19th Annual Fall Conference on High Risk Pregnancy

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19th Annual Fall Conference on High Risk Pregnancy

  1. 1. 19th Annual Fall Conference on Challenges in Taking Care of the HIGH RISK PREGNANCY Including topics on Late Preterm Births, Diabetes, Patient Safety, Ultrasound, Gestational Hypertension, and much more… Hilton Marco Island Beach Resort & Spa Marco Island, Florida (Near Everglades National Park) NOVEMBER 14-17, 2012 Sponsored by “It is the conference format, relevant topics, excellent faculty and locations that bring me back year after year. Great job, Symposia Medicus!” -Marta Roth, MD “These are the best conferences I have ever attended! The information is current, evidence-based, and certainly offers many areas of improvement for my practice.” -Jackie Brooks, CNM “I have attended Symposia Medicus CME for eight years and feel that SINCE 1978 they are high quality, with wonderful speakers. I always leave with more confidence dealing with the topics discussed.” A Non-Profit Corporation for -Brian K. Butcher, MDContinuing 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
  2. 2. CONFERENCE DESCRIPTION CONTINUING EDUCATION CREDITOur 19th Annual Fall Conference on High Risk Pregnancy is designed to Physiciansprovide the most current clinical information about the care of the high risk Symposia Medicus designates this live activity for a maximum of 18 AMA PRApregnancy to perinatologists, obstetricians, certified nurse midwives, obstetrical Category 1 Credit(s)™. Physicians should claim only the credit commensuratenurses and other healthcare professionals who take care of pregnant women. with the extent of their participation in the activity.The primary goal of this conference is to enhance knowledge and improvecompetence of attendees. Emphasis will be placed on practical application Application has been made with the American College of Obstetricians &of evidence-based topics and implementation of a variety of risk management Gynecologists (ACOG) for cognates, Formal Learning.strategies in an effort to improve patient outcomes. In addition to didacticlectures, ample time has been allotted for participant feedback and interaction. Two of the AMA PRA Category 1 Credit(s)™ are in the area of prevention of medical errors.Topics for this year’s conference have been selected based on extensive targetaudience needs assessment data resulting from professional practice gaps. Nurse Midwives & Physician AssistantsThese gaps were identified by a variety of sources including feedback and The American College of Nurse Midwives accepts Category 1 CME approvalevaluations from past participants, clinical expert input, Symposia Medicus’ from organizations accredited by the ACCME.online survey, and other medical and nursing data. The American Academy of Physician Assistants accepts Category 1 CMEConference format will include didactic lectures, smaller group discussion approval from organizations accredited by the ACCME.sessions, and question and answer periods. Nurse Practitioners & NursesAn outstanding faculty has been assembled for this conference. Faculty The ANCC contact hours awarded for the completion of this educational activitymembers are committed to providing participants with current and practical are 18.information. Each member was selected based on individual area of expertiseand ability to communicate evidence-based 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 19th Annual Fall Conference on High RiskPregnancy while sharing ideas and experiences with colleagues from across Pharmacology Credit for Prescriptive Authoritythe country in the beautiful setting of Marco Island. A maximum of 3 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 increased knowledgeof, and be more competent to… SMALLER GROUP BREAKOUT SESSIONS• Apply current recommendations for the diagnosis and management of Smaller group sessions will be held Friday afternoon. These breakout sessions gestational hypertension are organized to provide an opportunity for greater participant/faculty interaction, and will give you an opportunity to discuss subjects relating to• Discuss the impact of a primary C-section on future pregnancies your particular area of interest. Please indicate your breakout session topic choice on the conference registration form in this brochure. Space is limited• Cite new information regarding the use of progesterone in obstetrics so please reserve early. You are encouraged to bring cases or issues you are confronting in your clinical practice to discuss during these sessions.• Discuss indications and implications of late preterm birth• Manage the patient with pre-gestational diabetes and recognize early EDUCATIONAL RESOURCES complications Each registrant will receive an extensive conference syllabus containing pertinent information on each topic presented. The syllabus is available onACCREDITATION paper (black and white type/photos) or on a flash drive (full color). Please make your syllabus choice on the conference registration form.This educational activity was planned and produced in accordance with the By requesting your syllabus on a flash drive, you will not receive a paperACCME and ANCC Essentials and Standards relating to continuing medical and syllabus. If you request the flash drive syllabus and bring your laptop to thenursing education. conference, be aware that there are no electrical outlets at the conference tables. Make sure your laptop is fully charged each day.Symposia Medicus is accredited by the Accreditation Council for ContinuingMedical Education (ACCME) to provide continuing medical education for Extra copies of this syllabus, whether on flash drive or paper, are available forphysicians. purchase by writing, with payment ($60 for paper, $25 for flash drive) to: Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287Symposia Medicus is accredited as a provider of continuing nursing education (please refer to syllabus #1239 and indicate type of media preferred).by the American Nurses Credentialing Center’s Commission on Accreditation.Each participant should only claim credit commensurate with the extent of their GROUP TOURSparticipation in the activity. Tours are planned for participants and guests throughout the conference breaks.Certificates of credit will be given to participants on-site at the conclusion of the Additional information regarding tours, hotel, location and ground transportationconference. will be sent.Page 2 Conference Brochure #1239, 19th Annual Fall Conference on Challenges in Taking Care of the High Risk Pregnancy Since 1978
  3. 3. CONFERENCE FACULTY CONFERENCE SCHEDULEHaywood L. Brown, MD, FACOG Wednesday, November 14 Friday, November 16Roy T. Parker Professor & ChairObstetrics and Gynecology 7:00am Registration & Check-in 3:00pm Smaller Group Breakouts –Duke University During Continental Breakfast Session OneDurham, North Carolina 8:00 Welcome & Introduction A. Recurrent Spontaneous Washington Hill, MD Pregnancy LossJames W. Collins, Jr., MD, MPH E. Albert Reece, MD, PhD, MBAMedical Director, Neonatal Intensive Care Unit 8:15 Perinatal Cases We Can AllAssociate Director, Pediatric Residency Program Learn From (Rx= 10 minutes) B. Chronic Hypertension:Children’s Memorial Hospital Washington Hill, MD Evaluation, Management & Impact on Pregnancy OutcomeProfessor of Pediatrics 9:00 The Social Determinants of & Long-Term HealthNorthwestern University Feinberg School of Medicine Preterm Birth Haywood Brown, MDChicago, Illinois James Collins, Jr., MD, MPH C. After Maternal Mortality: SupportingPauline Hill, RN, MSN 9:45 Questions & Answers OB Grief & Loss on Your UnitsAdjunct Faculty Group Discussion Pauline Hill, RN, MSN &The University of Tampa, Department of Nursing Faculty Panel & Audience Washington Hill, MDTampa, Florida 10:15 Break D. Step Wise Evaluation &HeartsAfire Medical Missions, Not-For-Profit 501(c) 3 Management of SevereBoard of Directors 10:30 Midnight High Anxiety: The Category II Postpartum HemorrhageSarasota, Florida EFM Tracing on Admission Baha Sibai, MD Cydney Afriat Menihan, CNM, MSNWashington C. Hill, MD, FACOG 4:00 BreakChairman 11:15 Late Preterm Births: An Obstetrical Perspective (Rx= 10 minutes) 4:15 Smaller Group Breakouts –Clinical Professor, Department of OB/GYN Washington Hill, MD Session TwoUniversity of South Florida, College of Medicine (Session One Topics Repeated)Tampa, Florida Noon Late Preterm Births:Clinical Professor, Department of Clinical Sciences A Neonatal Perspective 5:15 BreakOB-GYN Clerkship Director - Sarasota Campus James Collins, Jr., MD, MPHFlorida State University, College of Medicine 5:30 Smaller Group Breakouts – 12:45pm Questions & Answers Session ThreeFirst Physician Group of Sarasota Group Discussion (Session One Topics Repeated)Maternal-Fetal Medicine Faculty Panel & AudienceSarasota Memorial Hospital 6:30 Adjourn for the DaySarasota, Florida 1:30 Adjourn for the DayCydney Afriat Menihan, CNM, MSN, RDMS 5:30- Group Reception Saturday, November 17Educator, Author and Consultant 7:00pm (For Faculty, Registrants & Their Guests) 7:30am Continental BreakfastPerinatal ProductionsVenice, Florida Thursday, November 15 8:00 Recent Recommendations for Diagnosis & Management ofE. Albert Reece, MD, PhD, MBA, FACOG 7:30am Continental Breakfast Gestational Hypertension &Vice President for Medical Affairs Preeclampsia (Rx= 15 minutes)University of Maryland 8:00 New Developments in Gestational Baha Sibai, MD Diabetes Care (Rx= 20 minutes)John Z. and Akiko K. Bowers E. Albert Reece, MD, PhD, MBA 8:45 The Impact of the Primary CesareanDistinguished Professor and Dean Section on Future PregnanciesUniversity of Maryland School of Medicine 8:45 Is This Medication Safe in Pregnancy? Haywood Brown, MDBaltimore, Maryland (Rx= 40 minutes) Mureena Turnquest Wells, MD 9:30 Questions & AnswersBaha Sibai, MD, FACOG Group DiscussionProfessor of Obstetrics and Gynecology 9:30 Questions & Answers Faculty Panel & Audience Group DiscussionDirector of Maternal-Fetal Medicine Faculty Panel & Audience 10:00 Break (Hotel check-out, if applicable)University of Texas Health Science CenterHouston, Texas 10:00 Break 10:30 Maternal Safety in Labor/Delivery: Preparing to Deal with Life-ThreateningMureena Turnquest Wells, MD, FACOG 10:15 Diabetes: Associated Complications & Maternal Emergencies (Rx= 10 minutes)Director of Maternal-Fetal Medicine Pregnancy Management (Rx= 10 minutes) Baha Sibai, MDSt. Marys Hospital for Women and Children E. Albert Reece, MD, PhD, MBA 11:15 The Dilemma of the Short CervixEvansville, Indiana 11:00 Patient Safety in Your OB Units (Rx= 10 minutes) (Rx= 10 minutes) Haywood Brown, MD Washington Hill, MDConsistent with ACCME and ANCC policy, faculty forthis educational activity are asked to disclose any Noon Whats New with Commonly-Usedcommercial interests that may create or may be 11:45 Logical Coexistance: Incorporating Drugs in Pregnancy: Steroids,perceived as creating a conflict related to the material Ultrasound into Nursing & Midwifery Progesterone & MgSO4 (Rx= 45 minutes)they will be presenting, as well as limitations on Cydney Afriat Menihan, CNM, MSN Mureena Turnquest Wells, MDclinical studies presented, and any “off-label” usesuggestions for medical products. Additionally,Symposia Medicus Board, Planning Committee, and 12:30pm Questions & Answers 12:45pm Questions & AnswersStaff Members have disclosed that they have no Group Discussion Group Discussionsignificant financial relationships that could pose a Faculty Panel & Audience Faculty Panel & Audienceconflict of interest to the planning of this conference.This information is intended to assist you in formingyour own judgments about content presented. 1:15 Adjourn for the Day 1:30 Conference AdjournsDisclosure information will be included in yoursyllabus and/or verbally disclosed at the conference. Rx= Pharmacology Credit for Prescriptive Authority will be Granted for these SessionsPage 3 Conference Brochure #1239, 19th Annual Fall Conference on Challenges in Taking Care of the High Risk Pregnancy Since 1978
  4. 4. CONFERENCE REGISTRATION INFORMATION CONFERENCE LODGING INFORMATIONEnrollment for this conference is limited in order to provide the best possible learning environment. Group Rates have been arranged at the beautiful Hilton Marco Island Beach Resort & Spa.Early registration is advised. By registering, you agree to the Terms & Conditions as stated in These rates will also be available three days before and three days after the conference,this brochure. based on availability, if you would like to extend your stay.Tuition: EARLY REGULAR Two nights’ deposit (room rate only) must accompany your reservation. The balance of your lodg- If postmarked by If postmarked after ing, hotel fees as stated below, and all incidental charges are due to the hotel upon check-out. The September 5, 2012 September 5, 2012 hotel accepts most major credit cards.Physicians $610 $710Residents, PAs, Nurses & All Others $510 $610 You can receive these rates by reserving the following ways:• Tuition includes continental breakfast on Wednesday, Thursday, and Saturday mornings, • On-line at our website, www.symposiamedicus.org; OR continuing education certification, extensive conference syllabus, refreshments, and group reception. The group reception is for faculty, registrants and their guests. • Calling Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR• Tuition may be paid by check, money order, Visa, MasterCard or Discover. • Faxing form with Visa, MasterCard, or Discover to (925) 969-1795; OR• Register on-line at www.symposiamedicus.org or by using the form in this brochure. • By mail, make checks payable to Symposia Medicus and send with registration form to 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287.• If paying by check, make payable to Symposia Medicus, and send with registration form to 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287; OR 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.• Telephone registrations can be made Monday-Friday, 8:30am-5:00pm (Pacific Time), by calling (925) 969-1789 or (800) 327-3161. Room Type/View Group Rates Description (Single/Double)• Registrations can also be faxed if paying with Visa, MasterCard or Discover to (925) 969-1795. Rooms vary only by view and are all considered junior Garden View $175/night suites. They feature private furnished balconies• Conference registration will be confirmed in writing and more information on travel, hotel and overlooking either the gardens or the Gulf of Mexico. group tours will be sent. Gulf View $195/night Amenities in each room include: sleeper sofa, room safe, refrigerator, coffee/tea service, 32-inch LCD• This conference meets the requirements for CE deductibility; however, we suggest you consult Deluxe Gulf View $215/night television with HBO, robes, bathrooms with double your financial authority for more information. vanity, telephone, and hair dryer.• For additional conference or lodging information, call Symposia Medicus at ROOM AMENITIES (800) 327-3161, (925) 969-1789, or visit our website at www.symposiamedicus.org. Group rates include unlimited fitness center admission, complimentary high speed internet, complimentary newspaper (Monday-Friday) and unlimited in-room coffee and tea.• For information on air reservations and ticketing assistance, you may either call the airlines direct or your travel agent. Please see the Airline Travel Information portion of this brochure for further information. TERMS AND CONDITIONS Hotel PoliciesAIRLINE TRAVEL INFORMATION • Group rates are per night and do not include 10% room tax (subject to change), meals, norThe Hilton Marco Island Beach Resort & Spa is located 30 minutes from Naples Airport, and 45 gratuities.minutes from Southwest Florida International Airport, just south of Ft. Meyers, and is served bymost major airlines. Miami and Ft. Lauderdale International airports are 90 minutes away. • Maximum number of people in room is four adults, or two adults & two children.Symposia Medicus has arranged group discounts with American, Delta and United Airlines for • Children 18 and under are free in room with adults (not to exceed maximum occupancy).this conference. Reservations can be made either through your travel agency or through theairlines’ Convention Desks at the numbers or websites listed below. • Third & fourth adult, 19 years and older, are an additional $25 each, per night.In order to receive the discounted rate, you or your travel agent must refer to the Symposia • Cribs are complimentary. Rollaways are $25 extra per room, per night (subject to change &Medicus Group ID numbers listed below. availability). American Airlines For discounts on American Airlines flights, please book online at • Check-in time is 4:00pm and check-out time is 11:00am. Late check-outs are subject to Convention Desk: www.aa.com and insert 82N2AY into the promotion code box. For availability. questions, please call the American Airlines Convention Desk at (800) 433-1790. • Self parking for hotel & non-hotel guests is $10 per day, or $14 per day for valet. Delta Airlines For discounts on Delta Airlines flights, please book online at • Please notify the hotel at check-in if there are any changes to your scheduled departure, Convention Desk: www.delta.com and click the box “from Airport” and another page will as an early departure fee of $50 is applicable to any guest who checks out before their appear. At the bottom of that page, click the link “Meeting Event Code” confirmed departure date. and insert NM9H2. For questions, please call the Delta Airlines Convention Desk at (800) 328-1111. • A 30-minute break has been allotted in our conference schedule on Saturday for those who need to check out. United Convention Desk: (800) 521-4041 # 563JI 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 October 10, 2012;CAR RENTAL DISCOUNT however, tuition, less 10% processing fee may be applied to a future Symposia Medicus conference.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 the • Per our hotel contract, hotel cancellations must be made in writing to Symposia Medicus and youconference/airport location when making your reservations. Please see below: will receive a full refund if postmarked by September 12, 2012. Between September 13, 2012 and October 10, 2012 one night’s deposit is forfeited. After October 10, 2012 no hotel refunds can be made. AVIS 800-331-1600 AWD # B766625 • All cancellations must be made in writing and postmarked by the dates stated above. Budget 800-772-3773 • In the unlikely event of conference cancellation by Symposia Medicus, full tuition and (if BCD # U076767 applicable) hotel deposit refunds will be made. Symposia Medicus will not be responsible for refunding travel or any other expenses.Page 4 Conference Brochure #1239, 19th Annual Fall Conference on Challenges in Taking Care of the High Risk Pregnancy Since 1978
  5. 5. CONFERENCE LOCATION Marco Island, the largest of Florida’s famous 10,000 islands on Tempting options for dining include the Paradise Café, which the southwest coast of the Gulf of Mexico, is graced with miles offers the area’s most spectacular views of the gulf, or the Beach of white-sand beaches, beautiful weather, sumptuous Club Bar and Grill, offering casual dining and tropical drinks restaurants, and fine shopping, dining, and entertainment. poolside. Elegant meals and local delicacies can be enjoyed in Recreational activities, ranging from boating and fishing, to the Sandcastles Dining Room, and nights come alive with golf and tennis, are set amid the stunning subtropical beauty entertainment at the Sandcastles Lounge. The Marco Walk that is unique to southwest Florida’s Gulf coast. Plaza is directly across from the resort, featuring a great variety of shops and restaurants, plus a movie theater. Just a short The Hilton Marco Island Beach Resort & Spa is in the premiere drive away is Everglades National Park, the largest subtropical location for fun and relaxation. Guest rooms at the Hilton feature wilderness in the United States – a place where you can tour the private furnished balconies overlooking lush tropical landscaping park with a ranger, photograph birds, take an afternoon hike, spot or the beautiful Gulf of Mexico. The Hilton Marco Island is host to alligators bathing in the sun, or canoe through the marshes. a multitude of recreational activities; whether you want to relax by the pool or on the white sand beach, or take part in sailing, You are sure to enjoy your trip to Marco Island while attending our parasailing, kayaking, or even experience unique Eco Tour and 19 th Annual Fall Conference on Challenges in Taking Care of shelling excursions. Enjoy an invigorating game of tennis, the High Risk Pregnancy. volleyball, or golf, or visit The Spa at Marco Island, offering serenity and wellness inspired by the exotic cultures of the Mediterranean. 2012 CALENDAR OF FUTURE CONFERENCES (For our complete calendar of conferences, please visit www.symposiamedicus.org) 1219 13th Annual National Conference on Fetal Monitoring Las Vegas, Nevada Apr 19-21 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 1226 13th Annual Summer Conference on Women’s Health Atlantis Resort, Bahamas Aug 1-4 1229 13th Annual Conference on Integrative Medicine in Women’s Health Sedona, Arizona Sep 12-15 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 1241 18th Annual Conference on Care of Women Over 50 Guanacaste, Costa Rica Nov 28-Dec 1 1243 18th Annual Conference on Challenges in Gynecology 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 info@symposiamedicus.org; 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 #1239, 19th Annual Fall Conference on Challenges in Taking Care of the High Risk Pregnancy Since 1978
  6. 6. CONFERENCE & LODGING REGISTRATION FORM SYMPOSIA MEDICUS Register on-line at www.symposiamedicus.org 19th Annual Fall Conference on Challenges in Taking Care of the OR complete this form and mail or fax with appropriate payment to: Symposia Medicus High Risk Pregnancy Hilton Marco Island Beach Resort & Spa 399 Taylor Blvd., Suite 201 Pleasant Hill, CA 94523-2287 Marco Island, Florida Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795 November 14-17, 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: (______)___________________________ 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. #1239 Please check here if you’d like your syllabus on flash drive. 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): FRIDAY BREAKOUT PREFERENCE (Please refer to schedule and select one breakout for each session): Session One:Session___B ___C ___D ___A One: ____A ____B ____C Two: ___A ___B ___C Two: ____A ____B ____C ____D ___C ___D Session ____D Session ___D Session Three: ___A ___B LODGING RESERVATIONS Please reserve accommodations at Hilton Marco Island Beach Resort & Spa for: Arrival:____________________ ________/________/______ Departure:_______________________ ________/________/______ (DAY of the week) Month Day Year (DAY of the week) Month Day Year • Group rates are per night and do not include 10% room tax (subject to change), TYPE OF ROOM GROUP RATES meals, nor gratuities. • Maximum number of people in room is four adults, or two adults & two children. Garden View $175/night • Children 18 and under are free in room with adults (not to exceed maximum occupancy). Gulf View $195/night • Third & fourth adult, 19 years and older, are an additional $25 each, per night. • Cribs are complimentary. Rollaways are $25 extra per room, per night (subject to Deluxe Gulf View $215/night change & availability). Preferred Bed Type: King/Queen ______ Two Beds _____ (Cannot Guarantee) 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 #1239, 19th Annual Fall Conference on Challenges in Taking Care of the High Risk Pregnancy Since 1978

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