Transcript of "18th Annual Conference on Challenges in Gynecology"
18th Annual Conference on Women’s Health: CARE OF WOMEN OVER 50 Including topics on: Obesity, Urinary Incontinence, Dermatology Issues, Female Sexual Dysfunction, Cardiovascular Disease, Cervical Cancer, Mammography, and much more… JW Marriott Guanacaste Resort & Spa Guanacaste, Costa Rica November 28 – December 1, 2012 Sponsored by “In addition to the clinically relevant topics, outstanding lecturers and exotic locations, Symposia Medicus is one of only a very few continuing education companies that provide both physician and nursing credits.” -Thaddeus Stephen Wojick, MD “Excellent mix of venue and academics!” -Tommy Megremis, MD SINCE 1978 “Symposia Medicus never disappoints. I can depend on the content, speakers, and location – everything runs smoothly.” A Non-Profit Corporation for -Jeanne Brock, WHNPContinuing Medical & Nursing Education for this conference or view other educational conferences at Register On-Line... w w w. s y m p o s i a m e d i c u s . o r g
CONFERENCE DESCRIPTION CONTINUING EDUCATION CREDITOur 18 Annual Conference on Women’s Health: Care of Women Over 50 th Symposia Medicus designates this live activity for a maximum of 18 AMA PRAhas been designed to provide physicians, nurse practitioners, physician Category 1 Credits™. Physicians should claim only the credit commensurateassistants and nurses with the most up-to-date and evidence-based clinical with the extent of their participation in the activity.research on women’s health. Emphasis will be placed on the practicalapplication of content presented. In addition to didactic lectures and small Application has been made with the American College of Obstetricians &group discussion sessions, there will be ample time for participant feedback Gynecologists (ACOG) for cognates, Formal Learning.and interaction. Application for CME credit has been filed with the American Academy ofTopics for this year’s conference have been selected based on professional Family Physicians. Determination of credit is pending.practice gaps identified that resulted from extensive target audience needsassessment data. This needs assessment data is derived from a variety of Nurse Midwivessources including feedback, evaluations and outcomes data from past The American College of Nurse Midwives accepts Category 1 CME approvalparticipants; clinical expert input; Symposia Medicus’ online survey; from organizations accredited by the ACCME.and other medical and nursing data. Physician AssistantsConference format will include didactic lectures, smaller group discussion The American Academy of Physician Assistants accepts Category 1 CMEsessions, and question and answer sessions. approval from organizations accredited by the ACCME.An outstanding faculty has been assembled for this conference. Faculty Nurse Practitioners/Nursesmembers are committed to providing participants with current and practical The ANCC contact hours awarded for completion of this conference are 18.information. Each member was selected based on individual area of expertiseand ability to communicate first-hand information to participants. Provider is also approved by the California Board of Registered Nursing, Provider #CEP2335, for 21.6 contact hours.You are sure to enjoy our 18 th Annual Conference on Women’s Health:Care of Women Over 50 while sharing ideas and experiences with Pharmacology Credit for Prescriptive Authoritycolleagues from across the country in the beautiful setting of Costa Rica. A maximum of 2 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 theCONFERENCE OBJECTIVES schedule.After participating in this conference, you should have an increasedknowledge of and be more competent to… SMALLER GROUP BREAKOUT SESSIONS• Cite the updated guidelines in mammography screening Smaller group sessions will be held Friday afternoon. These breakout sessions are organized to provide an opportunity for greater participant/faculty• Provide appropriate cervical cancer screening treatment options interaction, and will give you an opportunity to discuss subjects relating to your particular area of interest. Please indicate your breakout session topic• Recognize and manage common dermatologic problems seen in choice on the conference registration form in this brochure. Space is older women limited, so please reserve early.• Differentiate between the management options of hysterectomy or uterine fibroid embolization EDUCATIONAL RESOURCES• Use appropriate clinical interventions for incontinence and bladder pain Each registrant will receive an extensive conference syllabus containing pertinent information on each topic presented. The syllabus is available on paper (black and white type/photos) or on a flash drive (full color).ACCREDITATION Please make your syllabus choice on the conference registration form. By requesting your syllabus on a flash drive, you will not receive a paperThis educational activity was planned and produced in accordance with the syllabus. If you request the flash drive syllabus and bring your laptop to theACCME and ANCC Essentials and Standards relating to continuing medical conference, be aware that there are no electrical outlets at the conferenceand nursing education. tables. Make sure your laptop is fully charged each day.Symposia Medicus is accredited by the Accreditation Council for Extra copies of this syllabus, whether on flash drive or paper, are available forContinuing Medical Education (ACCME) to provide continuing medical purchase by writing, with payment ($60 for paper, $25 for flash drive) to:education for physicians. Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287 (please refer to syllabus #1241 and indicate type of media preferred).Symposia Medicus is accredited as a provider of continuing nursing educationby the American Nurses Credentialing Center’s Commission on Accreditation. GROUP TOURS / GROUND TRANSPORTATIONEach participant should only claim credit commensurate with the extent oftheir participation in the activity. Tours are planned for participants and guests throughout the conference breaks. Additional information regarding tours, hotel, location and groundCertificates of credit will be given to participants on-site at the conclusion of transportation will be sent to registrants.the conference.Page 2 Conference Brochure #1241, 18 th Annual Conference on Women’s Health: CARE OF WOMEN OVER 50 Since 1978
CONFERENCE FACULTY CONFERENCE SCHEDULEJames F. Barter, MD Wednesday, November 28 12:30pm Questions & AnswersGynecologic Oncologist Group DiscussionDirector of Gynecologic Oncology Research 7:00am Registration & Check-In Faculty Panel and AudienceHoly Cross Hospital Continental Breakfast 1:15 Adjourn for the DaySilver Spring, Maryland 8:00 Welcome & IntroductionClinical Professor Michael Cirigliano, MDGynecologic Oncology Friday, November 30George Washington University Medical Center 8:15 Obesity in America:Washington, DC Houston, We Have a Problem! 3:00pm Smaller Group Breakouts – Session One Michael Cirigliano, MDLinda D. Bradley, MD, FACOG A. Female Sexual Dysfunction Dilemmas 9:00 Uterine Fibroid Embolization: Linda Bradley, MDConference Co-Chairperson Is Hysterectomy Obsolete? (Rx=15 minutes)Professor of Surgery B. Herbal Medicine & Natural Products: Linda Bradley, MDCleveland Clinic Lerner College of Medicine of Are You Up-to-Date?Case Western Reserve University 9:45 Questions & Answers Michael Cirigliano, MDVice-Chairman of Obstetrics, Gynecology Group Discussionand Women’s Health Institute Faculty Panel and Audience C. Skin Cancers: Non-MelanomaDirector, Center for Menstrual Disorders, & MelanomaFibroids and Hysteroscopic Services 10:15 Break Toby Maurer, MDDepartment of Obstetrics and Gynecology 10:30 Mammography Screening Update D. Mesh for Prolapse Repairs:Cleveland Clinic Is It Good or Bad & Why Are James Barter, MDCleveland, Ohio So Many Lawyers Interested? 11:15 Hypertension: How to Deal with Charles Rardin, MDMichael Cirigliano, MD, FACP the Silent Killer (Rx=20 minutes)Conference Co-Chairperson Michael Cirigliano, MD 4:30 BreakAssociate Professor of MedicineUniversity of Pennsylvania Noon Dermatologic Issues of Women Over 50 4:45 Smaller Group Breakouts – Session Two (Rx=15 minutes) (Session One Topics Repeated)School of Medicine Toby Maurer, MDMedical Correspondent, FOX 29 News 6:15 Adjourn for the DayPhiladelphia, Pennsylvania 12:45pm Questions & Answers Group DiscussionToby Maurer, MD Faculty Panel and Audience Saturday, December 1Professor of Clinical DermatologyUniversity of California, San Francisco 1:30 Adjourn for the Day 7:30am Continental BreakfastChief, Department of Dermatology 5:30- Group Reception 8:00 Cervical Cancer Prevention in WomenSan Francisco General Hospital 7:00pm (Faculty, Participants and Their Guests) Over 50: At What Age Should ScreeningSan Francisco, California Be Stopped? James Barter, MDCharles R. Rardin, MD Thursday, November 29Associate Professor of Obstetrics and 8:45 Evaluation & Management of PainfulGynecology 7:30am Continental Breakfast Bladder SyndromeProgram Director, Fellowship in Female Pelvic Charles Rardin, MDMedicine and Reconstructive Surgery 8:00 Update in Female Urinary Incontinence Charles Rardin, MD 9:30 Questions & AnswersAlpert Medical School of Brown University Group DiscussionDirector, Minimally Invasive and Faculty Panel and Audience 8:45 Abnormal Uterine Bleeding: Approach toRobotic Surgical Services Evaluation & Treatment (Rx=15 minutes)Women & Infants’ Hospital of Rhode Island Linda Bradley, MD 10:00 BreakProvidence, Rhode Island 9:30 Questions & Answers 10:15 Cardiovascular Disease in Women: Group Discussion Living Heart Healthy After 50 (Rx=20 minutes)Consistent with ACCME and ANCC policy, Michael Cirigliano, MDfaculty for this educational activity are asked Faculty Panel and Audienceto disclose any commercial interests thatmay create or may be perceived as creating 10:00 Break 11:00 Ovarian Cancer Screening & Cysta conflict related to the material they will be Management in the Woman Over 50presenting, as well as limitations on clinical 10:15 Cervical Cancer Screening, Treatment James Barter, MDstudies presented, and any “off-label” use Options & HPV Vaccine for the Oldersuggestions for medical products. Woman: New ACOG Recommendations 11:45 Dermatologic Aging Dilemmas:Additionally, Symposia Medicus Board, (Rx=20 minutes) Approaches & PitfallsPlanning Committee, and Staff members Toby Maurer, MD James Barter, MDhave disclosed that they have no significantfinancial relationships that could pose aconflict of interest to the planning of this 11:00 Surgical & Nonsurgical Management of 12:30pm Questions & Answersconference. This information is intended to Female Pelvic Floor Dysfunction in the Group Discussionassist you in forming your own judgments Older Patient Faculty Panel and Audienceabout content presented. Disclosure Charles Rardin, MDinformation will be included in your syllabus 1:15 Conference Adjournsand/or verbally disclosed at the conference. 11:45 Alternatives to Hysterectomy (Rx=15 minutes) Linda Bradley, MD Rx= Pharmacology Credit for Prescriptive Authority will be Granted for these SessionsPage 3 Conference Brochure #1241, 18 th Annual Conference on Women’s Health: CARE OF WOMEN OVER 50 Since 1978
CONFERENCE REGISTRATION INFORMATION • Check-in time is 3:00pm; check-out time is Noon.Enrollment for this conference is limited in order to provide the best possible learning environment. • Cribs and rollaways are complimentary (subject to availability).Early registration is advised. Cancellation PoliciesTuition: EARLY REGULAR If postmarked by If postmarked after • Conference cancellations must be confirmed in writing and a 10% of paid tuition processing September 19, 2012 September 19, 2012 fee will be assessed. No refunds will be made if cancellation is postmarked after Physicians $610 $710 October 24, 2012; however, tuition, less 10% processing fee may be applied to a future Residents, PAs, Nurses & All Others $510 $610 Symposia Medicus conference.• Tuition includes continuing education certification, extensive conference syllabus, breakfast on • Per our hotel contract, hotel reservation cancellations must be made in writing to Symposia Wednesday, Thursday and Saturday, refreshments, and the group reception. The group reception Medicus and you will receive a full refund if postmarked by September 26, 2012. Between is for faculty, registrants and their guests. September 27, 2012 and October 24, 2012, one night’s deposit is forfeited. After October 24, 2012, no hotel refunds can be made.• Tuition may be paid by check, money order, Visa, MasterCard, or Discover. • All cancellations must be made in writing and postmarked by the dates stated above.• Register on-line at www.symposiamedicus.org • In the unlikely event of conference cancellation by Symposia Medicus, full tuition and (if• Telephone registrations can be made Monday-Friday, 8:30am-5:00pm (Pacific Time), applicable) hotel deposit refunds will be made. Symposia Medicus will not be responsible for by calling (925) 969-1789 or (800) 327-3161. Registrations can also be faxed to refunding travel or any other expenses. (925) 969-1795.• If paying by check, make payable and send with registration form to Symposia Medicus, AIRLINE TRAVEL INFORMATION 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. The JW Marriott Guanacaste Resort & Spa is located in Guanacaste, in the northwest area• Conference registration will be confirmed via email and more information on travel, hotel, and of Costa Rica. You can fly into Daniel Oduber Quirós International Airport (known as Liberia tours will be sent. International Airport), which is approximately a 1-1/4 hour drive to the hotel; however, lower fares can often be found by flying into Juan Santamaria International Airport, located in Costa Rica’s• This conference meets the requirements for CE tax deductibility; however, we suggest you capital city of San Jose, which is approximately a 4-5 hour drive to the hotel. Ground consult your financial authority for more information. transportation information from both airports will be sent to you via email after registration.• For additional conference or lodging information, call Symposia Medicus at Listed here are major airlines flying from the U.S. to Costa Rica, and Symposia Medicus has (800) 327-3161 or (925) 969-1789, or visit our website at www.symposiamedicus.org arranged group discounts with American, Delta and United Airlines for this conference. Reservations can be made either through your travel agency or through the airlines Convention• For information on air reservations and ticketing assistance, you may either call your Desk at the website or numbers listed. travel agent or the airlines direct. Please see the Airline Travel Information portion of this brochure for further information. In order to receive the discounted rate, you or your travel agent must refer to the Symposia Medicus Group ID number listed here:CONFERENCE LODGING INFORMATION Airlines that fly into Daniel Oduber Quirós International Airport (Guanacaste) and Juan Santamaria International Airport (San Jose):Group Rates have been arranged at the JW Marriott Guanacaste Resort & Spa. If you wish toextend your stay, these rates will also be available three days before and three days after the American Airlines For discounts on American Airlines flights, please book online atconference, based on availability. www.aa.com and insert 46N2BK into the promotion code box. For questions, please call the American Airlines Convention Desk at (800) 433-1790.Two nights’ deposit (room rate only) must accompany your reservation. The balance of your Delta Airlines For discounts on Delta Airlines flights, please book online at www.delta.comlodging, hotel fees as stated below, and all incidental charges are due to the hotel upon check-out. and click the box “from Airport” and another page will appear. At the bottomThe hotel accepts most major credit cards. of that page, click the link “Meeting Event Code” and insert NM9H3. For questions, please call the Delta Convention Desk at (800) 328-1111.You can receive these rates by reserving the following ways: United Airlines For discounts on United Airlines flights, please book online at www.ual.com• On-line at our website, www.symposiamedicus.org; OR and insert ZMTN245355 in the offer code box. For questions, please call the United Airlines Convention Desk at (800) 521-4041.• Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR Airlines that fly into Juan Santamaria International Airport (San Jose):• Fax form with Visa, MasterCard, or Discover to (925) 969-1795; OR American Airlines For discounts on American Airlines flights, please book online• By mail, make check payable to Symposia Medicus and send with registration form to at www.aa.com and insert 46N2BK into the promotion code 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. box. For questions, please call the American Airlines Convention Desk at (800) 433-1790.Please note that our block of rooms is limited and on a first come, first served basis. United Airlines For discounts on United Airlines flights, please book online at www.ual.comPLEASE RESERVE EARLY as rooms may sell out and/or room rates may increase. and insert ZMTN245355 in the offer code box. For questions, please call the United Airlines Convention Desk at (800) 521-4041. Group Rates Room Types Description (Single/Double) Other airlines that fly into Daniel Oduber Quirós International Airport (Guanacaste) and Juan Santamaria International Airport (San Jose) - No Conference Discounts Available:Deluxe Garden View $245/night All rooms have a balcony, air conditioning, mini-bar, complimentary in-room coffee/tea service, iron and Jet Blue Airways (800) 538-2583 www.jetblue.com ironing board, hair dryer, in-room safe, bathrobes, Deluxe Ocean View $295/night separate tub and shower, iPod port and alarm clock US Airways (800) 622-1015 www.usairways.com radio, DVD player, cable/satellite color TV, pay-per-view movies/videos, working desk, Deluxe Ocean Front $345/night and three telephones. GROUND TRANSPORTATION Included with our group rates, each room Shuttle transportation is available and the cost between the Guanacaste, Costa Rica Airport and also receives use of the fitness center, complimentary the hotel is approximately $90 per person, roundtrip. The cost between the San Jose, Costa Rica, parking, turndown service and a Airport and the hotel is approximately $100 per person, roundtrip. Please Note: You will need to 50% discount off the regular rate of $14.99 overnight in San Jose both ways at an additional cost to you. on high speed internet access. Symposia Medicus has arranged conference discounts with AVIS and Budget Car Rentals. Reservations can be made by phone. Please refer to the conference code and theTERMS & CONDITIONS conference/airport location when making your reservations. The roads in Costa Rica are safe for travel. Hotel Policies AVIS (800) 331-1600 AWD # B766625• Group rates stated are per night, and do not include the following mandatory charges Budget (800) 772-3773 BCD # U076767 (subject to change): - 13% sales tax Approximate cost of 5-Day (Tues-Sat) Lowest Car Class Rental at Daniel Oduber Quirós Int’l - $7.00 housekeeping charge, per room, per day Airport (In Guanacaste): - $9.00 bellman charge, per person, round trip (13 years and older) $125 Avis $120 Budget• Maximum room occupancy is four people, regardless of age. Approximate cost of 5-Day (Tues-Sat) Lowest Car Class Rental at Juan Santamaria Int’l• Children 12 years and under are complimentary in room with adults. Airport (In San Jose):• Third and fourth persons in room (13 years and older) are an additional $45 each, plus tax, $195 Avis $225 Budget per night.Page 4 Conference Brochure #1241, 18 th Annual Conference on Women’s Health: CARE OF WOMEN OVER 50 Since 1978
CONFERENCE LOCATION Beautiful Costa Rica (bordered by the Caribbean to the east, the Pacific Ocean to the west and Panama to the south) is a democratic country where peace is the most precious possession of its people. Costa Rica is known for its white sand beaches, beautiful sunsets, mountainous plains, numerous national parks, tropical forests, and wildlife reserves, all protected through renowned conservation efforts. It is a country with modern goods and services, combined with exotic charm. Our conference resort, the JW Marriott Guanacaste Resort & Spa, is an approximate 1 1/4 hour drive from Daniel Oduber Quirós International Airport (known as Liberia International Airport) and a 4-5 hour drive from Juan Santamaria International Airport, located in the capital city of San Jose, which is within driving distance to tourist attractions such as Arenal Volcano National Park (80 miles northwest of San Jose) and Monteverde Cloud Forest Reserve (110 miles north of San Jose). Located on Mansita Beach and nestled against a forest, the JW Marriott Guanacaste Resort & Spa is on the northwest coast of Costa Rica in the Province of Guanacaste. With five beaches, championship golf, an equestrian center, world class spa and more, your experience will be unforgettable. During conference breaks, you can also venture out of the resort and experience various activities such as horseback riding, fishing, national park tours, river floating, canoeing, snorkeling, ATVs, scuba diving, and a zip line canopy excursion through the rain forest. Costa Rica is truly a paradise for those who are in search of a combination of beauty, history, culture and both land and water sports. Costa Rica’s exotic setting, combined with our exciting 18th Annual Conference on Women’s Health: Care of Women Over 50, make this an opportunity you won’t want to miss. 2012 CALENDAR OF FUTURE CONFERENCES (For our complete calendar of conferences, please visit www.symposiamedicus.org) 1220 4th Annual Conference on Challenges in Obstetrics & Gynecology Las Vegas, Nevada Jun 11-13 1222 19th Annual Summer Conference on Obstetrics & Gynecology Napa, California Jul 18-21 1228 Hot Topics in Pediatric Emergencies Alaska Cruise (Celebrity Cruises – Infinity) Jul 27-Aug 3 1229 13th Annual Conference on Integrative Medicine in Women’s Health Sedona, Arizona Sep 12-15 1232 26th Annual Fall Conference on High Risk Obstetrics Anaheim, California Sep 27-29 1230 Current Issues in Women’s Health Care Mediterranean Cruise (Celebrity Cruises – Silhouette) Sep 29-Oct 11 1231 23rd Annual National Conference on Women’s Health Care Las Vegas, Nevada Oct 1-3 1233 30th Annual Fall Conference on Obstetrics Atlantis Resort, Bahamas Oct 10-13 1237 20th Annual Fall Conference on Issues in Women’s Health Big Island, Hawaii Oct 31-Nov 3 1236 Challenges in Obstetrics & Gynecology Eastern Caribbean Cruise (Celebrity Cruises – Eclipse) Nov 9-17 1239 19th Annual Fall Conference on High Risk Pregnancy Marco Island, Florida Nov 14-17 1243 18th Annual Conference on Challenges in Gynecology New York City, New York Dec 14-15 1244 16th Annual Conference on Emergencies in Primary Care New York City, New York Dec 14-15 For more information on any of these conferences, please write to: Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287; call (800) 327-3161 or (925) 969-1789; email us at email@example.com; OR visit our website at www.symposiamedicus.org to view brochures of upcoming conferences. Brochures are available 6-8 months prior to conference.Page 5 Conference Brochure #1241, 18 th Annual Conference on Women’s Health: CARE OF WOMEN OVER 50 Since 1978
CONFERENCE & LODGING REGISTRATION FORM SYMPOSIA MEDICUS 18 Annual Conference on th Register on-line at www.symposiamedicus.org Women’s Health: OR COMPLETE THIS FORM & MAIL OR FAX WITH APPROPRIATE PAYMENT TO: CARE OF WOMEN OVER 50 Symposia Medicus JW Marriott Guanacaste Resort & Spa 399 Taylor Blvd., Suite 201 Pleasant Hill, CA 94523-2287 Guanacaste, Costa Rica Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795 November 28 - December 1, 2012 PLEASE PRINT LEGIBLY: (Show name and one degree as you would like it printed on your conference materials): Registrant’s Name: ______________________________________________________________________________ Degree: ____________________ First Last E-mail Address (required): ______________________________________________________________________________________ In order to receive registration confirmation, as well as access to CME credit, tour and conference information, the REGISTRANTS single and unique email address must be provided. Mailing Address: __________________________________________________________________________________________________________ Street City State Zip If above is a hospital or office address, please show name/suite # here: __________________________________________________________________ Primary Work: (______) ________________________________________ Home: (______) ____________________________________________ Cell: (______) ________________________________________________ Fax: (______) ______________________________________________ Professional Name of Hospital Specialty: ______________________________________ or Workplace:______________________________________________________________ Do you have a copy of the brochure for this conference? Yes______ No______ Our conference syllabus is available on paper or flash drive. Please check here if you’d like your syllabus on flash drive. #1241 No paper syllabus will be given if you choose flash drive. FRIDAY BREAKOUT PREFERENCE (Please refer to schedule and select one breakout for each session): Session One: ____A ____B ____C ____D Session Two: ____A ____B ____C ____D LODGING RESERVATIONS Please reserve accommodations at the JW Marriott Guanacaste Resort & Spa for: Arrival:____________________ ________/________/______ Departure:_______________________ ________/________/______ (DAY of the week) Month Day Year (DAY of the week) Month Day Year GROUP RATES (Single/Double Occupancy): • Group rates are per night, and do not • Maximum room occupancy is four people, regardless Type of Room Group Rates include the following mandatory charges of age. (subject to change): Deluxe Garden View $245/night - 13% sales tax • Children 12 years and under are complimentary in room - $7.00 housekeeping charge, per room, with adults. Deluxe Ocean View $295/night per day • Third and fourth persons in room (13 years and older) - $9.00 bellman charge, per person, are an additional $45 each, plus tax, per night. Deluxe Ocean Front $345/night round trip (13 years and older) Preferred Bed Type (cannot guarantee): King/Queen ______ Two Beds _____ Names of All Room Occupants (and ages, if children) ___________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ Please circle names of room occupants (other than you) who are registered for this conference Other Comments/Requests _______________________________________________________________________________________________ TUITION AMOUNT DUE TWO NIGHTS’ LODGING DEPOSIT - ROOM RATE ONLY TOTAL (Note: Balance of hotel charges will be due to hotel upon check-out) $ $ $ Payment Type: ____ Check (Please Enclose) ____ ____ ____ Cardholder’s Name: ______________________________________________ Signature:______________________________________________________ Billing Address: ________________________________________________________________________________________________________________ (If different from above) Street City State Zip Card Number Expiration Date Security # Month/Year (last 3 digits on back of credit card) - - - / ALL INFORMATION STATED ABOVE WILL REMAIN CONFIDENTIAL TO SYMPOSIA MEDICUS By registering, you agree to the Terms & Conditions as stated in this brochure. Copies of this form can be used for additional registrations • Telephone registrations may be taken with Visa, MasterCard, or Discover by calling Monday-Friday, 8:30am-5:00pm (Pacific Time) • Phones: (800) 327-3161 or (925) 969-1789, or Fax (925) 969-1795 Visit our website for other educational conferences and/or to register on-line at: www.symposiamedicus.orgPage 6 Conference Brochure #1241, 18 th Annual Conference on Women’s Health: CARE OF WOMEN OVER 50 Since 1978