UAPD 2024 Triennial Registration

What is your role within UAPD?*

Board Member
Steward, Bargaining Team Member, or Already Elected Delegate
Delegate Nominee (Not Elected Yet)
UAPD Staff Member or Special Invitee
None of the Above — Regular UAPD Member

UAPD pays transportation and hotel costs for Board Members, Stewards, Bargaining Team Members, Elected Delegates, UAPD Staff Members, and Special Invitees. All other UAPD members are responsible for their own travel and lodging costs.

Name*

First Last

Where do you work?

Your Degree(s)

M.D.
D.D.S.
D.O.
D.P.M
N.P.
P.A.
Pharm.D

Home Address

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

Phone Number

Phone Number Type

Cell
Home

Personal Email

On Thursday I Will Attend:

Pre-Meeting Dinner (Thursday, October 24th)
UAPD Board Meeting (Thursday, October 24th)

I Will Attend the Following Events:*

AI in Healthcare Discussion (Friday, October 25th)
Stewards Panel (Friday, October 25th)
Membership Meetings (Friday, October 25th)
Financial Planning Courses (Friday, October 25th)
UAPD Reception (Friday, October 25th)
Triennial Convention (Saturday, October 26th)

What is Your Medical/Dental License Number?

Which Membership Meeting Will You Be Attending?

Which Financial Course Will You Be Attending?

Hotel and Transportation

Will You Require Accommodations at the Westin Bonaventure?

UAPD pays hotel room costs for Thursday, October 24th and Friday, October 25th for Board Members, Stewards, Bargaining Team Members, Elected Delegates, UAPD Staff Members, and Special Invitees. All other UAPD members are responsible for their own hotel costs.

To reserve a room at the Los Angeles Westin Bonaventure at a special rate, you must provide your credit card information to UAPD. How would you like to proceed?

I will call UAPD at 1-800-585-6977 to provide my credit card number
I would like a UAPD staff member to call me for my credit card number
I will fax my name, credit card number, and expiration date to 1-916-446-3827

DELEGATE NOMINEES: You must provide your credit card information to make a room reservation. If you are ELECTED as a delegate, UAPD will pay your hotel costs. If you are not elected, your hotel costs are your own. How would you like to proceed?

I will call UAPD at 1-800-585-6977 to provide my credit card number
I would like a UAPD staff member to call me for my credit card number
I will fax my name, credit card number, and expiration date to 1-916-446-3827

If you cannot attend the meeting, you must notify UAPD (1-800-585-6977) prior to October 18th so that your hotel room can be canceled. Failure to do so may result in your credit card being charged the room rate for one night.

Check In Date

Check Out Date

Single or Double Occupancy?

Name of Additional Guest

One or Two Beds?

Other Hotel Information

NOTE: You must provide your credit card information to UAPD to complete your room reservation. How would you like to proceed?

I will call UAPD at 1-800-585-6977 to provide my credit card number
I would like a UAPD staff member to call me for my credit card number
I will fax my name, credit card number, and expiration date to 1-916-446-3827

Because of the costs associated with no-shows, UAPD now requires that members provide a credit card number whenever a hotel room is reserved in their name. If you cannot attend the meeting, you must notify UAPD (1-800-585-6977) prior to October 18th so that your hotel room can be canceled. Failure to do so may result in your credit card being charged the room rate for one night.

Will you be flying to the event?

UAPD pays transportation costs for Stewards, County/Clinic Bargaining Team Members, Elected Delegates, Board Members, UAPD Staff Members and Invited Guests.

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

I wish to fly to LAX on (date):*

Preferred Departure Time:

:

I wish to return home on (date):

Preferred Return Time:

:

Will you need car parking for the meeting?

Anything Else We Should Know?

UAPD 2024 Triennial Registration

Hotel and Transportation

HEADQUARTERS

PHONE

Email