Registration

ACOG District XII Section
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Registrant Info
Text Message System

By providing your cellular phone number, you are enrolling into the ACOG District XII text alert system. ACOG District XII may send you SMS and MMS text messages, specifically related to the event for which you are registering, between the dates of August 14, 2015 and August 16, 2015. You will be able to reply STOP at any time to opt out of the system. Standard text messaging rates may apply.

Program Registration

CHECK FEE BASED ON MEMBERSHIP STATUS
Registration includes a thumb drive with the course syllabus on it (no paper syllabus will be provided) and 1 admission badge for food functions, excluding Saturday evening event.

CODING PROGRAM
(Friday, August 14)




SCIENTIFIC SESSIONS
(Friday, August 14-Sunday, August 16)








COMBINED COURSE REGISTRATION:
CODING PROGRAM & SCIENTIFIC SESSIONS
(Friday, August 14-Sunday, August 16)




I attest that I am a current Resident/Fellow enrolled in a Florida program. I am agreeing that I will or have already faxed in proof of residency/fellowship to 904-998-0855.
BREAKOUT SESSIONS

Please select the breakout session you would like to attend. There is no additional fee.

Saturday, August 15

Sunday, August 16

SPECIAL EVENTS
Member/Nurse: $0

The Legislative Luncheon is included in the Member and Resident/Fellow registration fee. However, you MUST pre-register to attend this event.

Fee: $25

Ticket NOT included in your registration fee.
Fee: $80

Ticket NOT included in your registration fee.
ADULT & CHILDREN GUEST TICKETS**







**Badges required for access to the exhibit hall and receptions.
Guest Name(s)

Please list the FULL NAME for each of your guests (one per line). Include ages for child guests. Note: Your badge is your pass to all exhibit hall events. Only registered individuals will receive a badge.

Special Assistance
Payment Information