Register seminar attendees

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Please complete the following questions to register for the 2018 Advanced Topics Seminar.
There is no registration fee for the 2018 AT Seminar.
There are no CME credits offered for the 2018 AT Seminar.
* denotes required fields.

Have you attended the HIMS Basic Seminar?*
Yes
No

Please Note: We will use the next 7-9 fields for your Name Badge

First Name*:
Last Name*:
First Name as you would like it to appear on your badge*:
I am a pilot*:
Yes No
Rank*:
Title*:
Airline or Company*:
Professional Category*:
Specify Category*:
Credential 1 (MD, PhD, DO, LCSW) Please use one per line.:
Credential 2:
Credential 3:
Email*:
Address*:
Extended Address:
City*:
State*:
Country*:
Zip*:
Phone*:

Is this your first HIMS Advanced Topics Seminar?*
Yes
No

Which days of the seminar will you attend?*
Monday, March 19th
Tuesday, March 20th

Breakout sessions are at 3:55 pm Monday, March 20th. Which breakout session will you attend?*
Peers
Management
AME's
Psychiatrists and Pyschologists
I will not be attending a breakout session

Will you be attending breakfast on Tuesday March 20th?*
Yes
No

Will you be attending lunch on Tuesday March 20th?*
Yes
No


For any issues regarding registration please email HIMS@Aviationmedicine.com or call 303-341-5220 and ask for HIMS Registration Support.

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Thank you for your interest in attending the HIMS Advanced Topic Seminar. A requirement for attending this seminar is that you have previously attended the HIMS Basic Seminar. You have indicated that you have not attended the HIMS Basic Seminar and registration for this event cannot be completed.

The next HIMS Basic Seminar will take place in September 2018 in Denver, Colorado. To get an invite to the Basic Seminar contact your Regional Flight Surgeon if you are an AME, contact Dr. Chesanow (Charles.Chesanow@faa.gov) if you are a Psychiatrist or Dr. Front (chris.front@faa.gov), if you are a Psychologist. If you are a pilot, please contact Capt. Slone (Corey.Slone@alpa.org) or Capt. Marc Grassie (Marc.Grassie@alpa.org).

Please contact HIMS@aviationmedicine.com for any other questions. Thank you.