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Brochure 24th Annual Convention 2019
1. AAPI-QLI
NY
AAPI-QLI
NY
โ AM
ERICAN ASSOCIATION
OFโ
PH
YSICIANS OF INDIAN ORI
GIN
American Association Of
Physicians Of Indian Origin
24th
Annual Convention 2019
Celebrating 24 Years of Excellence
PROGRAM SCHEDULE:
www.aapiqli.org
Annual Gala
NOV 23, 2019
5:30 PM to 11:30 PM
Annual AAPI-QLI Convention
Huntington Hilton, Long Island
598 Broad Hollow Road, Melville, NY 11747-5002
(516) 845-1000
CME
Nov 3, 2019
8:30 AM to 1:00 PM
CME Lectures & Educational Seminar*
(Breakfast & Lunch included)
DeMatteis Center
101 Northern Blvd., Greenvale, NY
Registration 5:00 PM onwards
Cocktail 6:00 PM to 7:30 PM
Awards Ceremony, Entertainment, Dinner & Dance & 7:30 PM to 11:30 PM
Ticket Price: $150.00 per person for members
Corporate Marketing, Partnership, Sponsorship, Recognition
2. Registration Form
You can register online at: WWW.AAPIQLI.ORG
(Tax I.D.: 113267715) 501(C)3 Tax Exempt Organization
Sponsorship Opportunities
q Grand Sponsor: $35,000.00
Signage at Registration & Ballroom, Tickets (10) for Gala Dinner, Booth 5โx10โ & Back Cover Convention Souvenir Book
q Diamond Sponsor: $25,000.00 q Platinum Sponsor: $15,000.00
Signage at Registration & Ballroom Signage at Registration
Tickets (10) for Gala Dinner Tickets (6) for Gala Dinner
Booth, Front Inside Cover Convention Souvenir Book Booth, Back Inside Cover Convention Souvenir Book
q Gold Sponsor: $10,000.00 q Silver Sponsor: $5,000.00
Corporate Signage at registration Corporate Signage at registration
Tickets (4) for Gala Dinner & 1 Gold Page Tickets (2) for Gala Dinner & 1 Silver Page
Souvenir Advertising:
q Gold Page: $2,000.00 q Silver Page: $1,500.00
q Full Page: $1000.00 q Half Page $500.00
Booth:
q Booth: $2,000.00
(2:00 pm onwards. Includes one 4โx6โ table & two chairs. Exhibitor 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 for Gala Event: Members & Spouse $150.00/Person | Non-Members $175.00/Person
First Name:_____________________Last:___________________________Company:___________________________
Title/Position:_____________________________________Email:___________________________________________
Address:_________________________________________City:__________________State:________Zip:___________
Payment Information: q Check for $___________ payable to AAPIQLI or q Charge $___________ to my
q Visa q Master Card q Discover q AMEX Card No:___________________ Exp.___/___ Sec. Code (CVV):______
Billing street address:_________________________________________________________ Billing Zip:___________
Name on card:_____________________________________________________ Signature:_____________________
Make Check Payable to: AAPIQLI or Register & Pay online at www.aapiqli.org
Mail to: Himanshu Pandya MD, President 427 Links Drive, Roslyn, NY 11576
----------------------#------------------------------------------#-------------------------
Form W-9(Rev. December 2014)
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.
Printortype
SeeSpecificInstructionsonpage2.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
Individual/sole proprietor or
single-member LLC
C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) โถ
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
the tax classification of the single-member owner.
Other (see instructions) โถ
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.)
6 City, state, and ZIP code
Requesterโs name and address (optional)
7 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 line 1 to avoid Social security number
AAPI OF QUEENS AND LONG ISLAND
427 Links Drive
Roslyn, NY 11576
Form W-9(Rev. December 2014)
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.
Printortype
SeeSpecificInstructionsonpage2.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
Individual/sole proprietor or
single-member LLC
C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) โถ
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
the tax classification of the single-member owner.
Other (see instructions) โถ
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.)
6 City, state, and ZIP code
Requesterโs name and address (optional)
7 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 line 1 to avoid
backup withholding. For individuals, this is generally 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 instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Social security number
โ โ
or
Employer identification number
โ
Part II Certification
AAPI OF QUEENS AND LONG ISLAND
207 Berkeley Place
Brooklyn, NY 11217
1 1 3 2 6 7 7 1 5
Form W-9(Rev. December 2014)
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.
Printortype
SeeSpecificInstructionsonpage2.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
Individual/sole proprietor or
single-member LLC
C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) โถ
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
the tax classification of the single-member owner.
Other (see instructions) โถ
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.)
6 City, state, and ZIP code
Requesterโs name and address (optional)
7 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 line 1 to avoid
backup withholding. For individuals, this is generally 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 instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Social security number
โ โ
or
Employer identification number
โ
Part II Certification
Under 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 โถ Date โถ
General Instructions โข Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
AAPI OF QUEENS AND LONG ISLAND
207 Berkeley Place
Brooklyn, NY 11217
1 1 3 2 6 7 7 1 5
--------------------------------------#------------------------------------------#-----------------------------------
3. AAPIQLI (American Association of Physicians of Indian Origin of Queens and
Long Island) is the largest chapter of AAPI (Association of Physicians of Indian
Origin). It enjoys a strong membership base of about 875 patron members plus
several hundred young physicians, including students, residents and fellows of
Indian origin residing in the New York and Long Island areas. We are an integral
part of the New York State Health Care system and research programs. Several
of our members act as department chairs and directors at both teaching and
non-teaching hospitals of greater New York. Above all AAPIQLI represents the
interest of over several thousand physicians of Indian origin practicing in the
boroughs of New York, Nassau and Suffolk Counties.
This year, we are celebrating our 24th annual convention with a Grand Annual
Gala and also a comprehensive cutting-edge CME program. The CME program is
scheduled for Sunday, November 3, 2019, at The De Mattieโs Center, Greenvale,
New York. The annual gala will be celebrated on Saturday, November 23, 2019,
at the Huntington Hilton Hotel in Melville, New York. Both events are celebrated
by more than 1000 attendees โ physicians, leaders in the health care and lead-
ers that make up the crรฉme de La crรฉme of the greater New York Community.
Every year the funds raised from the convention is donated to several charitable
organizations in the USA and abroad.
We are pleased to invite you to attend both these events, where you will have
the opportunity to meet and interact with our physicians of several specialties
and sub-specialties. These gatherings will give you ample time to display your
products and services, as well as the opportunity to partake in sponsorship for
the educational seminars, symposia and publications. To commemorate these
events, a Souvenir Journal is published which annually reaches the homes and
offices of several thousand readers across the country. Hence, this provides an-
other opportunity to advertise and market your products and services. We also
invite you to become a platinum, gold or silver sponsor of the Annual Conven-
tion to bring greater visibility to your product or services. If you have any ques-
tions or need further details, please do not hesitate to contact me or Dr. Tarun
Wasil, our convention Chairman.
Sincerely,
Himanshu Pandya, MD Tarun Wasil, MD Madhu Korrapati, MD
President, Convention Chairman, Chairman,
AAPIQLI Annual Gala Board of Trustees
pandyamd@yahoo.com tarunwasil@gmail.com madhukorrapati@gmail.com
917-903-3885 631-875-3032 516-426-0405
Executive Committee
President
Himanshu Pandya, MD
President Elect
Rajendra Bhayani, MD
Vice President
Abhay Malhotra, MD
Secretary
Vinni Jayam, MD
Treasurer
Rajender Jinna, MD
Immediate
Past President
Jagdish K. Gupta, MD
Board of Trustees
Madhu Korrapati, MD
(Chairman)
Himanshu Pandya, MD
Raj Bhayani, MD
Jagdish K. Gupta, MD
Davendra Shrivastava, MD
Bhavani Srinivasan, MD
Mohinder Gupta, MD
Sharwan Bagla, MD
Krishan Kumar, MD
Jagan Pahuja, MD
Satish K. Anand, MD
Shashi S. Shah, MD
Tarun Wasil, MD
Vaijinath Chakote, MD
Sunil Mehra, MD
Members at Large
Inderpal Chhabra, MD
Rakesh K. Sharma, MD
Bal K. Gilja, MD
Prabhu Mehta, MD
Holalkere Rajagopal, MD
Ravinder Ohri, MD
Bhupinder B. Singh, MD
Parag Mehta, MD
Jagat M. Rawal, MD
Venugopal R. Palla, MD
Advisory Board
Ajay K. Lodha, MD
Rakesh Dua, MD
Rajesh Kakani, MD
Rashmikant Baxi, MD
Womenโs Affair
Bhavani Shrinivasan, MD
Usha Bansal, MD
Rajani Goyal, MD
Tara Manandhar, MD
Isha Mehta, MD
Mina Ahluwalia, MD
Vimal Goyale, MD
Not for profit organization tax id# 11-3267715
427 Links Drive, Roslyn, NY 11576
Tel.: 917.903.3885 โข E-Mail: pandyamd@yahoo.com
AAPI-QLI
NY
AAPI-QLI
NY
โ AM
ERICAN ASSOCIATION
OFโ
PH
YSICIANS OF INDIAN ORI
GIN
American Association Of Physicians Of Indian Origin
of Queens & Long Island, Inc.
www.aapiqli.org
