30th year of the Eastern Allergy Conference

June 1-4, 2017  The Breakers ~ Palm Beach ~ Florida

EAC Registration Form

Complete the online registration form below:

Registration fee: $350.00
Guest Registration Fee $25.00

The registration fee is waived for fellows in training.
After May 15, 2017 add an additional $25 to registration fee.

Jointly Provided by: the American College of Allergy, Asthma & Immunology (ACAAI)

and the Eastern Allergy Conference (EAC) 

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Allergy, Asthma & Immunology and the Eastern Allergy Conference.  The American College of Allergy, Asthma and Immunology is accredited by the ACCME to provide continuing medical education for physicians.

Designation

The American College of Allergy, Asthma & Immunology (ACAAI) designates this live activity for a maximum of 15.25 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity is supported by educational grants from commercial interests. Complete information will be provided to participants prior to the activity.



In compliance with the Americans with Disabilities Act, EAC requests that any participant in need of special accommodations submit a written request to EAC well in advance.  Please email Ginny Loiselle at
GinnyLoiselle@easternallergyconference.org.

Cancellation Policy:
Refunds may be issued for cancellations received in writing (mail, fax, email)... before May 1, 2017 minus a $75.00 administration charge.

 

 

Eastern Allergy Conference
 June 1-4, 2017
Registration form

Please complete the form below, ensuring all * boxes have been filled in, and click submit.  When submitting this form, your information will be transmitted via SSL secure link to the Eastern Allergy Conference

*First Name:
*Last Name:
*Degree:
*Address Street 1:
Address Street 2:
*City:
*State:
*Zip Code: (5 digits)
*Daytime/Cell Phone:
Evening Phone:
*Email:
Name of Guest ($25.00/guest):
Please enter your payment information below:
*Credit Card number:
*Expiration Date:
*Initials to accept fees:
Registration PLUS any guests
Comments:
By clicking "Submit", you agree to register for the Eastern Allergy Conference at the above stated fee:



Or if you prefer...

print and fax the below form to:

Ginny Loiselle ~ 401-331-0223

Make check payable to Eastern Allergy Conference and mail to:

Eastern Allergy Conference

450 Veterans Memorial Parkway, #15 ~ East Providence, RI 02914
 

Name ________________________________________________________ Degree ________________

Address ______________________________________________________________________________

City ________________________________________ State ______________ ZIP _________________

E-mail _______________________________________________________________________________

Telephone ___________________________________ Fax # __________________________________

Name of Spouse or Guests _______________________________________________


Method of Payment

Registration $350.00

Guest $25.00

Credit Card Information: Circle one: Master Card VISA AMEX

Card Number _____________________________________ Expiration Date _____________

Signature _________________________________________ Today's Date _______________

Contact Us

Questions for the Conference Director or Conference Coordinator?

Contact Dr. Settipane or Ginny Loiselle at: (401) 223-1309

or Ginnyloiselle@easternallergyconference.org

Travel Planning? Contact Creative Meeting Planners at 800-431-3004 or

401-723-6770 for discounted room and airfares.

 Ask for Christie or Betty Lou.

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