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qd - National Medical Association 114th Annual Convention and
1 Letter from the Oice of the President Convention Preliminary Program - Marketplace (ours Social Events Description – Sponsorship Levels - Golf Event Schedule Camp NMA-Zing Daily Schedule Travel )nformation - pegistration dorms: Social Events Ticket Request Form Sponsorship Opportunities Souvenir Journal Ad Form Golf Signage Opportunities (ousing Request Form Camp NMA-Zing Registration Form 2 Auxiliary to the lational kedical Association, gnc. mice of the nresident Colesville Road, # Silver Spring, MD Fax: www.anmanet.org April VELVA S. CLARK, RN, BS President , Dear Auxiliary Members, Friends and Valued Supporters: (ave you seen the CBS television program Game Changers? )t alerts us to the diference one person can make in the game of life. )’m inspired by its stories. And )’m inspired by the eforts each one of you makes through your involvement in the ANMA. Will you become more involved through this year’s Annual Convention in Detroit, planned for August — ? That week has the potential to change the game of healthcare in America. And ) believe we all can agree that change is imperative to achieve the goal of our theme of Advocating and Engaging Communities: Transforming Our Behavior into Good Health. (ow can you help change the game? By going above and beyond good intentions to support the ANMA’s eforts inancially. Yes, this is a fundraising letter, sent with the hope of inspiring you to contribute to change through our Social Events, our Souvenir Program Booklet advertising, plus sponsorships for our Golf Tournament as well as our Memorial Service and Prayer Breakfast. Your support has strengthened our progress against the triple-threat of Women’s (eart (ealth— Obesity—Triple-Negative Breast Cancer and so many other challenges facing an underserved population. Since , the nonproit ANMA has lived its mission of providing community-based health education and advocacy programs. Our nursing scholarships help shape the future of (ealthcare. And so can you. You are one person with good intentions. Please ...make those intentions count and change the game in the favor of communities across the country. With sincere appreciation, Velva S. Clark, RN, BS 1 th AlkA Annual aonvention betroit karriott at the penaissance aenter penaissance brive betroit, kg Advocating and Engaging Communities: Transforming Our Behavior into Good Health AlkA aonvention aoordinators ahair: Sarita Cathcart-McLarin, MN, NP-C ao-ahairs: Sharon C. Melvin, RN, MP( and Sabrina Williams Velva S. Clark, RN, BS, President (elen Kinard Scott, DPA, Chairperson, Board of Directors FRIDAY, JULY : a.m. – : , p.m. Pre-Convention Board of Directors Meeting SATURDAY, AUGUST , : a.m. – : p.m. Golf Outing – Pine Knob Golf Course : a.m. – : a.m. Walk a Mile with a Child : a.m. – : p.m. ANMA General Registration : p.m. – : p.m. Civic Luncheon : p.m. – : p.m. ANMA Marketplace Formal Opening : p.m. – : p.m. ANMA Marketplace SUNDAY, AUGUST , : a.m. – : : a.m. – : a.m. ANMA/NMA Prayer Breakfast & Memorial Service a.m. ANMA Formal Opening : a.m. – : p.m. ANMA General Registration : a.m. – : p.m. ANMA Marketplace 2 : a.m. – : a.m. : noon – : : p.m. – : p.m. Motown Museum & Museum of African American (istory Tour : p.m. – : p.m. Past President’s Council Meeting : p.m. – : p.m. President’s Cruise Motown Review, Dinner & Dancing p.m. ANMA (ouse of Delegates – First General Session Edsel & Eleanor Ford (ouse Tour and Lunch MONDAY, AUGUST , : a.m. – : a.m. ANMA (ouse of Delegates Breakfast : a.m. – : p.m. ANMA General Registration : a.m. – : a.m. ANMA (ouse of Delegates – Second General Session : a.m. – : p.m. Ford Rouge Factory Tour : a.m. – : a.m. Youth (ealth Forum/Project Sun / NAAY) : a.m. – : noon – : p.m. p.m. ANMA Marketplace (enry Ford Museum TUESDAY, AUGUST , : a.m. – : a.m. Voting for : a.m. – : p.m. ANMA General Registration : a.m. – : a.m. ANMA (ouse of Delegates – Third General Session : a.m. – : a.m. – : : a.m. a.m. - ANMA Oicers African American Women & (eart Disease Symposium and Breakfast Detroit )nstitute of Art s : a.m. – : p.m. ANMA Marketplace : p.m. – : p.m. Fashion and Jazz Scholarship Luncheon 3 WEDNESDAY, AUGUST , : a.m. – : : a.m. – : a.m. ANMA (ouse of Delegates – Fourth General Session : a.m. Triple Negative Breast Cancer Symposium & Breakfast a.m. – : p.m. ANMA Marketplace th President and : a.m. – : p.m. )nstallation of the : p.m. – : p.m. ANMA’s President’s Reception : p.m. – : p.m. - Oicers Post-Convention Board of Directors Meeting qaturday, August : p.m. – : p.m. qunday, August : a.m. – : p.m. konday, August : a.m. – : p.m. ruesday, August : a.m. – : p.m. The ANMA Marketplace is one of the most exciting facets of our convention. Exhibits include Designer Apparel, Collages, Custom Artwork, Lady’s Accessories, and much more. uednesday, August : a.m. – : p.m. ANMA is grateful for the continued patronage of exhibitors and supporters. During breaks, please visit the Marketplace located in the mlrApgm cvfgBgr fALL cAqr pmmk in the Detroit Marriott at the Renaissance Center. 4 nglc ilmB emLd amspqc qaturday, August , : aost: $ /$ a.m.— : p.m. For years, golf enthusiasts from all over Michigan have made The Knob Golf Course a must play track. Perhaps it’s the beautiful championship layout featuring scenic views along a rolling terrain with dramatic elevation changes from tee to green with country club conditioning. Maybe it’s the awardwinning course designer, Dan Pohl, who has continually updated greens, bunkers and general course layout to make it a better golf experience in recent years. Consistent high quality and attention is paid to the details like landscaping and service. The course includes holes of championship golf that wind through lakes, woods and many scenic elevation changes with three distinctive nines to choose from: The Eagle, The Falcon, and The (awk. The irst tee-box on the Eagle course is the highest elevation in Oakland County, giving a player an amazing view, up to miles away on a clear day! Pine Knob has been rated stars out of ive by Golf Digest Places to Play. cbqcL & cLcAlmp dmpb fmsqc rmsp qunday, August , aost: $ / $ noon— : p.m. Experience the story of the Ford family in this historic mansion rich with art and antiques spanning the centuries. Situated along Lake St. Clair, the estate stands amid acres of beautifully landscaped gardens and grounds. (ighlights include visiting the enchanting playhouse and viewing Mr. and Mrs. Ford's personal cars. )t large, but does not seem imposing. Despite its size , square feet with sixty rooms , the estate has the unpretentious look of a quaint manor from the Cotswold (ills of England. Construction on the home began in , not long after the Fords commissioned Albert Kahn to design their ideal residence. Though intimate, the estate is quite grand. The ceilings in many rooms are adorned with plaster leur de lis details, the walls paneled with ornate linen fold wood from England, there are French wrought crystal chandeliers hanging; the number of intricate details in each room is at times overwhelming. This is especially evident on the irst loor of the home. Among the rooms on the irst loor are the art gallery, the drawing room, the library, the morning room and the dining room. )magine the large kitchen area connecting to three diferent rooms, the lower room, the game room, and Edsel’s study. Though intimate, the estate is quite grand. The ceilings in many rooms are adorned with plaster leur de lis details, the walls paneled with ornate linen fold wood from England, there are French wrought crystal chandeliers hanging; the number of intricate details in each room is at times overwhelming. This is especially evident on the irst loor of the home. Among the rooms on the irst loor are the art gallery, the drawing room, the library, the morning room and the dining room. )magine the large kitchen area connecting to three diferent rooms, the lower room, the game room, and Edsel’s study. Lunch included. 5 kmrmul ksqcsk & ksqcsk md AdpgaAl AkcpgaAl fgqrmpY rmsp qunday, August , aost: $ / $ : p.m.— : p.m. Despite the passage of time since Motown Records’ establishment in by Berry Gordy, tens of thousands of visitors pass through (itsville U.S.A., home to the Motown Museum, each year. Their presence is a testimony to Motown’s legacy and to the charisma, talent and staying power of the music and those who made it. The Motown Museum, which was founded by Esther Gordy Edwards in , is one of Southeast Michigan’s most popular tourist destinations. Visitors come from across America and throughout the world to stand in Studio A, where their favorite artists and groups recorded much-loved music, and to view the restored upper lat where Berry Gordy lived with his young family during the company’s earliest days. The Motown Museum is home to an extensive array of Motown artifacts, photographs and other memorabilia. The Motown Museum tells the story of how a man’s vision turned into one of the largest, most successful record companies of all time and how the music—the Motown Sound-captured the hearts of young people, not only in America, but across the globe. rhe aharles f. uright kuseum of African American fistory is the world's largest institution dedicated to the African American experience. Dr. Charles Wright, an obstetrician and gynecologist, envisioned an institution to preserve Black history after visiting a memorial to Danish World War )) heroes in Denmark. As a result of this visit, he was convinced that African Americans needed a similar resource center to document, preserve and educate the public on their history, life and culture. The Wright Museum houses over , artifacts and archival materials and is home to the Blanche Coggin Underground Railroad Collection, (arriet Tubman Museum Collection, Coleman A. Young Collection and the Sheield Collection, a repository of documents of the labor movement in Detroit. The museum also features: Maya Angelou’s And Still We Rise: Our Journey through African American (istory and Culture, the museum’s , square foot, interactive core exhibit. AlkA’s npcqgbclr’q bgllcp apsgqc qunday, August , : aost: $ / $ p.m.— : p.m. bon't kgqq the boat! Cruise the great waters of Michigan for - hours, journeying from (art Plaza past the Ambassador Bridge, just past to Belle )sle, and back to the dock–stunning historic landmarks of Detroit, Michigan. During the Detroit Princess moonlight cruise and dinner Auxilians, friends and spouses will enjoy a Motown Memories show, dancing to the Motown melodies while enjoying additional views of the Detroit and Windsor Canada skyline. Lake Michigan is one of the ive Great Lakes of North America, and the only one located entirely within the United States. )t is bounded, from west to east, by the U.S. states of Wisconsin, )llinois, )ndiana and Michigan. The word Michigan was originally used to refer to the lake itself and is believed to come from the Ojibwa )ndian word mishigami, meaning great water. 6 rfc dmpb pmsec dAarmpY rmsp konday, August , : aost: $ / $ a.m.— : p.m. The Ford Rouge Factory, a joint partnership between The (enry Ford and Ford Motor Company, ofers visitors the opportunity to tour the rich history of the Rouge, the birthplace of the Model A, the V- , Mustang and the Thunderbird while bearing witness to the future of manufacturing through the assembly of the new F- . The (enry Rouge Factory opened in as a school and was driven by Ford’s belief that the genius of the American people was not being taught in textbooks. Today, The (enry Ford Factory, in Dearborn, Michigan, is an internationally-recognized cultural destination that brings the past forward by immersing visitors in the stories of ingenuity, resourcefulness and innovation that helped shape America. This national historic landmark has ive unique venue attractions: Thomas Edison’s Menlo Park Laboratory, The Wright Brothers’ (ome & Bicycle Shop, Buckminster Fuller’s Dymaxion (ouse, one of Steve Jobs’ and Steve Wozniak’s Apple- computers and (enry Ford’s Quadricycle. These ive distinct attractions at The (enry Ford captivate and inspire more than . million visitors annually. fclpY dmpb ksqcsk konday, August , aost: $ / $ noon— : p.m. (enry Ford Museum showcases the American ideas and innovations, technological and social, that have ired our imaginations and changed our lives. (ere, visitors explore the irst years of light, browse through the world’s premier automotive collection, walk past an array of presidential limousines including the one in which John F. Kennedy was assassinated and see an unparalleled collection of artifacts representing powerful change such as the bus on which Rosa Parks took a stand for Civil Rights, the camp bed George Washington used during his tour of Revolutionary War sites and the chair in which Abraham Lincoln was sitting the night he was shot. bcrpmgr glqrgrsrc md Aprq ruesday, August , : aost: $ / $ a.m.— : p.m. The Detroit )nstitute of Art D)A has been a beacon of culture for the Detroit area for well over a century. Founded in , the museum was originally located on Jeferson Avenue, but, due to its rapidly expanding collection, moved to a larger site on Woodward Avenue in . The new Beaux-Arts building, designed by Paul Cret, was immediately referred to as the "temple of art." Two wings were added in the s and s, and a major renovation and expansion that began in was completed in . The D)A building measures , square feet. Completion of the museum's renovation and expansion project will add another , square feet. The Detroit )nstitute of Arts collection is among the top six in the United States. 7 l a n q $ , and above $ , and above One x booth in Marketplace One foursome in ANMA golf outing August , Recognition as a Golf (ole Sponsor Reserved seating for Table of at the Civic Luncheon )nclusion in Pre and Post Convention publicity Full page ad and CEO letter in Souvenir Journal Recognition on Convention Signage Recognition in E-Newsletter distributed nationally Recognition on ANMA Website n and above One Table of with priority seating at the Civic Luncheon Reserved seating for Table of at the Scholarship Luncheon Two x booths in Marketplace Two foursomes Convention Golf Outing August , Full page color ad on back cover or front inside cover of Souvenir Journal Logo on ANMA Website Company logo displayed on Call to Convention - distributed nationally Recognition as a Golf (ole Sponsor Recognition in any Convention Signage Listing in all releases b $ , One x booth in Marketplace Reserved seating for six at the Civic Luncheon Recognition as a Golf (ole Sponsor One foursome ANMA Golf Outing August , Recognition on Convention Signage Full page ad in Souvenir Journal Recognition in E-Newsletter distributed nationally Recognition on ANMA Website 8 $ , e Recognition as a Golf (ole Sponsor (alf page ad in Souvenir Journal Two Golfers at ANMA Golf Outing August , Recognition on Convention Signage Recognition in Souvenir Journal Five tickets to the Civic Luncheon with reserved seating Reserved seating for Table of at the Scholarship Luncheon )nclusion in Pre and Post Convention publicity Recognition in E-Newsletter distributed nationally Recognition on ANMA Website $ , q Quarter page ad in Souvenir Journal Two tickets to Motown and Museum of African American Tour Recognition on Convention Signage Recognition on ANMA Website $, BpmlZc Recognition in Souvenir Journal Recognition on Convention Signage Recognition on ANMA Website a and above r Table of q $ , for Civic Luncheon or Scholarship Luncheon 9 ANMA’s Golf Tournament is a major fundraising activity to support scholarships to medical and nursing school students and to support ANMA’s health education programs across the country. q d aontests: (ole-)n-One Women (ole-)n-One Men Closest to the Pin Women Closest to the Pin Men Men’s and Women’s Longest Drive eolf aommittee 7:00 a.m.—Buses depart from Detroit Marriott Renaissance Center 7:45 a.m.—Registration and light breakfast 7:45 a.m.—Driving Range opens 9:00 a.m.—Shotgun start Lunch on the Course 3:00 p.m.—Departure for hotel Robert Sims, D.O., Co-Chair (onorable Morris Overstreet, Co-Chair Jefrey Kimpson, M.D., Co-Chair Virginia Caine, M.D. Lonnie Joe, M.D. Aaron Maddox, M.D. Marilyn Maddox Jessie McGee, M.D. Wilma McGee James McMurtry, M.D. William Sharp, M.D. Daryl Thomas David Williams, M.D. Derrick Williamson, D.O. Sharon Williamson 10 CAMP NMA-ZING YOUTH 2015 PROGRAM – Detroit, MI Daily Schedule The NMA has contracted Kama`aina Kids, Hawai`i’s Enrichment and Education Professionals, to conduct a fun-filled, enriching program for youth of attendees of the NMA Convention and Scientific Assembly. The four-day Camp NMA-Zing program consists of morning and evening sessions, with cultural and recreational activities. Our chaperone-to-youth ratios ensure that participants receive safe, professional care. Program fees include: qualified chaperones certified in first aid and CPR; transportation; admissions; daily lunches; four t-shirts; and insurance. Parents must pick up children at 4:00pm daily, provide dinner for child, and drop child off at 6:00pm for evening program. Program takes place at Detroit Marriott at the Renaissance Center. Activities may be subject to change. AGE GROUPS GROUP 1 3-5 YEARS 1:5 GROUP 2 6-8 YEARS 1:6 GROUP 3 9-11 YEARS 1:8 GROUP 4 12-14 YEARS 1:10 GROUP 5&6 15+ YEARS 1:12 TIME SUNDAY August 2 TUESDAY August 4 WEDNESDAY August 5 8:30am – 4pm Greenfield Village GM Renaissance Center Tour Outdoor Adventure Center Detroit Zoo Michigan Science Center 6pm – 9:30pm PuppetART Center Story Rhythms by Karen Czarnik Dynamike Magic Show 8:30am – 4pm Greenfield Village GM Renaissance Center Tour Outdoor Adventure Center Mad Science Detroit Talent Show Detroit Zoo Michigan Science Center 6pm – 9:30pm PuppetART Center Story Rhythms by Karen Czarnik Dynamike Magic Show 8:30am – 4pm Greenfield Village GM Renaissance Center Tour Outdoor Adventure Center Mad Science Detroit Talent Show Detroit Zoo Michigan Science Center 6pm – 9:30pm Diamond Jack’s River Tours Detroit Lions’ Ford Football Field Tour Detroit Tigers Baseball Game at Comerica Park Mad Science Detroit Talent Show Project SUN GM Renaissance Center Tour Outdoor Adventure Center Detroit Zoo 8:30am – 4pm 6pm – 9:30pm Greenfield Village Diamond Jack’s River Tours 8:30am – 4pm Greenfield Village 6pm – 9:30pm Diamond Jack’s River Tours MONDAY August 3 Detroit Lions’ Ford Football Field Tour Project SUN Detroit Tigers Baseball Game at Comerica Park GM Renaissance Center Tour Outdoor Adventure Center Detroit Zoo Detroit Lions’ Ford Football Field Tour Detroit Tigers Baseball Game at Comerica Park Charles H. Wright Museum of African American History Michigan Science Center Camp NMA-Zing Teen Dance Michigan Science Center Charles H. Wright Museum of African American History Camp NMA-Zing Teen Dance 11 AIRLINE DISCOUNTS The National Medical Association is pleased to offer discounted airfare programs on two carriers, Delta and United. Detroit is also served by a number of other airlines, including American Jet Blue, Frontier, Southwest, US Airways and Air Canada. However, NMA does not have a discounted fare agreement on these carriers. Delta is offering a discount from July 29 – August 8, 2015. Reservations and ticketing are available via www.delta.com. When booking online, select “Book a Trip,” click on “Advanced Search,” and enter meeting code NML7J in the box provided on the “Search Flights” page. You may also reserve tickets by calling Delta Meeting Network Reservations at 1-800-328-1111. Please note that a direct ticketing charge will apply for booking by phone. Delta Booking Class Percentage Discount F / G / J / C / D / Y /A / P / I – 10% B / M / S / H / Q / K / L – 5% U / T / V / X – 2% United is offering a discount from July 29-August 8, 2015. You may book online at www.united.com and enter your Offer Code ZUND904332 in the Offer Code box when searching for your flights. If booking through a travel professional or United Meetings at 1-800-426-1122, please provide the following information: Agreement Code: 904332; Z Code: ZUND. For all tickets issued through the United Meetings Reservations Desk, there will be a $25 per ticket service fee. United Booking Class Percentage Discount F/J/Y – 10% C/A/B/M/E/U/H – 5% D/Z/P/Q/V/W/S/T/L/K/G/N – 2% AIRPOAIRPORT The Detroit Metropolitan Airport is located approximately 20 miles from NMA’s headquarters hotel, the Marriott Renaissance Center. Depending on the time of day, minimum travel time is estimated to be 20-30 minutes. During heavy traffic times, travel may take anywhere from 35 to 45 minutes AIPORT TRANSFERS/SHUTTLE SKOOT Detroit is the preferred shuttle service to and from Detroit Metro Airport. It offers service from/to the airport and downtown hotels (including the NMA headquarters hotel, the Detroit Marriott Renaissance Center), as well as to Cobo Hall. To make your shuttle reservation visit SKOOT online at www.rideskoot.com or by phone, call the toll-free number: 1-855-937-5668 or 313-230-2331. Reservations are highly recommended, although walk-ups are available. Use coupon code NMADET15 for a $2.00 discount off your round-trip ticket. Prices quoted are current and are subject to change. NOTE: SKOOT operates from 4:00 a.m. – 10:00 p.m. From Detroit Metro Airport to Marriott Renaissance Center Departs every 20 minutes, 8:00 a.m. – 10:00 p.m. / $23 per person From Marriott Renaissance Center to Detroit Metro Airport Departs every 90 minutes, 4:00 a.m. – 10:00 p.m. / $20 per person 12 DETROIT PEOPLE MOVER The Detroit People Mover is a quick, safe, and effective means of transportation between the host hotel and the Cobo Center. People Mover trains arrive every 3-4 minutes to deliver patrons in climate-controlled comfort. Handicap accessibility is available via elevators and escalators at stations. Station Locations: Detroit Marriott Renaissance Center (host hotel) – Tower 200, Level 2 Cobo Conference/Exhibition Center – Third Floor near Congress Street For additional information visit www.thepeoplemover.com SCOOTER RENTALS Binson’s Call 586.755.2300, ext. 4855 – Sandy Maxwell When calling the number above, identify yourself as an NMA convention attendee in order to receive the convention discount pricing, which is as follows: Scooters: $250 per week, with a security deposit of $250 and a pick-up and delivery fee of $75. Standard wheelchair: $90 per week, with a $90 deposit, and a pick-up and delivery fee of $75. Delivery and pickup for scooters and wheelchairs will be at the Marriott Renaissance Center. Major credit cards are accepted. Call at least two-three weeks in advance to secure the equipment needed. Scooters for use ONLY at Cobo Center The convention center hospitality desk has four scooters, the charge for which is $35 for four hours. Unlike the scooters reserved through Binson’s (see above), these may not be removed from the convention center. There are also several manual wheelchairs available on a first-come, first-served basis. Both the scooters and wheelchairs may be ordered only when onsite; there are no advance orders. ID must be left with the staff at the hospitality desk. CAR SERVICE If you wish to use a car service between the airport and your hotel, visit www.privatecarapp.com Use code NMADET15 to receive 5% off private car service to/from DTW airport and downtown Detroit. There is a “Meet and Greet “ in baggage claim. Car Rentals: NMA has made arrangements with Hertz for your car rental needs. Special discounted rates will apply. These meeting rates include unlimited mileage. Government surcharges, taxes, tax reimbursement, airport-related fees, vehicle licensing fees and optional items (refueling or additional driver fees) are extra. For your convenience, vehicles may be picked up and returned at either the Detroit Metro Airport or at the Marriott Renaissance. Advance reservations are recommended, as cars are subject to availability. Rates are based on round-trip rentals and are guaranteed from one week prior through one week after the convention dates. Reservations: Phone: 1.800.654.2240 or 1.405.749.4434. Identify yourself as an NMA convention attendee and provide special code: CV#022Q7437. Website: Click on link www.hertz.com (Note to NMA: link is provided with instructions from Hertz) 13 a : qocial Activities ricket pequest dorm qponsorship Level dorm qouvenir hournal Ad dorm eolf qignage dorm fousing pequest dorm aamp lkA-Zing pegistration dorm 14 rgaicr pcoscqr dmpk qocial cvents & aomplimentary uorkshops August – , Price Prior to June 30 Price After June 30 Golf Package Pine Knob Golf Course $150.00 $160.00 Saturday, August 1 12:30p.m. Civic Luncheon $75.00 $85.00 Saturday, August 1 4:30p.m. – 6:30p.m. Market Place Ribbon Cutting Welcome Reception Complimentary Saturday, August 1 NMA Formal Opening & Awards Ceremony See NMA Program Sunday, August 2 7:00a.m. – 9:00a.m. ANMA/NMA Prayer Breakfast/ Memorial Service $35.00 $45.00 Sunday, August 2 12:00noon - 4:00p.m. Edsel & Eleanor Ford House Tour and Lunch $60.00 $70.00 Sunday, August 2 12:30p.m. – 4:30p.m. Motown Museum & Museum of African American History Tour $50.00 $60.00 Sunday, August 2 6:15p.m. – 9:30p.m. ANMA President’s Cruise Motown Review, Dinner and Dancing $75.00 Cash Bar $85.00 Monday, August 3 9:00a.m. – 1:00 p.m. Ford Rouge Factory Tour $60.00 $70.00 Monday, August 3 12:00p.m. – 4:00 p.m. Henry Ford Museum $60.00 $70.00 Tuesday, August 4 9:00a.m. – 10:30 a.m. African American Women and Heart Disease Symposium and Breakfast Complimentary Tuesday, August 4 9:00 – 11:30 a.m. Detroit Institute of Arts $50.00 $60.00 Tuesday, August 4 12:30p.m. – 3:00p.m. Fashion and Jazz Scholarship Luncheon $100.00 $110.00 Tuesday Night NMA President-Elect Installation See NMA Program Wednesday. August 5 9:00a.m. – 10:30 a.m. Triple Negative Breast Cancer Symposium and Breakfast Complimentary Day/Date Social Events Saturday, August 1 7:00a.m. – 4:00p.m. TOTAL # of Tickets Price 15 All ticket request for Social Events MUST be received NO LATER than June 30, 2015. Social Events NOT meeting the minimal capacity (30) WILL BE CANCELLED in order to avoid ANMA penalties. Tickets reserved prior to June 30, 2015 may be picked up at the ANMA Social Events Desk in the Registration Area. PLEASE PRINT ALL INFORMATION IN INK AND LEGIBLY Name Email Address City Home Phone ( State Cell Phone ( ) Zip ) Cash, Traveler's Checks, MasterCard, Visa and American Express are accepted at Convention. NO PERSONAL CHECKS WILL BE ACCEPTED ON SITE! If you are paying by: MasterCard Account #: Visa or American Express, please complete the following: Security Code: Exp. Date: Name as it appears on the card: Signature: Date: Checks should be made payable to: ANMA, Inc. Ticket request for Social Events should be mailed to: ANMA, Inc. 8403 Colesville Road, Suite 820 Silver Spring, MD 20910 NO CHECKS “POSTMARKED” AFTER JUNE 30, 2015 For more information visit www.anmanet.org ***PRICES, TIMES AND EVENTS ARE SUBJECT TO CHANGE*** 16 A la a al al A a ,I . A A August 1 - 5, 2015 Detroit Marriott at the Renaissance Center Detroit, Michigan To confirm your support, please complete the information below and email to [email protected], or Fax to (301) 495-0037, or mail with your payment to the address below. Questions should be directed to ANMA Office at (301) 495-3779. (Please respond by June 30, 2015 to guarantee placement in Souvenir Journal.) Sponsorship Opportunities Please Print Clearly Contact Name: _______________________________________________Title:_____________________________ Company/Organization: _________________________________________________________________________ Address: ____________________________________________________ Suite/Floor________________________ City: _______________________________________________________ State: _____ Zip Code: _____________ Phone: _____________________________ Fax: ____________________ Email: ___________________________ Please list in printed materials as: __________________________________________________________________ I agree to support the ANMA Events at the following level (Please check): Sponsorship Opportunities: Presenting Sponsor $25,000 SOLD Diamond Sponsor $10,000 Platinum Sponsor $7,500 Silver Sponsor $2,500 Bronze Sponsor $1,500 Corporate Table Sponsor $2,000 Souvenir Journal: Full Page $300 (before 6/7/15) Full Page $350 Half Page $150 Quarter Page $75 Card (1/8) Page $50 Tickets: Civic Luncheon Individual Ticket $75 Scholarship & Jazz Luncheon $100 Total # of Tickets: ______ Total # of Tickets: ______ Please provide full payment when submitting this form. Any sponsorship not paid upon submission of this agreement will be invoiced for the amount of the selected level of sponsorship. Final payments must be made by June 30 th to guarantee tickets. Payment Method: □ MasterCard □ Visa □ American Express Payment by Check or Money Order: □ Check □ Money Order Please make payable to: ANMA, Inc. Cardholder's Name: _____________________________________Card #:_________________________________ (as it appears on card) Cardholder's Signature: _____________________________ Expiration Date: ___________ Security Code: _______ Mail this form to: ANMA Office, 8403 Colesville Road, Suite 820, Silver Spring, Maryland 20910 KEEP COPY FOR YOUR RECORDS 17 Auxiliary to the National Medical Association, Inc. 2015 Convention Souvenir Journal Ad Form We are requesting your support of the ANMA, Inc. by purchasing an ad in our 2015 Convention Souvenir Program Book. You may place a congratulatory or promotional message about your business, organization or auxiliary. You may also place an ad in memory of or in honor of someone you wish to acknowledge. Yes, I want to support the ANMA: Full-page ad $300 before 6/30/15 Quarter-page ad $ 75 Full-page $350 Card (1/8 page) $ 50 Half-page ad $150 Donation $______ Prices quoted are for black and white ads. Add $50.00 for Full-page color ads and $25.00 for color Half and Quarter page ads. Name to be printed Contact Person/Title: Telephone: Fax: Email: Address: City/State/Zip: Type of Business: Website: In Memory of: _______________________________________________________________________________ In Honor of: _________________________________________________________________________________ Payment: Check made payable to ANMA, Inc in the amount of $ Please charge my MC or VISA or AMEX $ Name as it appears on card: Card Number: Expiration Date: Security Code Billing address (if different) Signature: Please mail the completed form and method of payment to: ANMA, Inc. 8403 Colesville Road, Suite 820 Silver Spring, MD 20910 (301) 495-3779 Ad su issio deadli e is Ju e 7, 5. Please se d o pleted for opy i PDF or jpeg for at. alo g with a era ready We agree to indemnify the publishers against any claim resulting from unauthorized use of any names, photographs, sketches, artwork, registered trademarks, labels or words in our advertisement. OFFICE USE ONLY: Authorized Signature Date Received: 18 Golf Signage Opportunities To confirm your support, please complete the information below and email to [email protected], or Fax to (301) 495-0037, or mail with your payment to the address below. Questions should be directed to ANMA Office at (301) 495-3779. (Please respond by June 30, 2015 to guarantee placement in Souvenir Journal.) Please Print Clearly Contact Name: ______________________________________________________________Title:___________________________ Company/Organization: ______________________________________________________________________________________ Address: __________________________________________________________________ Suite/Floor_______________________ City: _____________________________________________________________________ State: _____ Zip Code: ____________ Phone: ____________________________________________ Cell#____________________________ Fax: ___________________ Email: ____________________________________________________________________________________________________ Please list in printed materials as: ______________________________________________________________________________ I agree to support the ANMA Golf Outing at the following level (Please check): SIGNAGE OPPORTUNITIES: Hole in One Sponsor …………………….…$2,000.00 4 Golfers Signage with logo on Tee and Green Recognition at Awards Ceremony Half page in the ANMA Souvenir Program Hole Sponsors ………………………………..$250.00 Signage with Company Logo on one of the 17 Tees Recognition in the ANMA Souvenir Program 19th Hole Sponsor ……………..…………..…$150.00 Quarter Page Ad Individual Golfer ………….………………...$150.00 To assure recognition in promotional materials, camera–ready artwork, ad copy/or logo, must be received by June 30, 2015. DONATIONS: I/We are unable to attend but would like to make a donation in the amount of $______ TOTAL AMOUNT DUE: $_______________ Payment Method: MasterCard Visa AMEX Check or Money Order Please make payable to ANMA, Inc. Check Money Order Mail to: ANMA, Inc. 8403 Colesville Road, #820 Silver Spring, MD 20910 Cardholder's Name: ________________________________________Card #:_______________________________________ (As it appears on card) Cardholder's Signature: ______________________________ Expiration Date: _____________ Security Code: _____________ GOLFERS NAME: Phone: EMAIL: NAME: Phone: EMAIL: NAME: Phone: EMAIL: NAME: Phone: EMAIL: I will ride the motor coach to and from the golf course. I will not ride the motor coach. 19 Detroit Marriott at the Renaissance Center Detroit, Michigan August – , g : Please complete all of the required information. Type or print legibly. )f you are sharing a room, please indicate in the space provided below. )f you are booking two rooms, connecting rooms may be available. l : _________________________________________________________________ c : _________________________________________________________________ A : ________________ b : __________________ l . ry p : _______ A Guest Rooms include either one King size bed or double beds for up to people. Rooms includes complimentary internet and use of the itness center qtandard poom—$ Single q p . =$ Double/Double poom with a tiew—$ Single plus $ plus $ Double/Double King . =$ King . . aonnecting pooms: Yes No : _______________________________________________________________________________ _______________________________________________________________________________________________ All reservations require a credit card at the time the reservation is made. aonirmation of your hotel room assignment will come from AlkA, gnc. fotel peservation nayment kethod: Name as it appears on card: _________________________________________________________________ Card #: __________________________________________ Exp. ____________________ CC: _________ Signature: _________________________________________________________________________________ nlease c-mail or dax completed form to: Email: [email protected] Fax: 20 2015 Camp NMA-Zing Registration Form CONFERENCE ATTENDEE NAME: YOUTH INFORMATION (PLEASE PRINT) FIRST, LAST, MIDDLE INITIAL SEX AGE BIRTH DATE T-SHIRT SIZE (YOUTH OR ADULT) 1. 2. 3. NOTE: AVAILABLE T-SHIRT SIZES—YOUTH S, M, L; ADULT S, M, L, XL, XXL, XXXL Program Information & Fees Fees include transportation, admission, some meals, snacks, chaperones, identification items and insurance. Advance registration is highly recommended (deadline: July 1, 2015). On-site registration and t-shirts are not guaranteed and will be accepted on a space-available basis. No refunds or cancellations after July 1, 2015.The Camp NMA-zing program offers age-appropriate activities for 4 days and evenings. 1. Pre-Registration $575/child x ________ = __________ 2. Registration (from July 2, 2015) $675/child x ________ = __________ 3. Daily Registration (for on-site only) $210/child x _________= __________ Sun Mon Tue Wed Parent/Guardian/Sponsor Information (Children listed on this form will be released ONLY to the following adults) FATHER/GUARDIAN CELL PHONE FATHER EMAIL ADDRESS MOTHER EMAIL ADDRESS EMERGENCY CONTACT CELL PHONE MOTHER/GUARDIAN HOTEL NAME ADDITIONAL AUTHORIZED PICK-UP CELL PHONE HOTEL ROOM # CELL PHONE Medical Conditions Our child(ren) has/have the following medical conditions/allergies and/or language and/or special needs: (please attach additional paper if necessary). Kama`aina Kids will contact you if necessary. Please note that youth who have fever will not be accepted in the program. Allergies/ Food Preference: ___________________________________________________________________________________________________ Waiver & Release I/We, the undersigned parent(s)/guardian(s), inconsideration of the contracted youth program services (“Kamaaina Kids”) providing child care for our child(ren)/ ward(s), named above, for the National Medical Association’s Convention (“the Association”) in Detroit MI, August 2-5, 2015,as designated below, do for myself/ourselves, my/our heirs, executors, administrators and assignees, hereby release and discharge demands, actions, causes of action, or suits of any kind or nature whatsoever, which may arise from my/our child(ren)’s participation in the youth program, except for gross negligence or willful misconduct on the part of Kama’aina Kids or the Association’s officers, directors, employees or agents. Furthermore, I/we agree to indemnify and to hold Kama’aina Kids & the Association harmless against loss from any and all claims, demands, damages, actions, causes of action, or suits of any kind or nature whatsoever, that may hereafter be made or brought by my/our child(ren)/ ward(s) or by anyone on his/her/their behalf and I/we waive any and all rights of exemption under any federal and/or state laws against all such claims. I/We give my child(ren)/ward(s) permission to attend and participate in the activities conducted by Kama’aina Kids during the NMA Convention. These activities may include, but are not limited to aquatics, off-property excursions, van/bus transportation, and enrichment activities. I/We authorize the Association & Kama’aina Kids to use my child’s name and video or photograph at any time and in any manner in connection with its advertising, publicity, and public relations program. The video/photo may only be used by Kama’aina Kids or Association. No further claims will be made by me/us. Discipline is used to assure the safety and well-being of all program participants. All participants are expected to respect themselves, other people and their property. If a participant is not following the guidelines of the NMA youth program staff consistent with these expectations, the parent(s)/guardian(s) will be notified that the participant may not be included in further programs. I/We hereby authorize the organization providing child care and its employees to exercise these discipline policies in regard to my child. I/We understand that there will be no refunds for the youth program once payment is made. I/We have read the above and understand this release. Furthermore, in the event of an emergency, the organization providing child care has my/our permission to administer first aid or obtain emergency medical treatment in our child’s best interest. I/We agree to pay all expenses incurred due to an emergency involving our child. Signature of Releaser: Date: TO COMPLETE REGISTRATION: Please fax form to: 808-261-0268 or scan/email to [email protected] Your submittal of this signed form completes your child’s Camp NMA-Zing registration. Kama`aina Kids will send a confirmation email upon receipt. Thank you. Kathy Hew 21 Auxiliary to the lational kedical Association, gnc. Colesville Road, Suite Silver Spring, MD —Fax cmail: [email protected] www.anmanet.org 22
