ACAP Annual Convention & Gala Registration Form

Last Name*

First Name*

Email*

Are You a Member of ACAP?*

Are You a Member of CANA or CASA?*

CANA (Chinese American Neurological Association)
CASA (Chinese American Society of Anesthesiology)

What Is Your Specialty?*

Which CME Seminar Will You Attend?*

Annual Convention (CME seminars) 9am – 5pm Sheraton LaGuardia East Hotel (135-20 39th Ave, Flushing, NY 11354)

Will you Stay for Lunch?*

Will you Attend Annual Gala?*

Annual Gala 6pm – 9:30pm Mudan Banquet Hall (136-17 39th Ave 2nd Floor, Flushing, NY 11354)

Number of People Attending Gala (Including Yourself)*

Special Requests

Comments

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Saturday Oct 5, 2019