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PACIFIC DERMATOLOGIC
ASSOCIATION
575 Market Street, Suite 2125
San Francisco, CA 94105
(415) 927-5729
(415) 927-5726 Fax
pda@hp-assoc.com

Last modified on 4/6/09

61st Annual Meeting
Pacific Dermatologic Association
August 12-16, 2009
Marriott Downtown Waterfront Hotel • Portland, Oregon
* Required
Date: 
Full Name: *
Degree:
Affiliation: *-
 (For Badge, please limit to 18 characters)-
Nickname/First Name: *-
(how would you like this to appear on your name badge?)
Address:-
City:
State:
Zip:
Country:
Phone: *
Fax:
Email: *
Spouse/Guest Full Name:

REGISTRATION CATEGORY & TICKET AMOUNT  
  BY JULY 6, 2009  
AFTER JULY 6, 2009  
       FEES       
  PDA Member
$300
$350
$
  Non Member
$550
$600
$
  Resident *
FREE
FREE
  Spouse/Guest ++
FREE
FREE
     Office Staff:
     Please contact the PDA for rates and information

* Dermatology residents may register for no fee with a letter from their program director.
++ Limited to one person per registrant.

Please indicate if you are a:
 New Member First Time Attendee

SOCIAL FUNCTIONS
Welcome Reception
Wed, August 12
@ No Fee
President’s Dinner
Sat, August 15
@ $99 Adult
@ $50 Child
$
$
Special Meal Requests:  Vegetarian Kosher
Other:

OPTIONAL ACTIVITIES (Friday, August 14)
Columbia River Gorge Tour
Limited to 54 people
@ $50 pp
$
Golf Tournament
@ $120 pp
$
      Handicap: 
      Club rental needed?
       Left-handed Right-handed
@ $30 pp
$
Tennis Tournament
@ $30 pp
$
      Racquet rental? Yes No
      Rating/Skill Level: Beginner Intermediate Advanced
TOTAL REGISTRATION FEES:

 $


ADDITIONAL COMMENTS:





It is very important to us that you enjoy PDA 2009. If due to a disability, you have any special needs or requirements, please call (415) 927-5729 and we will do our best to accommodate your needs.

Registration fees, less $25 administration fee, will be refunded following the meeting upon written notice of cancellation to the PDA headquarters office. In order to qualify for a refund of fees, cancellation notice must be received in writing no later than July 6, 2009. There will be no provisions for partial registration fees or refunds for activities not attended.