2012 Postgraduate Day Events for Summa Akron City & St. Thomas Hospitals - Registration Form

Event Information | Event List

Postgraduate Day Event Registration Form

Interactive Poster Session on Friday, June 1, 2012; 4 - 6 p.m., CCC Lobby
Oral Session on Monday, June 4, 2012; 8 - 11:00 a.m., RCF Auditorium

Please use this form to register for Postgraduate Day 2012 Events.

Registration Information

*First Name:
*Last Name:
*Phone:
*Pager:
*Department:
*Email:
*Please Select Only One:
I am a resident physician
I am a fellow.

If you are not a resident physician or fellow, you must call Summa Connections at 1-800-23-SUMMA to register.

Research Sessions

Poster Session: I will attend the Poster Session on Friday - June 1st from
      4-6 p.m.

Free Event

Oral Session: I will attend the Oral Session on Monday - June 4th from
      8-11 a.m.

Free Event


Event Information

Please select the events you plan to attend:

PLEASE NOTE: Recreation activities (Golf & Spa) occur concurrently, please select only one. Guests to Firestone Country Club and K's Nail Bar & Spa are not permitted to bring alcohol from the outside to these facilities.

Golf Activity

Activity (Golf): I will attend Golf at the Firestone Country Club on Monday
      June 4th.

Registration begins at 1 pm. Lunch is included in the fee for Golf: $215.00
Resident Physician or Fellow Fee: Covered by Medical Staff

Lunch: I will attend lunch at the Firestone Country Club on Monday
      June 4th from 12:15-1pm.

Lunch alone: $35.00
Resident Physician or Fellow Fee: Covered by Medical Staff

Lunch Option: Vegetarian

Spa Activity

PLEASE NOTE: This activity is for Residents & Fellows ONLY.

Activity (Spa): I will attend the spa activity at K's Nail Bar & Spa on Monday June 4th.

Lunch is included in the fee for the Spa: $215.00
Resident Physician or Fellow Fee: Covered by Medical Staff

Dinner

PLEASE NOTE: Due to the size of the venue NO guests are permitted.

Dinner: I will attend the Dinner at Firestone Country Club on
      Monday June 4th. Social Hour is 6-7 p.m.. Dinner begins
      promptly at 7 p.m. There will be no cash bar after 7 p.m.

Dinner is $65.00
Resident Physician or Fellow Fee: Covered by Medical Staff

Dinner Option: Vegetarian

Golf Information - If you are attending the Golf event please complete the additional information below. If not, please skip to the next section.

PLEASE NOTE: All foursome participants listed must complete their own Registration Form. Per Firestone Country Club, members pay standard outing rate. Include a mix of attendings & residents or fellows in your foursome or assignments will be made randomly. All golfers are randomly assigned to the West and North courses.

Please provide the names of those in your foursome.

All fields are required. Please identify if name is unavailable or if position is open.

Player One:
Player Two:
Player Three:
Player Four:

If you would like to be assigned to an available foursome, please indicate below.
No Team: Please assign me to a foursome

Spa Information - If you are attending the Spa event please complete the additional information below. If not, please skip to the next section.


PLEASE NOTE: K's Nail Bar & Spa will try to schedule you as close to your time preference as they can. Plan to arrive15 minutes before your scheduled time.

Everyone will receive either a manicure or a hand massage. All services are 30 minutes. Please choose either manicure or hand massage.

Click on the drop-down arrow to make your selection:

You will also receive two of the following services:

Please rank your other selections here:
First Choice:
Second Choice:
Third Choice:
Fourth Choice:

Spa service times will run from 11:30 a.m. to 5:30 p.m. Please select your preferred start time for each of your scheduled services:
Early Late Any time

A light lunch and beverages will be available. Please choose whether you will eat or not.
Yes No

Additional Information

You will receive an email confirming your attendance plans.
If you have any questions about this event, contact Summa Connections at (800) 237-8662 or (330) 379-9229.

Cancellation Policy: For those who pay a fee, no refunds will be given if cancellation occurs less than 72 hours prior to the event.

ATTENTION Residents and Fellows: If you fail to cancel reservations for spa, golf or dinner less than 72 hrs prior, you will be billed for these costs.