62nd Annual GSDDS Meeting
June 2-4, 2017
The Cloister at Sea Island

Contact Info, Bio, Itinerary

Contact Info, Bio, Itinerary | Educational Objectives | AV, Final Presentation, Handouts | Disclosure

Speaker Name: *
Email Address: *
Required entries with every submission*


Contact Information

Please list how you wish to be listed in the program (Name and Credentials)


Mailing address:
Office Phone:
Mobile Phone:
Home Phone:
Fax:
Assistant's Name:
Assistant's Phone:
Assistant's Email
Address:



BIO (used in the Syllabus and excerpts taken for verbal introduction)



CME
I am seeking CME credit for this meeting
I am NOT seeking CME credit for this meeting.


TRAVEL
I am driving to and from the meeting location (skip ahead to ACCOMODATIONS)
I am FLYING to and from the meeting location (please complete Arrival/Departure info below)

ARRIVAL
I DO / I DO NOT wish to be shuttled from the airport to the hotel and will arrange my own ground transportation
Airport:      Airline:
Arrival date:      Flight Number      Arrival Time:

DEPARTURE
I DO / I DO NOT wish to be shuttled from the airport to the hotel and will arrange my own ground transportation
Airport:     Airline:
Departure date:      Flight Number:      Departure Time:



ACCOMMODATIONS
I have been told the GSD will make my room reservation at the resort.
OR
I understand I will be making my own room reservation at the resort. Click here for accommodation details and options.

Please complete the following in either case:
I will be checking in on
I will be checking out on


GUESTS - Guest expenses are the responsibility of the speaker.  Please list the names of your guests (spouse, children/ages, relatives, guests, etc.)

Name , Relationship , Age (if under 18)

Name , Relationship , Age (if under 18)

Name , Relationship , Age (if under 18)

Name , Relationship , Age (if under 18)

Name , Relationship , Age (if under 18)

ACTIVITIES - Click here for agenda times, sign me and/or my guests up for the following:

 Friday pre-meeting refreshments in exhibit hall (attendees only)

 Friday Reception with the Exhibitors, number attending

 Friday Resident's Dinner, (guests invited), number attending

 Saturday Breakfast in the exhibit hall (attendees only)

 Saturday MOC Self Assessment Session (attendees only)

 Saturday Live Demo Session (attendees only)

 Saturday Suturing Session (attendees only)

 Saturday Ice Cream Social (guests invited), number attending

 Saturday Dinner & Party (guests invited), number attending adults, children

 Sunday Breakfast & Pearls with the Masters (attendees only)