SOUTHERN PSYCHIATRIC ASSOCIATION SPA KENTUCKY PSYCHIATRIC MEDICAL ASSOCIATION

SOUTHERN PSYCHIATRIC ASSOCIATION (SPA) & KENTUCKY PSYCHIATRIC MEDICAL ASSOCIATION (KPMA) ANNUAL MEETING REGISTRATION August 21 – 24, 2019 Brown Hotel, 335 W. Broadway, Louisville, Kentucky REGISTRATION INFORMATION: DEADLINE FOR REGISTRATION: July 20, 2019 Name Address Phone Email Dietary Restrictions MEETING INFORMATION: Check all below that apply to you SPA / KPMA Physician (Gala Farewell Dinner Included) BEFORE May 15 $ 450 SPA / KPMA Physician (Gala Farewell Dinner Included) AFTER May 15 $ 495 Member in Training – Contact Miranda Sloane to register: msloan@kypsych. org Early Career Psychiatrists (1 -3 yrs. ) (Gala Farewell Dinner Included) HOTEL INFORMATION: Brown Hotel – Louisville, KY 502 -209 -7346 or https: //www. phgsecure. com/IBE/booking. R edirect. ashx? property. Code=SDFBH&group= 08212019 SPA&arrival. Date=08 -202019&departure. Date=08 -262019&number. Of. Nights=5 Reserve Room by July 22, 2019 $ 250 • Dates: Aug 21 – 24, 2019 Non-Physicians - Note Discipline Below ________________ Gala Farewell Dinner $250 Non SPA/KPMA Member Gala Farewell Dinner $ 510 + $ 95 Daily Rate - Note Date(s): ______ (Gala Farewell Dinner Not Included) $ 185/Day + $ 95 • Identify yourself as associated with the Southern Psychiatric Association to receive the special rate of $ 179/night (plus applicable state and hotel service fees). THERE A LIMITED NUMBER OF ROOMS AVAILABLE AT THIS RATE, SO PLEASE BOOK AT YOUR EARLIEST CONVENIENCE. Guest(s): _____________ $ 195 x ____ (# guests) $________________ (Gala Farewell Dinner Included) + $ 95 Trolley Tour, Saturday, August 24 at 2 p. m. ($25 person) $ ______ # People _____ (Add all Checked Boxes) TOTAL: Please note if attending Gala on Saturday, August 24 and number attending: $_______ □ No □ Yes #: _____ Questions: Call Janet Bryan at 410 -938 -3452 Please enclose check for total registration amount, payable to Southern Psychiatric Association and mail to address below: Janet Bryan, Executive Director Southern Psychiatric Association 6501 North Charles Street Baltimore, MD 21204