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/Hospital Name of Lead Physician(s) Nurse Meeting Registration Fee Nurse - $100 + $25 late fee Medical Assistant - $80 + $25 late fee Physician - GC/AAP Member - $100 + $25 late fee Industry Professional - $200 + $25 late fee Practice Manager Meeting Registration Fee Practice Mgr/Office Staff/GPPMA Member - $100.00 + $25 late fee Physician – GC/AAP Member - $100.00 + $25 late fee Industry Professional - $200.00 + $25 late fee Practice Mgr or Physician - Non Member - $185.00 + $25 late fee MOC Part II: Injury Prevention Registration Fee Georgia AAP Member - $125 Non-Member - $175 MOC Part II: Injury Prevention: Children Birth to 4 years & Adolescents (Approved for ABP Maintenance of Certification Part 2 Points.Total $0.00
