28 Aug 2024

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Title *
Organization *
Street Address *
City *
   
State: *
  
Zip: *
Telephone *
 Fax:
Email Address *


Quantity Before Oct 1 After Oct 1 Amount
Full Conference Fee (Member) $125 $150
Full Conference Fee (Non-Member) $150 $200
Residents (with letter shown onsite) $ 50 $ 75
Award Reception Only $ 50 $ 75
Students (must show school ID onsite) $ 0 $ 0
* A portion of this fee goes towards sponsoring student attendees.

Yes, we will have an exhibit space (includes 1 conference registration) $2,500
Sponsoring Company
Special Needs / Dietary

Grand Total

Ways to Register

  1. By Check
    – Print and send completed form with payment to ESMA, 49 West 127th Street, Harlem, NY 10027 no later than October 28th.

  2. By Credit Card
    – Complete the above registration form and click Submit Registration button below or call 212.690.1363



    Limited free parking is available onsite. Additional parking at: Merit Parking; 107th Street (bet. 5th & Madison Ave.)

Accreditation: This activity has been planned and implemented in accordance with the Essential
Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME)
through the joint sponsorship of The New York Academy of Medicine and the Empire State
Medical Association. The New York Academy of Medicine is accredited by the ACCME to provide
continuing medical education for physicians. The New York Academy of Medicine designates
this educational activity for maximum of 3.0 Category 1 credits toward the Physician’s
Recognition Award of the AMA. Each physician should claim only those credits that he/she
actually spent in each activity. Disclosure Policy: The New York Academy of Medicine relies
upon invited faculty participants to provide educational information that is objective and as
free from bias as possible. In this spirit and in accordance with the guidelines of the session
sponsor, faculty participants are required to indicate any commercial relationship that might
be perceived as a real or apparent conflict of interest. Persons who have not completed a
conflict of interest disclosure form will not participate as faculty. Any presenter with disclosed
relationships that prove to create a conflict of interest with regard to their contribution to the
activity will not be permitted to present. The Academy also requires that faculty participating
in any CME activity disclose when discussing any unlabeled or investigational use of any
commercial product or device not yet approved for use in the United States.