Page 41 - Flying Physician Magazine Issue 1-2018

FPA Meetings RegistRAtion FoRM

Last Name First MI/Name Nickname for badge

Mailing Address City State Zip Code E-mail Address

Spouse Name Spouse CME Y/N Telephone Other Guests

Plane Type N#

Payment by Check -- Send with this completed form to FPA Headquarters, 11626 Twain Drive, Montgomery, Texas 77356
Payment by Credit Card -- Go to www.FPADRS.org and sign in as member. Select meeting of interest and double-click.
Scroll to the bottom of the meeting description for payment options. In completing information, provide your e-mail for pay-
ment receipt notification.
Please complete all information above. Check beside the meetings you plan to attend.

Northeast Chapter Hosted St Michaels Inn/Conf Center (___) $335 FPA/FDA Member single
Tri-Chapter St Michaels, Maryland (___) $535 FPA/FDA Member couple
September 20-23, 2018

Western-Southwest Chapters Paris Las Vegas Resort (___) $515 FPA/FDA Member single
November 1-4, 2018 Las Vegas, Nevada (___) $680 FPA/FDA Member couple
(___) OPTIONAL Cirque du Soleil “O” Tickets
$155 each (including all taxes & charges)

FPA Winter Board Meeting The Hangar Hotel (___) Send Information
February 8-10, 2019 Fredericksburg, Texas

Great Lakes-Dixie Chapters Embassy Suites (___) Send Information
April 11-14, 2019 Louisville, Kentucky

FPA 65th Annual Meeting The Hilton Downtown Hotel (___) Send Information
June 1-4, 2019 Fort Worth, Texas

Fax this form to 832-415-0287 or mail to:
FPA Chapters Meetings
11626 Twain Drive • Montgomery, Texas 77356

The Flying Physician vol. 61 - Issue 1 2018 41
The Flying Physician vol. 60 - Issue 2 2017 41