Register for the 2021 Annual Meeting - Kentucky Chapter American Academy of Pediatrics

Join us on August 20 – 21, 2021!

Name*
First Last
Title
AAP ID#
Address
Street Address Address Line 2 City State ZIP Code
County*
Email*
Phone*
I'll attend (select one)*
Member Category*
- Chapter Affiliate Member, Good Standing
- Associate Member, Good Standing (Pediatric Dentists, Family Physicians)
- Resident Member, Good Standing
- Allied Health Professionals, Good Standing (Licensed Pediatric Nurse Practitioner, Physician Assistant, Other)
- Non Member, Registration Fee - $150 (After August 1, $175)
By checking the box below, I acknowledge the following:*
- Participant Acknowledgement
Berea College will continue to make reasonable and concerted efforts to follow Kentucky Healthy at Work guidelines for the duration of the COVID-19 pandemic, which include reference to CDC COVID-19 guidelines, and as set forth in the College’s polices published at www.berea.edu/covid19
By checking the box below, I confirm the following:*
- Participant Confirmation
Participant confirms they are (1) vaccinated for COVID-19, meaning Participant shall have completed all the dosing requirements of a specific vaccine regimen more than two weeks prior to Participant’s arrival on campus, OR (2) Participant shall have received a negative COVID-19 test result not more than three (3) days prior to Participant’s arrival on the College’s campus.
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