20th Annual Fall Conference on Issues in Women's Health


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20th Annual Fall Conference on Issues in Women's Health

  1. 1. Exciting News…our hotel room rates include daily buffet breakfast. Please see our lodging information inside the brochure for more details. 20th Annual Fall Conference on Issues in Womens Health Including topics on: Contraception, Incontinence, Obesity, Sleep Disorders, Pregnancy Complications, and much more… Hapuna Beach Prince Hotel BIG ISLAND, HAWAII October 31-November 3, 2012 Sponsored by “I am always pleased with Symposia Medicus conferences. They are well organized, pertinent, and in great locations!” -Elaine Paul, MD “Symposia Medicus is my primary ‘go-to’ for conferences. The information is relevant, concise and current. I always walk away with information applicable and practical.” -Jennifer Wright-Bennion, CNM “I have attended at least eight Symposia Medicus conferences. I find them all clinically correlated to private practice. I get more useful day-to-day SINCE 1978 acts from their conferences than others. They streamline the system by A Non-Profit Corporation for making your hotel registration for you… -Thomas Shima, 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 20 th Annual Fall Conference on Issues in Women’s Health is Physiciansdesigned to provide the most current clinical information in the care of the Symposia Medicus designates this live activity for a maximum of 18 AMAfemale patient to obstetricians, gynecologists, family, internists, physicians, PRA Category 1 Credit(s)™. Physicians should claim only the creditnurse midwives, nurse practitioners, physician assistants, nurses and all commensurate with the extent of theirother healthcare professionals. The goal of this conference is to provide a participation in the activity.comprehensive update on the most current issues in Women’s Health. Application has been made with the American College of Obstetricians &Topics for this year’s conference have been selected based on extensive Gynecologists (ACOG) for cognates, Formal Learning.target audience needs assessment data resulting from professionalpractice gaps. These gaps were identified by a variety of sources including Application for CME credit has been filed with the American Academy offeedback and evaluations from past participants, clinical expert input, Family Physicians. Determination of credit is pending.Symposia Medicus’ online survey, and other medical and nursing data. Nurse Midwives/Physician AssistantsConference format will include didactic lectures, smaller group discussion The American College of Nurse Midwives and the American Academy ofsessions, and question and answer periods. Physician Assistants accept Category 1 CME approval from organizations accredited by the ACCME.An outstanding faculty has been assembled for this conference. Facultymembers are committed to providing participants with current and practical Nurse Practitioners/Nursesinformation. Each member was selected based on their individual area of The ANCC contact hours awarded for the completion of this educationalexpertise and their ability to communicate first-hand information to activity is 18.participants. Provider is also approved by the California Board of Registered Nursing,You are sure to enjoy our 20 th Annual Fall Conference on Issues in Provider # CEP2335, for 21.6 contact hours.Women’s Health while sharing ideas and experiences with colleaguesfrom across the country in the relaxing and beautiful environment of the Pharmacology Credit for Prescriptive AuthorityBig Island. A maximum of 1.5 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• Describe the prevalence and co-morbidities of pelvic floor disorders Smaller group sessions will be held Friday afternoon. These breakout in obese women sessions are organized to provide an opportunity for greater participant/faculty interactions, and will give you an opportunity to• Treat and manage female patients with overuse sports injuries discuss subjects relating to your particular area of interest. Please indicate your breakout session topic choice on the conference registration form• Recognize the pregnant patient with an increased risk for preterm in this brochure. Space is limited so please reserve early You are delivery encouraged to bring cases of issues you are confronting in your clinical practice to discuss during these sessions.• Manage patients with sleep disorders and describe the benefits of obtaining an optimum amount of sleep EDUCATIONAL RESOURCES• Recognize and manage patients with abnormal uterine bleeding Each registrant will receive an extensive conference syllabus containing pertinent information on each topic presented. The syllabus is availableACCREDITATION on 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 aACCME and ANCC Essentials and Standards relating to continuing medical paper syllabus. If you request the flash drive syllabus and bring your laptopand nursing education. to the 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 forContinuing Medical Education (ACCME) to provide continuing medical Extra copies of this syllabus, whether on flash drive or paper, are availableeducation for physicians. for purchase by writing, with payment ($60 for paper, $25 for flash drive) to: Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CASymposia Medicus is accredited as a provider of continuing nursing 94523-2287 (please refer to syllabus #1237 and indicate type ofeducation by the American Nurses Credentialing Center’s Commission on media preferred).Accreditation.Each participant should only claim credit commensurate with the extent of GROUP TOURS / GROUND TRANSPORTATIONtheir participation in the activity. Additional information about the Hapuna Beach Prince Resort, theCertificates of credit will be given to participants on-site at the conclusion of Big Island, ground transportation and group tours will be sent.the conference.Page 2 Conference Brochure #1237, 20 th Annual Fall Conference on Issues in Womens Health Since 1978
  3. 3. CONFERENCE FACULTY CONFERENCE SCHEDULEThomas J. Benedetti, MD, MHA Wednesday, October 31 Friday, November 2Professor, Vice Chairman,Director of Education 7:00am Registration & Check-in 3:30pm Smaller Group Breakouts –Department of Obstetrics & Gynecology Session One 8:00 Conference & Faculty IntroductionUniversity of Washington Michael Foley, MD A. Complimentary & AlternativeSchool of Medicine Medicine for MenopauseSeattle, Washington 8:15 Overview of Lower Urinary Tract Management (Includes Herbs, Anatomy, Physiology, Dysfunction, Soy and Bio-Identical Hormones)Michael R. Foley, MD, FACOG Evaluation & Treatment Ellen Hughes, MD, PhDConference Co-Chairperson Holly Richter, MD, PhDChief Medical Officer B. Protocols for Outpatient 9:00 Update on Contraception (Rx = 25 minutes) Hysterectomy & Office-BasedScottsdale Healthcare Bruce Kahn, MD ProceduresScottsdale, Arizona Bruce Kahn, MDClinical Professor 9:45 Questions & AnswersUniversity of Arizona Group Discussion C. Examination of the Knee,School of Medicine Faculty Panel & Audience Ankle & ShoulderTucson, Arizona James Garrick, MD 10:15 BreakJames G. Garrick, MD D. Hypertensive Crisis in 10:30 Office Management of Gradual Onset Pregnancy - "A New ApproachOrthopedic Surgeon of Overuse Injuries to an Old Problem"Director, Center of Sports Medicine James Garrick, MD Michael Foley, MDSaint Francis Memorial HospitalClinical Professor 11:15 Chronic Pelvic Pain & Interstitial Cystitis: 5:00 BreakDepartment of Pediatrics Pearls on Diagnosis & TreatmentUniversity of California, San Francisco (Rx = 20 minutes) 5:15 Smaller Group Breakouts –School of Medicine Bruce Kahn, MD Session TwoSan Francisco, California (Session One Topics Repeated) Noon Managing Physician/Nurse Burnout: Ancient Wisdom for Healthcare 6:45 Adjourn for the DayEllen Hughes, MD, PhD ProfessionalsClinical Professor of Medicine Emeritus Michael Foley, MDUniversity of California, San Francisco Saturday, November 3Osher Center for Integrative Medicine 12:45pm Questions & AnswersSan Francisco, California Group Discussion 8:00am Tools for the Obesity Epidemic: Faculty Panel & Audience Diet, Exercise, Pills & Surgery Ellen Hughes, MD, PhDBruce S. Kahn, MD, FACOG 1:30 Adjourn for the DayDirector, Fellowship in Minimally Invasive 8:45 Conservative Treatment of UrinaryGynecologic Surgery 5:30- Group Reception Incontinence & Prolapse:Department of Obstetrics & Gynecology 7:00pm (Faculty, Participants & Their Guests) The Ins & Outs of Pessary UseScripps Clinic Medical Group Holly Richter, MD, PhDLa Jolla, CaliforniaAdjunct Associate Clinical Professor Thursday, November 1 9:30 Questions & AnswersDepartment of Obstetrics & Gynecology Group Discussion 8:00am Nutrition in a Bottle: A Scientific Review Faculty Panel & AudienceUniformed Services of Vitamins, Minerals & SupplementsUniversity of the Health Sciences Ellen Hughes, MD, PhD 10:00 Break (Hotel check-out, if applicable)Bethesda, Maryland 8:45 A Pragmatic Approach to the Office 10:30 Abnormal Uterine Bleeding: CurrentHolly E. Richter, MD, PhD Management of Back Pain (Rx = 10 minutes) Diagnosis & ManagementConference Co-Chairperson James Garrick, MD (Rx = 20 minutes)Professor and Director Bruce Kahn, MD 9:30 Questions & AnswersDivision of Urogynecology and Group Discussion 11:15 Obesity & Pelvic Floor Disorders:Pelvic Reconstructive Surgery Faculty Panel & Audience A Review of the Literature &Department of Obstetrics and Gynecology Implications for Clinical CareUniversity of Alabama at Birmingham 10:00 Break Holly Richter, MD, PhDBirmingham, Alabama 10:15 Sleep Disorders in Women: Improving Noon Benefits & Risks of Fish the Quality of Sleep (Rx = 15 minutes) Consumption Before & DuringConsistent with ACCME and ANCC policy, faculty for Ellen Hughes, MD, PhD Pregnancythis educational activity are asked to disclose any Thomas Benedetti, MD, MHAcommercial interests that may create or 11:00 Evaluation, Diagnosis & Treatment ofmay be perceived as creating a conflict related Fecal Incontinence 12:45pm Questions & Answersto the material they will be presenting, as well as Holly Richter, MD, PhD Group Discussionlimitations on clinical studies presented, and any Faculty Panel & Audience“off-label” use suggestions for medical products. 11:45 New Strategies for the PreventionAdditionally, Symposia Medicus Board, PlanningCommittee, and Staff members have disclosed that of Preterm Birth 1:30 Conference Adjournsthey have no significant financial relationships that Thomas Benedetti, MD, MHAcould pose a conflict of interest to the planning ofthis conference. This information is intended to 12:30pm Questions & Answersassist you in forming your own judgments about Group Discussioncontent presented. Disclosure information will be Faculty Panel & Audience Rx = Pharmacology Credit for Prescriptive Authorityincluded in your syllabus and/or verbally disclosed will be granted for these sessionsat the conference. 1:15 Adjourn for the DayPage 3 Conference Brochure #1237, 20 th Annual Fall Conference on Issues in Womens Health Since 1978
  4. 4. CONFERENCE REGISTRATION INFORMATION TERMS & CONDITIONSEnrollment for this conference is limited in order to provide the best possible learning environment. Hotel PolicesEarly registration is advised. By registering, you agree to the Terms & Conditions as stated inthis brochure. • Above group rates do not include the following (subject to change): - State and local taxes of 13.416% per room, per nightTUITION: EARLY REGULAR - Mandatory porterage charge of $8.00 plus 4.166% tax per person, round trip (17 years If postmarked by If postmarked after and older) August 22, 2012 August 22, 2012Physicians $610 $710 • Maximum room occupancy is three adults or two adults and two children (three adults andResidents, Nurses, PAs & All Others $510 $610 one child is OK).• Tuition includes continuing education certification, extensive conference syllabus, group • Mandatory additional person charges (see below) include daily buffet breakfast, tax & gratuity: reception, and refreshments. - Children ages 5 and under are free - Children ages 6-12 are $15 each, per night• Tuition may be paid by check, money order, Visa, MasterCard, or Discover. - Persons ages 13 and older are $25 each, per night• Register on-line at www.symposiamedicus.org. • Rollaway beds are $60 per night (subject to availability) – one per guestroom is allowed.• Telephone registrations can be made Monday-Friday, 8:30am-5:00pm (Pacific Time), • Housekeeping gratuity is optional. However, $2.50 per room, per day is suggested. by calling (925) 969-1789 or (800) 327-3161. Registrations can also be faxed to (925) 969-1795. • Check-in time is 3:00pm and check-out time is noon. Requests for late checkout should be directed to the front desk the day prior to departure, and are subject to availability and charges.• If paying by check, make payable and send with registration form to Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. • Rates may be available at the Hapuna’s sister hotel, the historic Mauna Kea Hotel, located next door. Please call us for more information.• Conference registration will be confirmed in writing and more information on travel, hotel, and activities will be sent. • A 30-minute break has been allotted in our conference schedule on the last day for those of you who need to check out.• This conference meets the requirements for CE tax deductibility; however, we suggest you consult your financial authority for more information. Cancellation Policies• For additional conference or lodging information, call Symposia Medicus at (800) 327-3161 • Conference cancellations must be confirmed in writing and a 10% of paid tuition processing or (925) 969-1789, or visit our website at www.symposiamedicus.org. fee will be assessed. No refunds will be made if cancellation is postmarked after September 26, 2012; however, tuition, less 10% processing fee may be applied to a• For information on air reservations and ticketing assistance, you may either call your future Symposia Medicus conference. travel agent or the airlines direct. Please see the Airline Travel Information portion of this brochure for further information. • 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 August 29, 2012. Between August 30, 2012 and September 26, 2012, one night’s deposit is forfeited. After September 26, no hotel refunds can be made.CONFERENCE LODGING INFORMATION (Group Rates - Include Daily Buffet Breakfast forSingle/Double Occupancy) • All cancellations must be made in writing and postmarked by the dates stated above.Group Rates have been arranged at the beautiful Hapuna Beach Prince Hotel. These rates will • In the unlikely event of conference cancellation by Symposia Medicus, full tuition andalso be available three days before and three days after the conference, based on availability, (if applicable) hotel deposit refunds will be made. Symposia Medicus will not be responsibleif you wish to extend your stay. for refunding travel or any other expenses.Two nights’ deposit (room rate only) must accompany your reservation. The balance of lodging,hotel fees as stated below, and all incidental charges are due to the hotel upon checkout. The hotelaccepts most major credit cards. AIRLINE TRAVEL INFORMATIONYou can receive these rates by reserving the following ways: You will fly into the Kona Airport, which is approximately 27 miles from the Hapuna Beach Prince Hotel.• On-line at our website, www.symposiamedicus.org; OR Symposia Medicus has arranged for discount fares with Alaska, American, Hawaiian and United• Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR Airlines for this conference. Reservations can be made either through your travel agency or through the airlines’ Convention Desk at the website or numbers listed below.• Fax form with Visa, MasterCard, or Discover to (925) 969-1795; OR In order to receive the discounted rate, you or your travel agent must refer to the Symposia• By mail, make checks payable to Symposia Medicus and send with registration form to Medicus ID numbers listed below. 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. Alaska Airlines For discounts on Alaska Airlines flights, please book online atPlease note that our block of rooms is limited and are on a first come, first served basis. Convention Desk: www.alaskaair.com and insert ECMG522 into the e-certificate codePLEASE RESERVE EARLY as rooms may sell out and/or room rates may increase. box. For questions, please call the Alaska Airlines Convention Desk at (800) 445-4435.GROUP RATES (single/double occupancy) include daily buffet breakfast: American Airlines For discounts on American Airlines flights, please book online at Group Rates Convention Desk: www.aa.com and insert 46H2AZ into the promotion code box. For Room Type (Single/Double) Descriptions questions, please call the American Airlines Convention Desk at (800) 433-1790. Terrace View $199/night Views of the manicured grounds and tropical landscaping. Hawaiian Airlines For discounts on Hawaiian Airlines flights, please book online at Convention Desk: https://www.hawaiianair.com/affiliate/affiliate.aspx?affcode=SYMPOSIA MED Partial Ocean View $224/night Views of the manicured grounds, tropical landscaping, with partial ocean view. United Airlines Convention Desk: (800) 521-4041 563JI Ocean View $244/night Views of the manicured grounds, tropical landscaping, with ocean view. Premium Ocean View $264/night Highest floors in main building with panoramic CAR RENTAL DISCOUNT view of the beach and ocean. Also, view of the manicured grounds and tropical Symposia Medicus has arranged conference discounts with AVIS and Budget Car Rentals. landscaping. Reservations can be made by phone; please refer to the conference code and the conference/airport location when making your reservations. Please see below: Ocean Front $299/night In the building closer to the beach, with views of the beach and ocean. AVIS 800-331-1600 All guestrooms are approximately 630 sq. ft. and feature private lanai, mini-refrigerator, AWD # B766625 coffee maker with Kona blend coffee replenished daily, two Japanese yukatas (robes), two pairs of indoor slippers, complimentary shampoo/conditioner/body lotion, hair dryer, Budget 800-772-3773 television, complimentary safe, and nightly turn down service. BCD # U076767 By reserving with Symposia Medicus, self and valet parking is complimentary, as well as guest room internet connection and admission to the Fitness Center.Page 4 Conference Brochure #1237, 20 th Annual Fall Conference on Issues in Womens Health Since 1978
  5. 5. CONFERENCE LOCATION Aloha! Hawaii’s Big Island isn’t just big, it’s still growing. The Each guest room at the Hapuna Beach Prince Hotel has a private, Big Island of Hawaii is the youngest island in the Hawaiian furnished lanai, with picturesque views of lush gardens, partial chain and is also by far the biggest, providing a vast canvas of ocean, or full ocean views. Superb breakfast buffets are served in environments to discover a variety of unrivaled natural wonders. an indoor-outdoor area, while lunch and dinner options include a This is the home of one of the world’s most active volcanoes seafood grill, a steakhouse and sushi bar, and a poolside bar. Our (Kilauea), the tallest sea mountain in the world at more than group room rates include full buffet breakfast, as well as 30,000 feet (Mauna Kea), the largest by volume volcano in the complimentary internet, self and valet parking, and world (Mauna Loa) and the largest park in the state (Hawaii admission to the fitness center for each day of your stay. Volcanoes National Park). All but two of the world’s climate zones generate everything from lush rain forests to volcanic deserts, Water activities are plentiful at the Hapuna Beach Prince Hotel, snow-capped mountaintops to beautiful black sand beaches. from swimming, snorkeling, and scuba diving, to sailing, whale watching or deep-sea fishing. Pamper yourself at the Paul Brown Situated on the sunny Kohala Coast, the Hapuna Beach Prince Salon and Spa or spend an afternoon golfing on the 18-hole golf Hotel has defined Big Island luxury since its opening in 1994. course designed by Arnold Palmer and Ed Seay. Enjoy dining at Perfectly nestled into the bluffs above the #1-rated Hapuna the many varied restaurants located near the hotel. Kids will love Beach, the hotel features a contemporary Hawaiian style where sandcastle building or Lei making at the Prince Keiki Kids Club. guests experience the true essence of rejuvenation. The Hapuna Beach Prince Hotel is adjacent to its sister property, the Mauna The Hapuna Beach Prince Hotel’s beautiful and relaxing setting, Kea Beach Hotel. Guests at Hapuna Beach Prince Hotel are able to combined with our exciting 20th Annual Fall Conference on use and charge to their room the services and amenities at Issues in Women’s Health, makes this an opportunity not to be Mauna Kea. missed. 2012 CALENDAR OF FUTURE CONFERENCES (For our complete calendar of conferences, please visit www.symposiamedicus.org) 1215 19th Annual Spring Conference on Women’s Health Aruba, Dutch Caribbean Mar 14-17 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 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 1238 23rd Annual Conference on Hot Topics in Primary Care Medicine Aruba, Dutch Caribbean Nov 7-10 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 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 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 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 #1237, 20 th Annual Fall Conference on Issues in Womens Health Since 1978
  6. 6. CONFERENCE & LODGING REGISTRATION FORM SYMPOSIA MEDICUS Register on-line at www.symposiamedicus.org 20th Annual Fall Conference on OR complete this form and mail or fax with appropriate payment to: Issues in Women’s Health Symposia Medicus Hapuna Beach Prince Hotel 399 Taylor Blvd., Suite 201 Big Island, Hawaii Pleasant Hill, CA 94523-2287 October 31-November 3, 2012 Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795 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______ #1237 Our conference syllabus is available on paper or flash drive. 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): Session One: ____A ____B ____C ____D Session Two: ____A ____B ____C ____D LODGING RESERVATIONS Please reserve accommodations at Hapuna Beach Prince Hotel for: Arrival:____________________ ________/________/______ Departure:_______________________ ________/________/______ (DAY of the week) Month Day Year (DAY of the week) Month Day Year Group Rates (Single/Double Occupancy) - INCLUDES FULL BUFFET BREAKFAST Type of Room Group Rates • Above group rates do not include the • Mandatory additional person charges following (subject to change): (see below) include daily buffet breakfast, Terrace View $199/night - State and local taxes of 13.416% tax & gratuity: per room, per night - Children ages 5 and under are free Partial Ocean View $224/night - Mandatory porterage charge of $8.00 - Children ages 6-12 are $15 each, plus 4.166% tax per person, round trip per night Ocean View $244/night (17 years and older) - Persons ages 13 and older are $25 each, per night Premium Ocean View $264/night • Maximum room occupancy is three adults or two adults and two children (three adults • Rollaway beds are $60 per night (subject to Ocean Front $299/night and one child is OK). availability) – one per guestroom is allowed 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 #1237, 20 th Annual Fall Conference on Issues in Womens Health Since 1978