Program Registration for The 7th Philadelphia Prenatal Diagnosis. Ultrasound, Genetics & Obstetrics MaternalFetal Medicine Conference at Hilton Philadelphia on City Avenue, Philadelphia, PA
First Name
Last Name
Institution
Address (home or office)
City
State
Zip
Phone
Fax
Email
Please indicate your academic degree from the following list and provide the appropriate identification numbers:
 PhD, Practicing Physician
ACOG ID:
MD
 MD/PhD, (Not ACOG), or Radiologists Enter Specialty Society:
 MS, CGC (Genetic Counselor)
NSGC ID:
 Nurse/Nurse Practitioner (NP)/Physician Assistant
 (PA) Midwife
 Sonographer
ARDMS ID:
DOB
 Resident/Fellow/Student (must bring verification of residency/fellowship/student status)
Please make your selection from the following options for registration purposes
 Breakfast, lunch and snacks will be provided all four days of the conference and are included in registration costs.
 No Extra Cost -CME/CE/CEU credits included in registration fee. Please mark your CME request below
Single day registration
Friday, May 1st,
Professional Position Thursday, April 30th,
Saturday, May 2nd,
Saturday May 2nd, 2015
2015
2015 without hands on Hands On & Conference Day
2015
Physicians MD/PhD
Sonographer, Fellow
Nurse/ NP /PA
Genetic Counselor
Midwife
Resident/Student
Industry/Others
Obstetric/MFM
Update
$200
$150
$150
$150
$150
$100
$250
Ultrasound &
Genetics
$200
$150
$150
$150
$150
$100
$250
Dinner $70
Tour $30
Ultrasound &
Genetics
$200
$150
$150
$150
$150
$100
$250
Dinner $70
$70Tour $30
$30
Ultrasound Hands On
Fetal Echo & Anatomy
& $400 Fetal ECHO only
$400 Fetal Anatomy
only
$400
Fetal ECHO &
Fetal Anatomy
Three hours “hands on" by the
experts includes detailed Anatomy &
detailed Fetal ECHO
Multiple day registration
Thurs. & Fri.
Apr 30th - May 1st
Physician MD/PhD
Sonographer, Fellow
Nurse, NP, PA, MW, GC
Resident/Student
Industry/Others
$400
$300
 $300
$200
$500
Fri. & Sat
Thurs. & Sat
Thurs, Fri & Sat
May 1st -2nd May 1st
Without Hands On
Without Hands On
$400
$300
$300
$200
$500
$400
$300
 $300
$300
$500
$600
$400
 $400
$300
$750
Thurs, Fri & Sat
With Hands On
$950
$650
$650
$ 600
$1100
*If you would like to join us for dinner and/or a tour one evening, please mark
which night you would like to attend.
th
REQUEST: CME  CE 
CEU 
AFTER April 25 &ON-SITE REGISTRATION – ADD $75
Total Payment: $
Payment Method: Please make check payable to PPC or: Visa MasterCard
American Express
Cardholder Name
Card #
Exp. Date
Security Code (3 digits on back of card)
Authorization Signature
Mail or Fax Registration and Payment to: Prenatal Diagnosis Institute, PO Box 188, Bala Cynwyd, PA 19004
Fax: 215-627-8008
Any questions regarding registration can be directed to 215-627-2229 or prenataldiagnosis@gmail.com
Self-parking is available for $5 a day at the hotel. Special and limited conference room rates are available at the
Hilton Philadelphia by calling 215-879-4000.