SATURDAY & SUNDAY, SEPTEMBER 17TH-18TH, 2011
HILTON HOTEL
300 Almaden Boulevard, San Jose, CA
Hotel Room Reservations for discounted rate of $99+/night

This year, the 2011 Ethnic Physician Leadership Summit will be a 2-day event which will focus on "The Challenges of Healthcare Reform."

The Summit will start on Saturday, September 17th with be a keynote address on the Challenges and Benefits of Health Care Reform. This will be followed by panel discussions on Physician Shortage & Diversity, updates on Health Information Technology implementation and Health Homes /Accountable Care Organizations. The day will end with a Networking Reception and Ethnic Physician Leadership Award Presentation.

On Sunday, participants will hear from a panel of medical students addressing and responding to the Saturday speakers. Participants will also attend leadership training workshops on media and policy advocacy, quality care in diabetes, HPV/cervical cancer and obesity prevention. The Summit will conclude with closing comments from attendees during a wrap-up luncheon.

• $50 for Physicians and Members of a Community-Based Organization
  
• $25 for Medical Students (Limited scholarships are available for medical students for travel & hotel. Please contact Anna Gutierrez for details at 916.779.6627 or agutierrez@thecmafoundation.org)
  
• $150 for Other Attendees

All attendees will have full access to Summit activities including the Ethnic Physician Leadership Award Presentation and Networking Reception. The CMA Foundation will provide conference materials to all participants. Travel, hotel accommodations and expenses for the Ethnic Physician Leadership Summit will be the obligation of each individual participant. You may receive the Hilton Hotel room discount rate of $99+/night by going to the Hilton personalized page by clicking here.

Please complete the form below to register for the Ethnic Physician Leadership Summit. Space is limited - register today!

(* required)
Registrant Information:
*Member Type:	Please select... Physicians - $50 Members of Community Based Organizations - $50 Medical Students - $25 Other attendees - $150
*First Name:
*Last Name:
*Degree:	(MD, etc.)
*Ethnic Physician Organization/Business Name:
Title:
*Mailing Address: (including suite number):
*City:
*State:
*Zip Code:
*Daytime Phone:
Fax Number:
*Email Address:
Dietary  Preference:
Workshop Attendance
To indicate your choice of workshops, click the appropriate option.
Session A - 90 Minute Workshop 9:00 - 10:30 a.m. - (please select one)
Policy Advocacy Physician Champions - Obesity Prevention Diabetes (Repeats in Session B) I will not be attending Workshop Session A
Session B - 90 Minute Workshop 10:45 - 12:15 p.m. - (please select one)
HPV / Cervical Cancer Media Advocacy Diabetes (Same as Session A) I will not be attending Workshop Session B
In our efforts to save paper, instead of receiving a binder at the Summit, you can receive a CD.
Please make a selection below. * Summit Presentations (binder materials) will be available on our website one month after Summit. CD Only Binder Only Both, Binder & CD

Billing Information:
Payment Type:	Select... Check Credit