THE 101st PACIFIC COAST
OTO-OPHTHALMOLOGICAL SOCIETY MEETING
The Fairmont Orchid, Big Island, Hawaii
June 23-26, 2017
The Fairmont Orchid
The Fairmont Orchid boasts luxurious accommodations on an expansive white sand beach
with beautifully landscaped grounds. Rooms are 540 sq feet with marble baths and lanais.
CME credits up to 21.00 hrs
Esteemed speakers covering clinical and scientific updates
in Otolaryngology and Ophthalmology
Friday Morning – Conjoint session
Friday Afternoon – Specialty Sessions
Saturday, Sunday, and Monday Mornings– Specialty Sessions
Big Island Attractions: Volcanoes National Park, City of Refuge Historic Park, Observatory
on Mauna Kea, Snorkel at Captain Cook Monument, numerous Farmer’s Markets, Coffee Plantations,
Botanical Garden in Hilo, Akaka Falls Park, Kailua-Kona, Black Sand Beaches
Call Thelma de Souza at 415-269-0089 or email:
Hotel Information:
A limited number of rooms are available at very special rates for PCOOS meeting attendees:
$214 Garden/Waterfall View, $234 Partial Ocean View, and $259 Ocean View
Discounted Resort Fee is $10 daily and includes:.
Internet, local calls, parking, snorkel clinics, fitness center, cultural activities for
children & adults, bottled water, in-room safe, mini-refrigerator, coffee & tea
Fifty percent discount on Fun & Sun Activity package for PCOOS
hotel guests-one time fee is good for duration of your stay.
Free on-demand shuttle throughout the Mauna Lani area and the
shopping complex with restaurants, shops, and supermarket.
The 101st Pacific Coast Oto-Ophthalmological Society Meeting
Meeting Registration Form
SOCIAL EVENTS
Families are encouraged to attend social events.
Please purchase guest tickets by June 3, 2017
CONTINENTAL BREAKFAST
Friday, June 23 (1 Ticket included with registration)
Guest Tickets:
$31 Adult #______$______
$17 Child (5-12) # ______$______
Saturday, June 24 (1 Ticket included with registration)
Guest Tickets:
$31 Adult #______$______
$17 Child (5-12) # ______$______
Sunday, June 25 (1 Ticket included with registration)
Guest Tickets:
$31 Adult #______$______
$17 Child (5-12) # ______$______
Monday, June 26 (1 Ticket included with registration)
Guest Tickets:
$31 Adult #______$______
$17 Child (5-12) # ______$______
PRESIDENT’S Welcome Reception - Included
Friday, June 23 (1 Ticket included with meeting Registration).
*Please check if you plan to attend:______
Additional Tickets:
$59 Adults # ______$______
$29 Children (5-12) # ______$ ______
*If purchasing guest meals, please provide all name/s including children
______
______
______
Badges must be worn at all times during the program and social events.
Please indicate any dietary restrictions:
______ / REGISTRATION
Please Print
NAME
/
ADDRESS
/
CITY STATE ZIP
/
PHONE:
/
E-MAIL (required – please print clearly)
/
ACADEMIC AFFILIATION or COMPANY
/
Ophthalmology ____ or Otolaryngology ______
/
REGISTRATION / Early Bird
Rate by
*02/15/17 / By
4/15/17 / By
6/15/17 / On-Site
¨ PCOOS MEMBER
(Active/Senior) / $589* / $649 / $699 / $719
¨ NON-MEMBER PHYSICIAN / $769* / $829 / $869 / $889
¨ Medical Student/ RESIDENT/FELLOW / $279* / $319 / $349 / $369
¨ Corporate Attendee / $1,150* / $1,250 / $1,295 / $1,285
¨ MEMBERSHIP RENEWAL / $149 / $149 / $169 / $169
¨ NEW MEMBERSHIP / $99 / $99 / $99 / $99
Registration includes:
Continental Breakfast and Refreshment Breaks Daily and
Friday Reception
Meeting Registration (above) $ ______
Social Program (left side) $ ______
Membership Renewal (above) $ ______
TOTAL $ ______
Please make checks payable to: PCOOS
1681 17th Avenue, San Francisco, CA 94122
*Meeting Cancellation: Refund minus $65 provided if cancellation is received in writing by May 21, 2017
PACIFIC COAST OTO-OPHTHALMOLOGICAL SOCIETY
1681 17th Avenue
San Francisco, CA 94122
Email: ; Website: WWW.PCOOSonline.org
Thelma de Souza, Society Manager, Telephone: (415) 269-0089
2017 MEMBERSHIP DUES STATEMENT
r ANNUAL DUES ...... $ 149
r ANNUAL DUES New Member ...... $ 99
r Age 65 and Retired...... $ 25 (Optional)
r RETIRED and over 70……………………………...…Complimentary
r Medical Student, Residents and Fellows ...... Complimentary
(Donations appreciated: Non-profit TAX ID #95-6059535)
*Add $20 if dues not received by 4/15/17
OPH_____ OTO______Sub-Specialty:______
Name of Member : ______
Affiliation: ______
Email (required):______Phone:______
Current Mailing Address: ______
______
______
Would you like to be listed in the PCOOS Directory? ___ YES ___ NO
Amount $______Signature:______
Please make check payable to: PCOOS
Mail to: Thelma de Souza
1681 17th Avenue
San Francisco, CA 94122
THANK YOU - WE APPRECIATE YOUR SUPPORT!