Registration GPNA-GPPMA GPNA & GPPMA Registration Late Fee Name First Last Credential CMPE LPN ADN RN MA CPC Other Work Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEmail Name of Practice/HospitalName of Lead Physician(s)Nurse Meeting Registration FeeNurse - $100 + $25 late feeMedical Assistant - $80 + $25 late feePhysician - GC/AAP Member - $100 + $25 late feeIndustry Professional - $200 + $25 late fee Practice Manager Meeting Registration FeePractice Mgr/Office Staff/GPPMA Member - $100.00 + $25 late feePhysician – GC/AAP Member - $100.00 + $25 late feeIndustry Professional - $200.00 + $25 late feePractice Mgr or Physician - Non Member - $185.00 + $25 late feeMOC Part II: Injury Prevention Registration FeeGeorgia AAP Member - $125Non-Member - $175MOC Part II: Injury Prevention: Children Birth to 4 years & Adolescents (Approved for ABP Maintenance of Certification Part 2 Points.Total $0.00
