Section V: Scientific Program Registration

Fees (see facing page)

Section VI: ICD-9-M Coding Workshop

Section VII: CPT Coding Workshops

Section VIII: Payment of Fees

“Taste of America” Party Friday, October 1, 1993 7:00 pm

0 OMSF Members (prior to 7/4/93)/Residents/Candidates Qty_ x $45 = CI Non-OMSF Members (and all on-site ticket purchases, except residents) Qty__ x $75 =

Total Se&n IV

Do not include payment for courses with your registration. You will be billed at a later date for confirmed courses.

The ICD-PCM Coding Workshops has limited attendance. (Indicate only the number of places you wish to reserve.) A check for your registration fee(s) must be enclosed. You do not have to register for the Annual Meeting to attend this course. Registration forms without the appropriate fees will not be accepted. The non-refundable registration fee includes the ICD-9-CM Fourth Edition Volumes 1 and 2, an AAOMS ICD-9-CM study workbook and lunch. Once you have been confirmed in this course, the registration fee is nonrefundable.

_ Monday, September 27, 1993, 9:00 am - 5:OO pm

$ 275

Attendee Name

Total Section VI

The CRT Coding Workshops have limited attendance. (Indicate only the number of places you wish to reserve.) A check for your registration fee(s) must be enclosed. You do not have to register for the Annual Meeting to attend this course. Registration forms without the appropriate fees will not be accepted. The nonrefundable registration fee includes a complimentary copy of both the full AMA CRT 1993 and the Head and Neck Surgery Minibook for OMS, a study guide, refreshment breaks and a luncheon. Once you have been confirmed in this course, the registration fee is nonrefundable.

Rank Date Desired in Order of Preference: _ Tuesday, September 28, 1993, 9:00 am - 5:00 pm _ Wednesday, September 29, 1993,9:GU am - 5:oO pm

Attendee Name

Total Section VII

$ 225

Return your registration form(s) for the Annual Meeting, ICD-9-CM Coding Workshop, CM Coding Workshops and Professional and Allied Staff program, together with your check for the general registration, ICD-9-CM Coding Workshop and CPT Coding Workshops fee(s) payable to AAOMS in U.S. Dollars to

AAOMS Lockbox 71027

Chicago, IL 60694-1027

Also include your completed Scientific Program registration form with your general registration form. No payment is required at this time for PCs, SCs, PMLs, Eat & Learn Breakfasts and AMLs. Upon confirmation of course availability, AAOMS will submit an invoice to you for payment.

Total Section I-VII

For AAOMS Use Only

Date By:

Check (no. 1 Grand Total $

PAYMENTS MUST BE MADE IN U.S. DOLLARS

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SCIENTIFIC PROGRAM REGISTRATION Numerically rati. your choices within each time period indicated, i.e., #l for first choice, #2 for second choice, etc. Kindly note that even though you may indicate a number of courses by preference, you will be registered for one course per time period and a maximum of 4 SCs and/or PCs combined. There is no limit to the number of MLs you may select. Registration for all SCs, PCs, and MLs is subject to availability.

Maximum of one (1) course selection per each time slot per day.

WSq.27

w _sc 085 $75 _SC 086 $75 _sc 087 $75 _sc 088 $75 _sc 089 $75 _sc 090 $75

3:0Orrm-5:OOpm 1 selection on1 _sc 091 s _sc 092 s:: _sc 093 $75 _sc 094 $75 _sc 095 $75 _SC 096 $75

5:30Dm-7:30Dm 1 selection only _sc 097 $75 _SC 098 $75 _sc 099 $75 _sc 100 $75 _sc 101 $75 _sc 102 $75

‘cIRL,sept.28 8:00am-10:OOam 1 selection only _sc 103 $75 _sc 104 $75 _sc 105 $75 _SC 106 $75 _sc 107 $75 _SC 108 $75

8:OOam-11:OOam 1 selection only _PML 319 $90

10:30am-12:30Dm 1 selection only _sc 109 $75 _sc 110 $75 _sc 111 $75 _sc 112 $75 _sc 113 $75 _sc 201 $75

1:00Dm-3:OODm 1 selection only _sc 114 $75 _sc 115 $75 _SC 116 $75 _sc 117 $75 _SC 118 $75 _sc 119 $75

l:OOum-4:0&m 1 selection only _PML 419 $90

3:30Dm-5:30Dm 1 selection on1 _sc 120 P 75 _sc 121 $75 _sc 122 $75 _SC 123 $75 _SC 124 $75 _sc 125 $75

We&, Sept. 29

7:30am-9:30am 1 selection only _SC 126 $75 _SC 127 $75 _SC 128 $75 _SC 129 $75 _sc 130 $75 _sc 131 $75 _SC 208 $75 _SC 213 $75

3:OOum-5:OOum 1 selection on1 _PC 132 P 75 _PC 133 $75 _PC 134 $75 _PC 135 $75 _PC 136 $75 _PC 137 $75 _SC 204 $75 _sc 220 $75

7:30am-9:OOam 1 selection only _ET 1 _ET 2 f;; _ET 3 $25 _ET 4 _ET 5 3;; _ET 6 _ET 7 s:; _ET 8 $25 _ET 9 _ET 10 K _ET 11 $25 _ET 12 $25 _ET 13 _ET 14 5;: _ET 15 $25

7:30am-9:30am 1 selection only _sc 138 $75 _sc 139 $75 _sc 140 $75 _sc 141 $75 _SC 142 $75 _sc 143 $75 _sc 144 $75 _sc 145 $75

9:00am-12:OOnoon _PML 320 $90

10:30am-12:30um 1 selection only _PC 184 $75 _PC 185 $75 _PC 186 $75 _PC 187 $75 _PML 321 $75

l:OOum-3:000m 1 selection on1 _PC 188 P 75 _PC 189 $75 _PC 190 $75 _PC 191 $75

3:30Dm-5:30Dm 1 selection on1 _SC 146 3 75 _sc 147 $75 _SC 148 $75 _sc 149 $75 _sc 150 $75 _sc 151 $75 _SC 152 $75 _sc 153 $75

hi.Jkt.1

7:30am-9:OOam 1 selection only _EF 1 _EF 2 5;: _EF 3 $25 _EF 4 _EF 5 K _EF 6 _EF 7 3;; _EF 8 $25 _EF 9 _EF 10 f;: _EF 11 $25 _EF 12 _EF 13 s;: _EF 14 $25 _EF 15 $25

7:30am-9:30am 1 selection onl _sc 154 P 75 _sc 155 $75 _SC 156 $75 _sc 157 $75 _SC 158 $75 _sc 159 $75 _SC 160 $75 _SC 161 $75

9:OOam-12:OOnoon _PML 322 $90

10:30am-12:3Orrm 1 selection on1 _PC 192 s 75 _PC 193 $75 _PC 194 $75 _PC 288 $75

10:30am-2:30Dm _PC 195 $120

12:30Dm_4:30Dm _PML323 $90

l:OOum-3:00Dm 1 selection only _PC 196 $75 _PC 197 $75 _PC 198 $75 _PC 286 $75 _PML324 $75

3:30om-5:30Dm 1 selection on1 _SC 162 P 75 _SC 163 $75 _SC 164 $75 _SC 165 $75 _sc 166 $75 _SC 167 $75 _sc 168 $75 _SC 169 $75

Do not include payment for courses with your registration form. You will be billed at a later date for confirmed courses.

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7:30am-9:30am 1 selection on1 _sc 170 $ 75 _sc 171 $75 _SC 172 $75 _sc 173 $75 _sc 174 $75 _sc 175 $75 _SC 176 $75 _sc 177 $75

10:30am-12:30Dm 1 selection onl _PC 199 s 75 _PC 292 $75 _PC 293 $75 _PC 296 $75

1 l:OOam-12:30Dm 1 selection on1 _AML 001 P 75 _AML 002 $75

l:OOpm-2:30Dm 1 selection on1 _AML 003 P 75 _AMLOO4 $75

l:OOam-3:OODm 1 selection on1 _PC 285 P 75 _PC 290 $75 __PC 298 $75 __PC 299 $75 _PML 325 $75

3:OODm-4:30Dm 1 selection on1 _AML 005 P 75 _AMLOO6 $75

3:30om-5:30am 1 selection on1 _sc 178 P _SC 180 S:: _SC 181 $75 _SC 182 $75 _sc 183 $75 _SC 263 $75 _sc 264 $75

TERMS AND CONDITIONS

Qualifications for Attendance AAOMS and GSOMS fellows and members in good standing (those whose 1993 dues are paid in full, and who are not under any professional conduct sanctions), candidates whose application is on file, residents/students in accredited oral and maxillofacial surgery programs, and guests specifically invited by the AAOMS president are eligible to attend.

USA and German oral and maxillofacial surgeons eligible for any category of membership and who are not fellows or members of the AAOMS/GSOMS may attend subject to the following conditions: that sufficient space is available at the annual meeting site and upon payment of the non- member USA or GSOMS oral and maxillofacial surgeon registration fee. Persons in health professions not eligible to become AAOMS or GSOMS fellows or members may attend subject to the following conditions: that sufficient space is available at the annual meeting site and upon payment of the non-member registration fee. Consultants may be invited to the business sessions at the discretion of the Board of Trustees.

Residents/students not on file with the AAOMS/GSOMS who wish to attend the meeting must have their chiefs write to AAOMS headquarters verifying residency status.

Registration Preregistration is strongly recommended. Registration materials for the annual meeting and educational programs are included in this preliminary program. Please read the following information and complete the registration form carefully. The pre-registration deadline is August 24, 1993. Registration fees vary based upon receipt of your registration form by AAOMS, and fees are indicated on the registration form. There is no registration fee for allied staff or spouses.

Preregistration forms received after the August 24, 1993 deadline date will be held for on-site registration and are subject to on-site registration fees. Allied staff must register separately from their member/employer. The registration form may be duplicated for additional attendees. You will receive a confirmation of your registration information once your registration form is received and accepted by AAOMS. Please note we are unable to accept credit cards or facsimile registration forms for registration.

Purchase of clinic and lecture tickets still available will be conducted at a special booth at the registration center. Tickets for special events may also be available on-site. However, since many of these programs have limited attendance, you are encouraged to preregister.

Reminder: Any AAOMS members who made meeting registration by April 30, 1993 will receive preference when signing up for scientific sessions prior to June 15, 1993.

AAOMS 1993 Annual Meeting Cancellation Policy Requests for cancellation of meeting registration must be made in writing to AAOMS. All meeting registration cancellations will be charged a percentage of the registration fee as follows: 15% if cancelled between May 1,1993 and August 30,1993; and 50% if cancelled between September 1, 1993 and October 10, 1993. No refund requests will be honored after October 10, 1993 or for “no-shows.” The cancellation date will be the date written notice is received at AAOMS headquarters. Refunds for ticketed events will not be granted.

Responsibility Travel Service Corporation acts only in the capacity of agent for the passenger and sponsoring organization, respectively, in all matters relating to hotels, sight-seeing and transportation by airplane, motorbus, motor car, taxi, steamship, boat or other means of transportation, and Travel Service Corporation and the American Association of Oral and Maxillofacial Surgeons (AAOMS) hold themselves free of any responsibility for loss, injury, accident, illness or for any additional expenses or inconveniences caused by delayed trains or airplanes or other means of transportation whether caused by strikes, wars, acts of God or due to the fault or negligence of any company or person entrusted with any of the above services or from any cause whatsoever. The right is reserved to make any alterations, additions or omissions in the program schedule when in our opinion, such alteration is necessary. No airline or railroad or steamship company shall incur any liability except its liability as a common carrier. The airlines concerned are not to be held responsible for any act, omission or event during the time passengers are not on board their planes or conveyance. The passage contract in use by the airlines concerned, when issued, shall constitute the sole contract between the airlines and the passengers. AAOMS, in addition, is not liable for any loss incurred by participants for arrangements made through Travel Service Corporation.