Medical Student
Sponsorship Request Form
The Ohio Psychiatric Physicians Foundation (OPPF), in cooperation
with the Ohio Psychiatric Physicians Association (OPPA) is pleased
once again to offer student sponsorships to attend the 2017 OPPA
Annual Psychiatric Update .
Sponsorship recipients will receive complimentary registration and
will be paired with a psychiatrist for the day-long educational
event. This is a great opportunity to gain additional exposure into
psychiatry, to interact with and be mentored by current
professionals and receive cutting-edge psychiatric education. There
will also be time at a designated student breakfast to meet with
other Ohio medical students and to learn from residents and others
about psychiatry residency and career opportunities. Sponsors and
students will be acknowledged during the meeting.
Students may apply for a sponsorship by completing the Medical
Student Sponsorship Request form, which can be found online at
www.ohiopsychiatry.org/annualpsychupdate/foundation; or complete and
fax registration form to (614)481-7559; email us
at [email protected] or call us at (614)763-0040. Students
will be notified by March 4, 2017 if there a sponsorship available.
Don’t delay, sponsorships are limited and are available on a firstcome, first-served basis.
Register on-line:
www.ohiopsychiatry.org
Contact Information
Please print
Name
Degree ___________
School ________________________________________________________
Address
City/State/Zip
Phone
E-mail
Which medical school are you attending?
Expected graduation year? _______________________________________
Which specialties are you considering? Rank in order.
1)
____________________________________
2)
____________________________________
3)
____________________________________
AMERICANS WITH DISABILITIES ACT
What area of psychiatry are you interested in (i.e. Child & Adol., General)
If you need assistance related to sight, sound, or mobility, please contact the OPPA office as soon as possible so that we may accommodate
reasonable requests.
______________________________________________________________
CANCELLATION POLICY
If you are not able to attend, please notify us immediately so that we
can offer a sponsorship to another student.
MEALS
A breakfast and lunch buffet will be provided on Sun., March 12.
How did you hear about the sponsorship opportunity?
______________________________________________________________
Have you attended the OPPA Annual Psychiatric Update in the past?
 Yes  No
HOTEL ACCOMMODATIONS
A LIMITED number of rooms have been set aside at the Hilton Easton
until Feb. 9, 2017 at the rate of $177 single/double plus applicable tax.
To reserve a room please contact the hotel ASAP at (614) 414-5000
and ask for the OPPA’s room block or to reserve online go to
www.columbusoh.hilton.com
SYLLABUS
Every registered attendee will receive a printed syllabus at registration.
Also, as a show of our support to be “GREEN”, we will also be offering
a limited supply of the syllabus on a USB drive. If you prefer to have a
copy of the syllabus on a USB drive, in lieu of a printed copy, please be
sure to check this option on the printed registration form or when registering online.
Ohio Psychiatric Physicians Association
3510 Snouffer Road, Suite 101
Columbus, OH 43235-4217
(614) 763-0040
(614) 481-7559