Register seminar attendees

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This registration page is for NON PROFESSIONAL PILOTS only. Registration under this category includes Educational Credits.
Registration fee is $350.00
Please select the category that represents you: *
Specify Other Category:

This year we are making the attendee list available.  For those that “Opt-In” to have their information shared, the following information will provided: your name & credentials, your email address and the company you work for.*
Please opt in or out.
Opt-In
Opt-Out
(Only those that Opt-In, will recieve a copy of the attendee list, following the Seminar.)

* denotes required fields.

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

First Name*:
Last Name*:
First Name as you would like it to appear on your badge*:
Title*:
Credential 1 (MD, PhD, ABPP, etc.) Please use one per line.:
Credential 2:
Credential 3:
HIMS Category*:
Specify HIMS Category*:
Airline or Company*:
Email*:
Address*:
Extended Address:
City*:
State*:
Country*:
Zip*:
Phone Number*:

Is this your first HIMS Basic Seminar?*
Yes
No

Thank you for your interest in attending the HIMS Basic Seminar. You have indicated that this is your first HIMS Basic Seminar. You must be invited to attend the seminar and you must enter a code to continue. (Correct code must be input)*:

To get an invite to the Basic Seminar, contact your Regional Flight Surgeon if you are an AME, Dr. Chesanow (Charles.chesanow@faa.gov) if you are a psychiatrist, or Dr. Georgemiller (Randy.J.Georgemiller@faa.gov) if you are a psychologist. They will provide you with the code needed to complete registration.

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


Seminar Manual? *
I want a hard copy of the Seminar Manual when I check-in
I do not need a hard copy of the manual, I will download the manual from the website

Which days of the seminar will you attend?*
Note: Full registration fee is required regardless of days attended.
Monday, September 23rd
Tuesday, September 24th
Wednesday, September 25th

Will you be at Birds of a Feather meeting (Public Welcome!) on the evening of Monday, September 23rd?*
Yes
No

Breakout sessions are at 10:30 am Tuesday, September 24th. Which breakout session will you attend?*
Peer Monitors and Union HIMS Chairs
Management HIMS Team
Neuropsychologists
Psychiatrists
AME: New AME's/3rd Class
AME: First Class/HIMS Programs
Counselors, EAP, Other Mental Health Professionals
Family Support Volunteers
I will not be attending a breakout session

Will you be attending breakfast on Wednesday, September 25th?*
Yes
No


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

This is an example of how your seminar badge will be printed. If everything looks correct press continue below. If you need to edit your badge, select Edit and scroll to the top of the registration page and make your corrections. Select Continue to view your badge again.

Thank you for your interest in the 2019 HIMS Basic Education Seminar. You fall under Priority 2 for registration. Please return to the main page and complete the Wait List Form and send it to www.HIMS@aviationmedicine.com. There is more information on the main seminar info page regarding the Wait List. Thank you.