Register for the 2017 UAPD Annual Meetings

Name*

First Last

Your Degree(s)

Personal Email*

Home Address

Street Address City State / Province / Region ZIP / Postal Code

Phone (Home or Cell)

Where do you work?

What is your role at the meetings?*

I Will Attend the Following Events (Board, Staff, Guests):

UAPD Board Dinner (Friday October 27 at 6 pm)
UAPD Board Meeting (Friday October 27 at 7 pm)
CME/CE on Pain Management and Opioid Addiction (Saturday October 28, 8:30 am - 1 pm)
Membership Meeting (Saturday October 28, 1 - 4 pm)

I Will Attend the Following Events (Stewards and Bargaining Teams):

CME/CE on Pain Management and Opioid Addiction (Saturday October 28, 8:30 am - 1 pm)
Membership Meeting (Saturday October 28, 1 - 4 pm)

I Will Attend the Following Events (Regular Members):

CME/CE on Pain Management and Opioid Addiction (Saturday October 28, 8:30 am - 1 pm)
Membership Meeting (Saturday October 28, 1 - 4 pm)

Which Membership Meeting Will You Attend?

State of Washington Units
State BU 16
County/Clinic
UC/CSU
Private Practice
Retiree

What is Your Medical/Dental License Number?

Saturday Lunch Choice

Beef
Poultry
Vegetarian
Vegan
Gluten-Free

A box lunch will be provided during the CME/CE on Saturday.

Hotel and Transportation

Will You Require a Guest Room at the Los Angeles Airport Marriott?

UAPD will pay for Friday night hotel (10/27) for Board Members, UAPD Staff Members, Invited Guests, Stewards and Bargaining Team Members. Regular Members will be required to pay $134 plus tax and fees per night.

A Credit Card is Needed to Make Your Room Reservation. How Will You Provide It?

Members can reserve a room at the special UAPD rate of $134 plus fees and taxes

A Credit Card is Needed to Make Your Room Reservation. How Will You Provide It?

UAPD will pay Friday night hotel for Stewards and Bargaining Team Members. UAPD may charge your credit card if you fail to use the room and do not notify UAPD of the cancellation.

Check In Date

Check Out Date

Single or Double Occupancy?

One or Two Beds?

Other Hotel Information

Will you be flying to the event?

UAPD will pay transportation costs for Board Members, UAPD Staff Members, Invited Guests, Stewards and Bargaining Team Members.

Do you know what flights you want to take?

Save time! We encourage you to go online now and research the flights that work best for you. Provide the airport, airline, dates, times, and flight numbers below, and we will do our best to book that itinerary for you. Alternatively, you can give us a general sense of your travel plans and a staff member will contact you with flight options.

Tell us the flights you want

Please provide us with the airport, airline, dates, times and flight numbers for your preferred flights to and from this event. If those flights are available and reasonably priced, we will go ahead and book them for you. You may provide your frequent flyer number for the airline as well.

I wish to depart from/return to (airport):

I wish to depart on (date):

Preferred Departure Time:

: HH

MM

I wish to return home on (date):

Preferred Return Time:

: HH

MM

What is your date of birth (for airline reservation)?

Optional: What is your Known Traveller Number?

Will you require parking for a car at the meeting?

Yes
No

Anything Else We Should Know?

Our Partner

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Register for the 2017 UAPD Annual Meetings

Hotel and Transportation