29th Annual Perinatal Partnership Conference

First Name *

Last Name *

Home Address *

Address (extra field)

City *

Your State of Residence *

Zip *

Email *

Phone Number *

Profession/Credentials *

Employer *

Perinatal Association Membership? *

Which days will you attend? *

Both Days (Day 1 and Day 2) [$260.00]

Which days will you attend? *

Both Days (Day 1 and Day 2) [$295.00]

Pre-conference Workshop (Select One) *

Pre-conference 1 [$100.00]

Pre-conference 2 [$100.00]

I do not plan to attend a pre-conference workshops

Pre-conference Workshop (Select One) *

Pre-conference 1 [$100.00]

Pre-conference 2 [$100.00]

I do not plan to attend a pre-conference workshops

CONCURRENT SESSION A (PLEASE SELECT ONE)

A-1 Pelvic Floor Physical Therapy

A-2 A Review of Neurosteroids for Postpartum Depression B

A-3 Late Preterm Protocol

CONCURRENT SESSION B (PLEASE SELECT ONE)

B-1 Evidence Based Approaches to Optimize Perinatal Care for Patients with Obesity

B-2 Strategies to Optimize Breastfeeding

B-3 Neonatal Topic

Which Business Lunch do you plan to attend

NC

SC

I have dietary restrictions (i.e. vegetarian, gluten free, allergies)

No

Yes

I have dietary restrictions (i.e. vegetarian, gluten free, allergies) Yes

If Yes, please tell us what your dietary restrictions are.

Please indicate if you will attend the Reception

Yes

No

Mid-Carolina AHEC