10th Annual Summer Conference on Emergency Medicine
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10th Annual Summer Conference on Emergency Medicine

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10th Annual Summer Conference on Emergency Medicine 10th Annual Summer Conference on Emergency Medicine Document Transcript

  • 10th Annual Summer Conference on EMERGENCY MEDICINE Including topics on: Cardiac Dilemmas, Community & Healthcare-Associated Pneumonia, Simulation & Team Training, Ultrasound, Pediatric Emergencies, and much more... NAPA VALLEY MARRIOTT HOTEL & SPA Napa, California July 16-19, 2014 SPONSORED BY “Symposia Medicus provides an all-access pass to world-class lectures covering clinical, relevant topics in the most inviting settings. Your first Symposia Medicus conference will not be your last!” – John Mirabello, MD “I consistently seek to attend Symposia Medicus conferences. The subjects taught are always relevant and the speakers are very knowledgeable.” – Cynthia Wallace, MSN A Non-Profit Corporation for Continuing Medical & Nursing Education Register On-Line... Page 1 3 “Symposia Medicus remains the greatest resource for CME conferences. The meetings are excellent, the staff is always so helpful, and the locations are always great areas of fun and relaxation.” – C.H. Griffith, MD for this conference or view other educational conferences at w w w. s y m p o s i a m e d i c u s . o r g Conference Brochure #1300, 10th Annual Summer Conference on Emergency Medicine Symposia Medicus A Non-Profit Corporation for Continuing Medical & Nursing Education
  • CONFERENCE DESCRIPTION CONTINUING EDUCATION CREDIT Our 10th Annual Summer Conference on Emergency Medicine is designed to provide emergency physicians, nurses, nurse practitioners, physician assistants, as well as out-of-hospital providers, with state-of-the-art information on some of the challenges in emergency medicine. The primary goal of this conference is to increase knowledge and enhance the competence of attendees. Emphasis will be placed on practical application of the evidencebased topics presented. Physicians Symposia Medicus designates this live activity for a maximum of 18 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Topics for this year’s conference have been selected based on the educational needs determined from the identified professional practice gaps. The gaps were derived from a variety of sources including evaluations and outcomes data from past participants; clinical expert input; Symposia Medicus’ online survey; and other medical and nursing data. This continuing medical education activity has been reviewed by the American Academy of Pediatrics and is acceptable for a maximum of 18 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics. Application has been made with the American College of Emergency Physicians for ACEP Category 1 credit. Conference format will include didactic lectures, simulation training, smaller group breakout sessions, case studies, and question and answer sessions. Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending. An outstanding faculty has been assembled for this conference. Each member was selected based on their individual area of expertise and ability to communicate current, evidence-based and practical information to participants. You are sure to enjoy our 10th Annual Summer Conference on Emergency Medicine while sharing ideas and experiences with colleagues from across the country in the beautiful setting of the Napa Valley. Physician Assistants AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 18 hours of Category 1 credit for completing this program. CONFERENCE OBJECTIVES As a result of participating in this conference, you should have increased knowledge and enhanced competence to… • Identify high risk orthopedic injuries • Apply up-to-date clinical interventions for the identification and treatment of community and healthcare-associated pneumonia • Individualize a plan of action for procedural sedation • Recognize atrial fibrillation emergencies • Perform and interpret the basic focused assessment with sonography for trauma (FAST) exam ACCREDITATION This educational activity was planned and produced in accordance with the ACCME and ANCC Essentials and Standards relating to continuing medical and nursing education. Symposia Medicus is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Symposia Medicus is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Each participant should only claim credit commensurate with the extent of their participation in the activity. Nurse Practitioners/Nurses The ANCC contact hours awarded for completion of this conference are 18. Provider is also approved by the California Board of Registered Nursing, Provider #CEP2335, for 21.6 contact hours. Pharmacology Credit for Prescriptive Authority A maximum of 3.25 hours in pharmacology credit for prescriptive authority may be earned by attending this educational conference. Sessions awarding pharmacology credit for prescriptive authority are denoted with an Rx in the schedule. SMALLER GROUP BREAKOUT SESSIONS Smaller group sessions will be held Friday morning. These breakout sessions are organized to provide an opportunity for greater participant/faculty interaction, and will give you an opportunity to participate in discussions on subjects relating to your particular area of interest. Please indicate your breakout session topic choice on the conference registration form in this brochure. Space is limited so please reserve early. EDUCATIONAL RESOURCES Each registrant will receive an extensive conference syllabus that includes materials on each topic presented. The full color digital syllabus will be available for download approximately two weeks prior to the conference (you’ll receive an email with instructions). If you wish to receive a paper syllabus (black and white type & photos), please check the box on the registration form in this brochure. If you bring your tablet/laptop to the conference, be aware that there are no electrical outlets at the conference tables. Make sure your tablet/laptop is fully charged each day. Certificates of credit will be given to participants on-site at the conclusion of the conference. If you are unable to attend this conference, extra copies of this syllabus (either paper or digital copy) will be available one week after the conference. The cost is $60 for a paper syllabus and $25 for the digital copy. To place your order, please email publications@symposiamedicus.org. This CME activity meets the requirements under the California Assembly Bill 1195, continuing education and cultural and linguistic competency. GROUP TOURS / GROUND TRANSPORTATION Tours are planned for participants and guests throughout the conference breaks. Additional information regarding activities, hotel, location, and ground transportation will be sent to registrants. Page 2 3 Conference Brochure #1300, 10th Annual Summer Conference on Emergency Medicine Symposia Medicus A Non-Profit Corporation for Continuing Medical & Nursing Education
  • CONFERENCE FACULTY Fredrick Abrahamian, DO, FACEP, FIDSA Conference Co-Chairman Clinical Professor of Medicine UCLA School of Medicine Los Angeles, California Director of Education Department of Emergency Medicine Olive View - UCLA Medical Center Los Angeles, California Steven A. Godwin, MD, FACEP Professor of Emergency Medicine Chair and Chief of Service Department of Emergency Medicine Assistant Dean, Simulation Education University of Florida College of Medicine Jacksonville, Florida Kenneth Jackimczyk, MD, FACEP Vice-Chair Department of Emergency Medicine Maricopa Medical Center Phoenix, Arizona Medical Director Air Methods Region 3 Arizona/New Mexico Eric Snoey, MD Conference Co-Chairman Clinical Professor of Emergency Medicine University of California, San Francisco Vice Chairman, Dept. of Emergency Medicine Alameda County Medical Center Oakland, California Aparajita Sohoni, MD Clinical Professor of Emergency Medicine Department of Emergency Medicine Alameda County Medical Center Highland Hospital Oakland, California Consistent with ACCME and ANCC policy, faculty for this educational activity are asked to disclose any commercial interests that may create or may be perceived as creating a conflict related to the material they will be presenting, as well as limitations on clinical studies presented, and any “off-label” use suggestions for medical products. Additionally, Symposia Medicus Board, Planning Committee, and Staff members have disclosed that they have no significant financial relationships that could pose a conflict of interest to the planning of this conference. This information is intended to assist you in forming your own judgments about content presented. Disclosure information will be included in your syllabus and/or verbally disclosed at the conference. Page 3 CONFERENCE SCHEDULE Wednesday, July 16 7:00am Registration & Check-in During Continental Breakfast 8:00 Welcome & Introduction Eric Snoey, MD 8:15 Trauma: A Visual Odyssey 9:00 Challenging Cases: Cardiac Dilemmas in the Emergency Department Eric Snoey, MD 9:45 Questions & Answers Group Discussion Faculty Panel & Audience 10:15 Break 10:30 Management of Community-Associated Methicillin-Resistant Staphylococcus aureus Skin & Soft Tissue Infections 11:15 Bedside Focused Assessment with Sonography for Trauma (FAST) Exam: Pearls & Pitfalls for the Emergency Physician Aparajita Sohoni, MD Noon Procedural Sedation: From the Young to the Elderly – Getting in Right! (Rx = 40 minutes) Steven A. Godwin, MD (Rx = 20 minutes) Kenneth Jackimczyk, MD (Rx = 40 minutes) Fredrick Abrahamian, DO 12:45pm Questions & Answers Group Discussion Faculty Panel & Audience 1:30 Adjourn for the Day 5:30- 7:00 Wine & Cheese Reception (Faculty, Participants & Guests) Thursday, July 17 7:30am Continental Breakfast 8:00 Uncommon Presentations of Common Illnesses in the Emergency Department (Rx = 10 minutes) Kenneth Jackimczyk, MD Atrial Fibrillation: A Practice Guide to Emergency Department Management 12:30pm Questions & Answers Group Discussion Faculty Panel & Audience 1:15 Adjourn for the Day Friday, July 18 7:30am Continental Breakfast 8:00 Smaller Group Breakouts – Session One A. Shoulders, Hips, & Ankles: Ultrasound for the Musculoskeletal System Aparajita Sohoni, MD B. Acute Coronary Syndrome: Risk Analysis & Disposition Eric Snoey, MD C. Medical-Legal Pitfalls in Infectious Diseases: Interactive Case Discussion Fredrick Abrahamian, DO D. Chest Pain: Making Sense of History & Diagnostic Tests Kenneth Jackimczyk, MD 9:30 Break 9:45 Smaller Group Breakouts – Session Two (Session One Topics Repeated) 11:15 Adjourn for the Day Saturday, July 19 7:30am Continental Breakfast 8:00 Treatment Update on Pediatric Fevers 8:45 An Update on Community & HealthcareAssociated Pneumonia (Rx = 30 minutes) Fredrick Abrahamian, DO 9:30 Questions & Answers Group Discussion Faculty Panel & Audience 10:00 Break (Hotel check-out, if applicable) 10:15 It’s Just a Pediatric Airway, Don’t Make it Difficult Steven A. Godwin, MD (Rx = 30 minutes) Steven A. Godwin, MD 8:45 Eric Snoey, MD 11:00 ECHO in the ED: A Basic Primer for the Emergency Physician Aparajita Sohoni, MD 9:30 Questions & Answers Group Discussion Faculty Panel & Audience 11:45 EKG Pearls for Your Practice Fredrick Abrahamian, DO 10:00 Break 10:15 High Risk Orthopedics in the Emergency Department: Pearls & Pitfalls (Rx = 15 minutes) Kenneth Jackimczyk, MD 11:00 The Simulation Challenge: Keeping it Real! (Interactive session using simulation) Steven A. Godwin, MD & Eric Snoey, MD (Rx = 10 minutes) Conference Brochure #1300, 10th Annual Summer Conference on Emergency Medicine 12:30pm Questions & Answers Group Discussion Faculty Panel & Audience 1:15 Conference Adjourns Rx = Pharmacology Credit for Prescriptive Authority will be granted for these sessions Symposia Medicus A Non-Profit Corporation for Continuing Medical & Nursing Education
  • CONFERENCE REGISTRATION, LODGING, & TRAVEL INFORMATION Enrollment for this conference is limited in order to provide the best possible learning environment. Early registration is advised. You can register and receive our lodging group rates by reserving the following ways: • On-line at our website, www.symposiamedicus.org; OR CONFERENCE LODGING INFORMATION Group Rates have been arranged at the Napa Valley Marriott Hotel & Spa. These rates will also be available three days before and three days after the conference, based on availability, if you wish to extend your stay. • Fax form with Visa, MasterCard, American Express, or Discover to (925) 969-1795; OR Two nights’ deposit (room rate only) must accompany your reservation. The balance of your lodging, hotel fees as stated below, and all incidental charges are due to the hotel. The hotel accepts most major credit cards. • By mail, make check payable to Symposia Medicus and send with registration form to 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. Please note that our block of rooms is limited and on a first come, first served basis. PLEASE RESERVE EARLY as rooms may sell out and/or room rates may increase. For additional conference or lodging information, call Symposia Medicus at (800) 327-3161 or (925) 969-1789, or visit our website at www.symposiamedicus.org. Room Type CONFERENCE REGISTRATION INFORMATION Standard Room (view of perimeter and exterior of hotel) $269/night Garden View Room (view of hotel’s courtyard) $289/night *Concierge Room (view of hotel’s courtyard) $319/night • Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR TUITION: EARLY If postmarked by May 7, 2014 REGULAR If postmarked after May 7, 2014 Physicians $615 $715 Residents, Nurses, PAs & All Others $515 $615 • iscounts are available for retired healthcare providers as well as groups of three or more. D For more information, please contact Symposia Medicus. • uition includes continuing education certification, extensive conference syllabus, break T refreshments, continental breakfast every morning of the conference, and group reception. The group reception is for faculty, registrants and their guests. Concierge lounge access includes complimentary continental breakfast, daily midday snacks, nightly hors d’oeuvres and dessert, non-alcoholic beverages, and business services • Conference registration will be confirmed via email and more information on travel, hotel, and activities will be emailed and also available on our website. Description All rooms are approximately 375 sq. ft. and feature either one king bed or two double beds. They also include air conditioning, pillow top mattresses, mini refrigerators, coffee makers with complimentary coffee, pay-per view movie access, and flat screen TVs. All guestrooms are non-smoking. Complimentary internet access is available when booking with Symposia Medicus. Due to strict fire codes, rollaway beds and cribs are not permitted in a room with two beds. Only one rollaway or crib is permitted in a room with a King bed. *Very Limited – Reserve Early • This conference meets the requirements for CE tax deductibility; however, we suggest you consult your financial authority for more information. Group Rates (Single/Double) TERMS & CONDITIONS Hotel Policies AIR TRAVEL INFORMATION The closest airport to the Napa Valley Marriott Hotel & Spa is Oakland International Airport; however, lower fares can sometimes be found by flying into San Francisco International Airport, Sacramento International Airport, or San Jose International Airport. Oakland is approximately 50 miles from the hotel, while San Francisco and Sacramento are approximately 60 miles, and San Jose is approximately 85 miles. Information on ground transportation will be sent to registrants and available online at our website. Symposia Medicus has arranged for discount fares with Alaska, American, Delta, and United Airlines for this conference. Reservations can be made either through your travel agency or through the airlines at the website or Convention Desk numbers listed below. In order to receive the discounted rate, you or your travel agent must refer to the Symposia Medicus Group ID number listed here. Alaska Airlines For discounts on Alaska Air flights, please book online at www.alaskaair.com and insert ECMU895 into the e-certificate code box. For questions, please call the Alaska Airlines Convention Desk at (800) 445-4435. American Airlines For discounts on American Airlines flights, please book online at www.aa.com. Click on the link “Refine your search” (located under the blue button “Search”) and another page will appear. Enter all your information, and at the bottom of the page insert the promotion code 2874AA. For questions, please call the American Airlines Convention Desk at (800) 433-1790. Delta Airlines For discounts on Delta Airlines, please visit www.delta.com and click on the link “More Search Options”, located at the bottom of the “Book a Trip” box. Once you click on this link, another page will appear. On this page, you will need to insert NMG7E in the “Meeting Event Code” box, located at the right hand side of the page. For questions, please call the Delta Airlines Convention Desk at (800) 328-1111. United Airlines • Above Group Rates do not include the following (subject to change): - 12% tax - 0.065% California Tourism Assessment Fee - 2% Tourism Business Improvement District Assessment • Maximum occupancy in room is four people and cannot be exceeded (due to fire codes) • There are no additional charges for 3rd and 4th guests in room • Rollaways & Cribs: Rollaways and cribs are complimentary (subject to change). • Check-in time is 4:00pm and check-out time is noon. Requests for late check-out can be made with hotel front desk on day of departure (subject to availability). • Failure to arrive on confirmed arrival date will be charged the entire reserved stay • Parking: Self-parking is complimentary for conference guests. Valet is not available at the hotel. For discounts on United Airlines flights, please book online at www.ual.com and insert ZQPY123059 in the offer code box. For questions, please call the United Airlines Convention Desk at (800) 426-1122. Cancellation Policies • Conference cancellations must be confirmed in writing and a 10% of paid tuition processing fee will be assessed. No refunds will be made if cancellation is postmarked after June 11, 2014; however, tuition, less 10% processing fee may be applied to a future Symposia Medicus conference. • Per our hotel contract, hotel reservation cancellations must be made in writing to Symposia Medicus and you will receive a full refund if postmarked by May 14, 2014. Between May 15, 2014 and June 11, 2014, one night’s deposit is forfeited. After June 11, 2014, no hotel refunds can be made. • All cancellations must be made in writing to Symposia Medicus (via email, fax or mail) and postmarked by the dates stated above • In the unlikely event of conference cancellation by Symposia Medicus, full tuition and, if reservation was made with Symposia Medicus, hotel deposit refunds will be made. Symposia Medicus will not be responsible for refunding travel or any other expenses. CAR RENTAL DISCOUNT For conference discounts, Symposia Medicus has made arrangements with AVIS and Budget Car Rentals. Reservations can be made by phone; please refer to the conference code and the conference/airport location when making your reservations. Please see below: AVIS 800-331-1600 AWD #B766625 Budget 800-772-3773 BCD #U076767 Page 4 3 Conference Brochure #1300, 10th Annual Summer Conference on Emergency Medicine Symposia Medicus A Non-Profit Corporation for Continuing Medical & Nursing Education
  • CONFERENCE LOCATION California’s wine country offers scenic countryside, great wines and superb restaurants. With over 450 wineries offering a variety of wines for all tastes, it’s no wonder that the Napa Valley is considered the heart of the American wine industry. Located approximately 50 miles north of San Francisco, there is much more to Napa than just its grapes! Enjoy hot-air ballooning, horseback riding, mountain biking, hiking, or playing golf amid the vineyards. Find incredible discounts on your favorite brand-names at the Napa Premium Outlets or visit Old Town for more unique shopping. Visit the recently restored Napa Valley Opera House for music headliners. It might be wine that comes to mind when thinking of the Napa Valley, but with world-renowned restaurants, such as The French Laundry, it’s the food that will lead you to a happy stomach and heart. With so much to do, you’ll find that fine wine is only a part of this abundant valley. If the Napa Valley isn’t enough to keep your interest, San Francisco, with Fisherman’s Wharf, Chinatown and famous cable cars, is just an hour away; Muir Woods National Monument is a mere 45 minutes away; or the kid inside you will love the excitement of Six Flags Amusement Park located just 20 minutes away. The Napa Valley Marriott Hotel & Spa combines modern convenience with traditional comfort. Exercise at the state-of-the-art fitness center, or enjoy “The Spa,” one of the best full-service spas in the Napa Valley. Enjoy the cuisine at VINeleven, the hotel’s indoor/outdoor restaurant and bar, specializing in small and shared plates, and featuring an amazing list of Napa Valley’s finest wines. Whatever your pleasure, you are sure to find it at our 10 th Annual Summer Conference on Emergency Medicine in Napa, California! For our complete calendar of conferences, please visit www.symposiamedicus.org. Brochures are available 6-8 months prior to the conference. 2013 CALENDAR OF FUTURE CONFERENCES 1277 1279 1275 1281 1283 24th Annual Conference on Hot Topics in Primary Care 14th Annual Fall Conference on Emergency Medicine Hot Topics in Pediatric Emergencies 5th Annual Conference on Emergencies in Pediatrics 17th Annual Conference on Emergencies in Primary Care Maui, Hawaii Atlantis, Bahamas Eastern Caribbean Cruise (Celebrity Cruises - Reflection) New York City, New York New York City, New York 1287 1288 1294 1303 1301 1302 1309 1313 1317 1320 1322 3rd Annual Winter Conference on Primary Care 14th Annual Winter Conference on Pediatric Emergencies 18th Annual Spring Conference on Pediatric Emergencies 19th Annual Summer Conference on Emergencies in Primary Care Hot Topics in Pediatric Emergencies Challenges in Obstetrics and Gynecology Hot Topics in Pediatric Emergencies Current Issues in Women’s Health Care 15th Annual Fall Conference on Emergency Medicine 6th Annual Conference on Emergencies in Pediatrics 18th Annual Conference on Emergencies & Challenges in Primary Care Nov 6-9 Nov 13-16 Nov 16-23 Dec 20-21 Dec 20-21 2014 CALENDAR OF FUTURE CONFERENCES Page 5 3 Conference Brochure #1300, 10th Annual Summer Conference on Emergency Medicine Big Sky, Montana Beaver Creek, Colorado St. Maarten, Caribbean Jackson Hole, Wyoming Alaska Cruise (Celebrity Cruises - Solstice) Alaska Cruise (Celebrity Cruises - Solstice) European Cruise (Celebrity Cruises - Infinity) Caribbean Cruise (Celebrity Cruises - Reflection) Playa del Carmen, Mexico (Mayan Riviera) New York City, New York New York City, New York Feb 18-22 Feb 25-Mar 1 Apr 9-12 Jun 25-28 Jul 18-25 Aug 1-8 Sep 19-Oct 1 Nov 1-8 Nov 19-22 Dec 19-20 Dec 19-20 Symposia Medicus A Non-Profit Corporation for Continuing Medical & Nursing Education
  • CONFERENCE & LODGING REGISTRATION FORM Register on-line at www.symposiamedicus.org SYMPOSIA MEDICUS 10TH ANNUAL SUMMER CONFERENCE ON OR COMPLETE THIS FORM AND MAIL OR FAX WITH APPROPRIATE PAYMENT TO: EMERGENCY MEDICINE Symposia Medicus 399 Taylor Blvd., Suite 201 Pleasant Hill, CA 94523-2287 Phone: (800) 327-3161 OR (925) 969-1789 FAX: (925) 969-1795 NAPA VALLEY MARRIOTT HOTEL & SPA Napa, California JULY 16-19, 2014 PLEASE PRINT LEGIBLY: (Show name and one degree as you would like it printed on your conference materials): Registrant’s Name:_____________________________________________________________________________ Degree: __________________ First Last Registrant Email Address (required): _________________________________________________________________________________________________________ All registrants must provide their individual email address in order to register for this conference. Confirmation/receipt will be emailed to this address. Email an additional copy of my confirmation/receipt to: ________________________________________________________________________ (Provide additional email address) Mailing Address: _______________________________________________________________________________________________________ Street City Check if above address is: Work____ Home____ State Zip Provide office/workplace name here: ______________________________________________ Primary Work: (__________) ___________________________________ Home: (__________) ________________________________________ Cell: (__________) __________________________________________ Fax: (__________) __________________________________________ Professional Specialty: __________________________________________________ The digital conference syllabus will be available for download on our website approximately two weeks before the conference. If you prefer a paper syllabus please check here FRIDAY BREAKOUT PREFERENCE (Please refer to schedule and select one breakout for each session): Session Two: ____ A ____ B ____ C ____ D Session One: ____ A ____ B ____ C ____ D LODGING RESERVATIONS Arrival:________________________________________ (DAY of the week) TYPE OF ROOM GROUP RATES Standard Room $269/night Garden View Room $289/night *Concierge Room $319/night *Very Limited – Reserve Early Preferred Bed Type (cannot guarantee): Please reserve accommodations at the Napa Valley Marriott Hotel & Spa for: ________/________/________ Month Day Year (Single/Double) #1300 Departure:______________________________________ (DAY of the week) • Above Group Rates do not include the following (subject to change): - 12% tax • Maximum occupancy in room is four people and cannot be exceeded (due to fire codes) • There are no additional charges for 3rd and 4th guests in room - 0.065% California Tourism Assessment Fee • Rollaways & Cribs: Rollaways and cribs are complimentary (subject to change). Due to strict fire codes, rollaway beds and cribs are not permitted in a room with two beds. Only one rollaway or crib is permitted in a room with a King bed. - 2% Tourism Business Improvement District Assessment King__________ ________/________/________ Month Day Year Two Beds__________ Names of Room Occupants (and ages, if children):_______________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ Please circle names of the room occupants (other than you) who are registered for this conference Other Comments/Requests: _______________________________________________________________________________________________ TWO NIGHTS’ LODGING DEPOSIT ROOM RATE ONLY TUITION AMOUNT DUE ADDITIONAL LODGING DEPOSIT $ $ Payment Type (Please Check One): $ _____ Check (Please Enclose) _____ TOTAL (If you wish to include an additional amount for lodging, please state here) (Balance of hotel charges will be due to hotel) $ _____ _____ _____ Cardholder Name: _________________________________________________________ Signature: _________________________________________________________________ Billing Address: ________________________________________________________________________________________________________________________________________ (If different from above) Street Card Number City State Expiration Date Zip Security # Month/Year (on front or back of card) / By registering, you agree to the Terms & Conditions as stated in this brochure. ALL INFORMATION STATED ABOVE WILL REMAIN CONFIDENTIAL TO SYMPOSIA MEDICUS Page 6 3 Conference Brochure #1300, 10th Annual Summer Conference on Emergency Medicine Symposia Medicus A Non-Profit Corporation for Continuing Medical & Nursing Education