AAPI QLI Convention Brochure

AAPI-QLI

NY

AAPI-QLI

NY

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MERICAN ASSOCIATION OF ★

PH

YSICIANS OF INDIAN ORIGIN

AMERICAN ASSOCIATION OFPHYSICIANS OF INDIAN ORIGIN

C O R P O R A T E M A R K E T I N G O P P O R T U N I T I E S

19th Annual AAPI-QLI Convention

Celebrating 19 Years of Excellence

SATURDAY DEC. 13TH, 2014Huntington Hilton, Long Island

598 Broad Hollow Road, Melville, NY 11747-5002516-845-1000

Our Honorees for 2014

Samin K. Sharma, MDFACC, FSCAI

Director of Clinical Cardiology & InterventionDean of International Clinical Affiliations

President of the Mount Sinai Heart NetworkZena & Michael A. Wiener Professor Medicine,

Cardiology

WWW.AAPIQLI.ORG

Uma Mysorekar, MDRetired Obstetrician/Gynecologist

President of the Hindu Temple Society of North America in Flushing, NY.

Ashok Shaha, MDProfessor of Surgery,

Jatin P. Shah Chair in Head & Neck Surgery, Memorial Sloan Kettering Cancer Center, NY

Ganesh J. Bhat, MDCo-Founder, Atlantic Dialysis Management Services

Chancellor, Xavier University School of MedicineMember, NY State Public Health & Health Planning Council

Chairman, Committe on Health Personnel and Interprofessional Relations, NYSDOH

SUNDAY DEC. 7TH, 2014CME Lectures & Educational Seminar

Akbar Restaurant

AAPI-QLI

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AAPI-QLI

NY

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MERICAN ASSOCIATION OF ★

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AMERICAN ASSOCIATION OF PHYSICIANS OF INDIAN ORIGIN OF QUEENS & LONG ISLAND, INC.7 Oakridge Lane, Roslyn, NY 11576www.aapiqli.org

Executive Committee

PresidentAjay K. Lodha, MD

President ElectMadhu Korrapati, MD

Vice President Vaijinath Chakote, MD

SecretaryRakesh K. Dua, MD

TreasurerJagdish K. Gupta, MD

Immediate Past PresidentTarun Wasil, MD

Board of TrusteesShashi S. Shah, MD ChairmanBal Gilja, MDJagan Pahuja, MDKrishan Kumar, MDMohinder P.Gupta, MDRashmikant Baxi, MDSatish K Anand, MDSharwan K Bagla, MDSunil Mehra, MDTarun Wasil, MDTKS Rao, MD

Members at LargeAbhay Malhotra, MDAnil Kanth, MDArun Aggarwal, MDGagan Gulati, MDHimanshu Pandya, MDHolalkere Rajgopal, MDInderpal Chhabra, MDParesh C Kothari, MDRaj Bhayani, MDRaj Jinna, MDSwaran Gupta, MD

Advisory BoardAmit Power, MDChairmanDayanand Huded, MDNarendra Hadpawat, MDRajiv Datta, MDSukhvinder S. Ranu, MDVinni Jayam, MD

MSRFPrachi Dua, MD

YPSJigar Patel, MDPreeti Mehta, MD

Ajay K. Lodha, MDPresidentShashi S.Shah,MDChair,Board Of TrusteeConvention CommitteeRaj Bhayani, MDConvention ChairHimanshu Pandya, MDHolalkere Rajgopal, MDConvention Co-ChairFundraisingRajiv Datta, MD ChairAmit Powar, MD Chair Vaijinath Chakote, MD Co-Chair Arun Aggarwal, MD Tarun Wasil, MDSunil Mehra, MDVinni Jayam, MDDayanand Huded,MDAnil Kant,MDInderpal. Chhabra, MDAbhay Malhotra, MDKrishan Kumar, MDMadhu KorrapatiAmy Nagarajan Shah,MDFood CommitteeRakesh Dua, MD ChairDayanand Huded, MD Co-ChairHost CommitteeSatish K. Anand, MD ChairMadhu Korrapati, MD ChairAbhay Malhotra, MD Co-ChairRaj Jinna, MD Co-ChairEditorial and PublishingTarun Wasil, MD ChairInderpal Chhabra, MD Co-ChairCMET.K. Sreepada Rao, MD ChairSharwan K Bagla, MD ChairVinni Jayam, MD ChairAnil Kant, MD Co-ChairAwards / HonoreesRasmikant Baxi, MD ChairNarendra Hadpawat, MD Co-ChairSunil Mehra,MD Co-ChairJagdish Gupta,MD Co-ChairBoothMadhu Korrapati, MD ChairRakesh Dua, MD ChairParesh Kothari, MD Co-ChairSheetal Seth, MD Co-ChairEntertainmentJagdish Gupta, MD ChairBhavani Srinivasan, MD Co-ChairCharitable CommitteeMohinder P.Gupta, MD ChairArun Aggarwal, MD Co-ChairReception CommitteeSunil Mehra, MD ChairJagan Pahuja, MD ChairSharwan K.Bagla, MD ChairSatish Anand, MD ChairSukhvinder S. Ranu, MD ChairNarendra Hadpawat, MD ChairMedia & Public RelationsKrishan Kumar, MD ChairBal K. Gilja, MD Co-ChairRaj Jinna, MD Co-ChairRegistrationHimanshu Pandya, MD ChairGagan Gulati, MD Co-ChairSwarn Gupta, MD Co-ChairParesh Kothari, MD Co-ChairDecorationSmita Lodha, MDDipali Pandya, DMDAsha Dua, MDJyoti Chakote, MDPushpa Shah, MDSeema WasilSireesha KorrapatiWebsite & DatabaseInderpal. Chhabra, MD ChairTarun Wasil, MD ChairAmit Powar, MD Co-ChairMSRFPrachi Dua, MD ChairYPSJigar Patel, MD ChairPreeti Mehta, MD Co-Chair

Ajay K. Lodha, [email protected]

347-865-7906

Raj Bhayani, [email protected]

718-249-9383

Himanshu Pandya, [email protected]

917-903-3885

Holalkere Rajgopal, [email protected]

516-305-9030

PROGRAM SCHEDULE:Sunday, December 7th 2014

CME Lectures & Educational Sponsor Seminarat Akbar Restaurant

9:00 am to 9:30 am - Breakfast9:30 am to 11:00 am - CME / Educational Seminar

11:00 am to 11:15 am - Tea Break11:15 am to 12:45 pm - CME / Educational Seminar

12:45 pm - Lunch

Saturday, December 13th 2014at Huntington Hilton

1:00 pm to 5:00 pm - Professional Singles Speed Dating Event5:30 pm to 7:00 pm - Cocktail Reception7:00 pm to Midnight - Cultural Program,

Felicitation of Honorees, Dinner & Bollywood Style Entertainment

President Convention Chair

Convention Co-Chair Convention Co-Chair

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AAPI-QLI

NY

AAPI-QLI

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M

ERICAN ASSOCIATION OF ★

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AMERICAN ASSOCIATION OF PHYSICIANS OF INDIAN ORIGIN OF QUEENS & LONG ISLAND, INC.7 Oakridge Lane, Roslyn, NY 11576Phone: 347-865-7906 • E-Mail: [email protected]

REGISTRATION FORMYou can register online at: WWW.AAPIQLI.ORG

(Tax I.D.: 113267715) C5013C Non Profit Tax Organization

SPONSORSHIP OPPORTUNITIESq Grand Sponsor: $35,000.00 Signage at Registration & Banner inside Ballroom Tickets (10) for Gala Dinner Booth Back Cover Convention Souvenir Book

q Diamond Sponsor: $25,000.00 q Platinum Sponsor: $15,000.00Signage at Registration & Ballroom Signage at Registration Tickets (10) for Gala Dinner Tickets (6) for Gala Dinner Booth Booth Front Inside Cover Convention Souvenir Book Back Inside Cover Convention Souvenir Book

q Gold Sponsor: $10,000.00 q Silver Sponsor: $5,000.00Corporate Signage at registration Corporate Signage at registration Tickets (4) for Gala Dinner Tickets (2) for Gala Dinner1 Gold Page Convention Souvenir Book 1 Silver Page Convention Souvenir Book

SOUVENIR ADVERTISING:q Gold Page: $2,000.00 q Silver Page: $1,500.00q Full Page: $1000.00 q Half Page $500.00

BOOTH:q Booth: $2,000.00 (Exhibit 2:00 pm onwards. Includes one 4’x6’ table & two chairs. Exhibi-tor will be responsible for Internet, Decoration, Lighting, Security & other requirements.)

CORPORATE SPONSOR:q Corporate Table for 10 guests: $3,000.00 (Signage on Table)

AAPI-QLI is proud to host this event to raise funds for charitable causes and we look forward for your support.

Registration: Members & Spouse $100.00/Person Non-Members $125.00/Person

First Name: _______________Last: _____________________Company: ____________________Title/Position: ____________________________Email: __________________________________Address: ________________________________City: _____________ State: ____ Zip: ________

Payment Information:q Check in U.S. dollars for $______________________________________ payable to AAPIQLIq Charge $_______________________ to my qVisa qMaster Card qDiscover qAMEXCard No:___________________________ Exp. Date______/______ Security Code (CVV):_____Billing street address:_________________________________________ Billing Zip:___________Name on card:____________________________________ Signature:______________________

Make Check Payable to: AAPIQLI or Register online at www.aapiqli.org and pay by Pay PalMail to: Ajay K. Lodha MD, President7 Oakridge Lane, Roslyn, NY 11576Cell: 347-865-7906 • Email: [email protected]

AAPI-QLI

NY

AAPI-QLI

NY

★ A

M

ERICAN ASSOCIATION OF ★

PH


AMERICAN ASSOCIATION OF PHYSICIANS OF INDIAN ORIGIN OF QUEENS & LONG ISLAND, INC.7 Oakridge Lane, Roslyn, NY 11576Phone: 347-865-7906 • E-Mail: [email protected]

Form W-9(Rev. August 2013)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

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2.

Name (as shown on your income tax return)

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification:

Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Other (see instructions) ▶

Exemptions (see instructions):

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Requester’s name and address (optional)

List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

Employer identification number

–

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. I am a U.S. citizen or other U.S. person (defined below), and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. The IRS has created a page on IRS.gov for information about Form W-9, at www.irs.gov/w9. Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page.

Purpose of FormA person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the

withholding tax on foreign partners’ share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct.

Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien,

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,

• An estate (other than a foreign estate), or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

Cat. No. 10231X Form W-9 (Rev. 8-2013)

AAPI OF QUEENS AND LONG ISLAND, INC.

✔ TAX EXEMPT CHARITABLE ORGANIZATION

7 OAKRIDGE LANE

ROSLYN, NY 11576

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AAPI QLI Convention Brochure

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