57th Pediatric Postgraduate Course - Group Registration Form | Nicklaus Children's Hospital Continuing Medical Education

Thank you for your interest in registering your group for this year's Pediatric Postgraduate Course!

This year, Group Registration will involve Registration Coupon Codes - not individual user registrations. In order to purchase your group registrations, please complete the required fields below and we will contact you with payment details.

After submitting the form, you will be able to download a welcome packet with instructions to send to the members of your group.

Group Point of Contact

The following questions pertain to the person in charge of the group's registration. This will be the person we will send the payment information to, and the person that would have to request any changes to the group.

Point of Contact Name *

Enter one or more names of the person(s) in charge of this group registration. Separate multiple names with a comma.

Point of Contact Email *

Enter one or more emails for the point of contact person(s). Separate multiple emails with a comma.

Point of Contact Company *

Enter the name of the company in charge of the group registration.

Is there a 3rd party group sponsoring this group's registration? *

No, the Point of Contact company/group is in sponsoring this group's registration

Yes, there is an additional 3rd party sponsoring the registration of this group

3rd Party Information *

Please enter the name of this third party. If there is someone from this group that needs to be informed/notified of this registration, please enter their contact information as well.

Point of Contact Location *

Enter the address, city, state/province, and country of the company/person(s) in charge of this group registration.

Group Registration Options

Select the type of group registrations you intend to purchase below. If you need to purchase multiple types of group registrations please submit separate forms.

Select your payment method *

Enter how you wish to complete the payment for your registration

Via credit card

Via wire transfer

Choose registration *

Number of registratons *

Enter the number of registrations you intend to purchase (min. 3)

Purchase Terms of Service

Before completing your group registration request, please read and agree to the purchase terms of service statement below

Terms and Conditions of Purchase

Thank you for your interest in completing a group registration for the 57th Annual Pediatric Postgraduate Course. The Nicklaus Children's Hospital Department of Medical Education requests that you review and agree to the following terms and conditions prior to submitting your Group Registration request. Should you have any questions regarding the terms below, or need assistance in completing your registration, please contact us via email at cme@nicklaushealth.org.

1. Pricing and Payment Terms

Pricing per individual registration is as follow:
- General Registration (General Admission): $100/per person for US & Domestic Physicians, $75/per person for PA's, APRNs, and International Participants
- CME Registration (CME Admission): $125/per person for US & Domestic Physicians, $100/per person for PA's, APRNs, and International Participants
- MOC Add-On: An additional $25, available only to those already registered under CME Admission
Payments can be completed via credit card or wire transfer. Information and details on how to complete the payment will be sent based on your selection above.
After payment is completed, you will receive a set of unique registration codes for your group along with instructions on how to create an account, and how to register for the course. Each member of your group will need a code to reduce the price at registration to $0.
The deadline to register for the course is April 1, 2022, at 6:00 PM EST.
Registration Codes are valid until the April 1, 2022 registration deadline, after which the codes will expire.
Expired registration codes are not transferable, and do not qualify for refunds.
Late registration for the course, after April 1, 2022, is not available.

2. Registration Requirements and Terms

In order to complete registration for the course, each member of your group will have to do the following:

Create a free learner account in our Learning Management Platform at www.ilearnpeds.com
Complete the self-registration process for the course as instructed in the registration package given to the point of contact after purchasing group registrations.

Registration to the course includes the following:

General Registration includes:
- Access to the live transmission for both days of the conference (Saturday, April 2, and Sunday, April 3, 2022).
- Conference virtual networking room access (during the days of the live transmission).
- Access to the presentation recordings for 6 months after the live date (available April 4, 2022).
- Downloads of all conference handouts and supplemental content.
- Downloadable Conference Participation Certificate upon completion of Activity Evaluation Survey.
- Access to the conference content until October 3, 2022, at 11:59 PM EST.
CME Registration includes:
- Everything included with General Registration.
- Up to 10 hours of CME Credit (AMA Pra Category 1^tm) are available to learners as they complete the required CME Content.
- For medical doctors licensed in the State of Florida ONLY: Automatic Reporting to CE Broker of the total earned credits upon completion of the course (the learner must have provided their Florida Medical License number in their user profile)
MOC Add-On module includes:
- Everything included with General Registration.
- Everything included with CME Registration.
- A 32 question self-assessment based on the course content.
- 10 ABM MOC Part 2 points for learners that complete the self-assessment portion with a score of 70% or higher.
- (NOTE: Registration for the MOC Add-on module is restricted to registrants with CME Admission, the learner must be a certified member of the American Board of Pediatrics and have provided their Board ID number in their user profile)

Registration does not guarantee certificates of completion, or credits. Credits and Certificates will only be issued to learners who complete the minimum required course content as listed for each registration option at the following links: for General Registration (http://www.ilearnpeds.com/57ppgc/general-admission#group-tabs-node-course-default3), for CME Registration (http://www.ilearnpeds.com/57ppgc/cme-admission#group-tabs-node-course-default3), for the MOC Add-on Module (http://www.ilearnpeds.com/57ppgc/moc-addon#group-tabs-node-course-default3).

3. Refund and Cancelation Policy

Group Registration refund and cancelation requests must be made in writing and no later than March 31, 2022, at 12:00 pm EST. Only requests made by the individuals and emails listed as Point of Contact in the form above will be considered. Individual members within a group cannot request a refund or cancelation unless they are listed as a point of contact. If processed, the money returned will be sent to the credit card used during purchase or bank account number listed in the wire transfer

If approved, refund requests will be processed minus a $25 transaction fee. Cancelation requests made for credit card transactions may be canceled without a transaction fee if the request is made and approved before the registration codes are issued. To request a refund or cancelation please contact us at cme@nciklaushealth.org. In your written refund request you must include the following information:

The invoice number OR transaction ID (for card purchases, found in your receipt).
State if you request a cancelation of your purchase or a full or partial refund.
The number of codes to be refunded (if requesting a partial refund).
For partial refunds, a list of the exact codes to be refunded is needed.

If your request is approved, the codes issued (or the individual codes requested) will be removed from the system. Any registrations completed with the codes issued will be canceled and the user's enrollment in the course will be terminated. User accounts created for course registration will not be deleted.

4. Responsibilities of the Group Registrant

The Point of Contact(s) registering the group are responsible in:

Distributing the information in the Group Registration Packet to the members of the group
Distributing the registration codes issued to the group members in such a way that the Point of Contact can track which code is given out to each member of the group
Contact us at cme@nicklaushealth.org to inform us of any issues with the codes PRIOR to the deadline for refunds.
Ensuring the group members are registered for the course by the registration deadline of April 1, 2022, after which any registration code issued will expire.

I have read and agree to the terms outlined above *

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57th Pediatric Postgraduate Course - Group Registration Form

Terms and Conditions of Purchase

1. Pricing and Payment Terms

2. Registration Requirements and Terms

3. Refund and Cancelation Policy

4. Responsibilities of the Group Registrant