26th Annual Fall Conference on High Risk Obstetrics


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26th Annual Fall Conference on High Risk Obstetrics

  1. 1. 26th Annual Fall Conference on HIGH RISK OBSTETRICS Including topics on: Obstetric Emergencies, Severely Obese Gravida, Cardiac Disease in Pregnancy, Electronic Fetal Monitoring, Gestational Diabetes and much more... ANAHEIM MARRIOTT Anaheim, California (Near Disneyland/California Adventure) September 27-29, 2012 Sponsored by “I have been attending Symposia Medicus conferences for the last 19 years and I’m always amazed at the quality of speakers, fascinating locations and depth of knowledge gained. I recommend Symposia Medicus as theSymposia Medicus most integrative conferences at the forefront of medical practices.” A Non-Profit Corporation for -David W. French, MDContinuing Medical Education “Symposia Medicus speakers continue to give excellent presentations. Pleasant Hill, California They are always open to questions, both during and after the conference. Year after year I take home information that I can use to improve my practice.” -Gloria Yoder, CNM “Symposia Medicus chooses top notch speakers, who are highly credentialed and do a superb job of communicating information. The conferences are always well organized and stay on time! Thank you.” -Margueritte H. Kuhn, MD Since 1978 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 26 Annual Fall Conference on High Risk Obstetrics has been th Physiciansdesigned for physicians, certified nurse midwives, nurse practitioners, Symposia Medicus designates this live activity for a maximum of 19 AMAphysician assistants, nurses, and other healthcare professionals who face PRA Category 1 Credit(s)™. Physicians should claim only the creditchallenges in the care of the high risk pregnant patient. commensurate with the extent of their participation in the activity.The goal of this conference is to present current clinical data on key issues Application has been made with the American College of Obstetricians &in the care of the high risk obstetric patient. Topics for this year’s Gynecologists (ACOG) for cognates, Formal Learning.conference have been selected based on extensive target audience needsassessment data resulting from professional practice gaps. These gaps are This CME activity meets the requirements under California Assembly Billidentified by a variety of sources including feedback and evaluations from 1195, continuing education and cultural and linguistic competency.past participants, clinical expert input, Symposia Medicus’ online survey,and other medical and nursing data. Certified Nurse Midwives/Physician Assistants The American College of Nurse Midwives accepts Category 1 CMEThe outstanding faculty have been selected based on their individual areas approval from organizations accredited by the ACCME.of expertise, ability to communicate first-hand knowledge to others, andcommitment to address issues of current concern to attendees. The American Academy of Physician Assistants accepts Category 1 CME approval from organizations accredited by the ACCME.You are sure to enjoy this 26 th Annual Fall Conference on High RiskObstetrics while sharing ideas and experiences with colleagues from Nurse Practitioners/Nursesacross the country in the exciting setting of Anaheim, California. The ANCC contact hours awarded for the completion of this educational activity are 19.CONFERENCE OBJECTIVES Provider is also approved by the California Board of Registered Nursing, Provider # CEP2335, 22.8 contact hours.After participating in this conference, you should have an increasedknowledge of, and be more competent to… Pharmacology Credit for Prescriptive Authority A maximum of 3 hours in pharmacology credit for prescriptive authority• Manage acute endocrine and hypertensive emergencies during may be earned by attending this educational conference. Sessions pregnancy awarding pharmacology credit for prescriptive authority are denoted with an Rx in the schedule.• Avoid errors in intrapartum Electronic Fetal Monitoring• Manage the severely obese pregnant patient EDUCATIONAL RESOURCES• Identify and avoid litigation hot spots in the pregnant patient Each registrant will receive an extensive conference syllabus containing pertinent information on each topic presented. The syllabus is available• Use a practical approach to manage cardiac disease in pregnancy on paper (black and white type/photos) or on a flash drive (full color). Please make your syllabus choice on the conference registration form. By requesting your syllabus on a flash drive, you will not receive aACCREDITATION paper syllabus. If you request the flash drive syllabus and bring your laptop to the conference, be aware that there are no electrical outlets at theThis educational activity was planned and produced in accordance with the conference tables. Make sure your laptop is fully charged each day.ACCME and ANCC Essentials and Standards relating to continuing medicaland nursing education. Extra copies of this syllabus, whether on flash drive or paper, are available for purchase by writing, with payment ($60 for paper, $25 for flash drive)Symposia Medicus is accredited by the Accreditation Council on to: Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CAContinuing Medical Education (ACCME) to provide continuing 94523-2287 (please refer to syllabus #1232 and indicate type of mediamedical education for physicians. preferred).Symposia Medicus is accredited as a provider of continuing nursingeducation by the American Nurses Credentialing Center’s Commissionon Accreditation. SURROUNDING AREA & GROUND TRANSPORTATION Additional information about the Anaheim Marriott,Each participant should only claim credit commensurate with the extent of surrounding area and ground transportation will be sent.their participation in the activity.Certificates of credit will be given to participants on-site at the conclusion DISNEYLAND & CALIFORNIA ADVENTURE TICKETSof the conference. We have specially-priced Disneyland ® and California Adventure tickets. Please go to www.disneyconventionear.com/ZM2I12A for pricing and to purchase tickets.Page 2 Conference Brochure #1232, 26th Annual Fall Conference on High Risk Obstetrics Symposia Medicus Since 1978
  3. 3. CONFERENCE FACULTY CONFERENCE SCHEDULE Thursday, September 27 10:15 Managing the Acute Endocrine OBMark C. Alanis, MD, MSCR Emergencies of Diabetic Ketoacidosis &Assistant Professor 7:00am Conference Registration/Check-in Thyroid Storm (Rx = 20 minutes)Maternal-Fetal Medicine During Continental Breakfast Connie Graves, MDMedical University of South CarolinaCharleston, South Carolina 8:00 Conference & Faculty Introduction 11:00 EFM: Interpretation & Management: Connie Graves, MD An Interactive ReviewDonna Dizon-Townson, MD, FACOG David Miller, MDAssociate Professor 8:15 Thrombophilia: Who to Screen, When toDepartment of Obstetrics and Gynecology Screen & How to Treat (Rx = 15 minutes) 11:45 Questions & AnswersUniversity of Utah Health Sciences Donna Dizon-Townson, MD Group DiscussionSalt Lake City, Utah Faculty Panel & AudienceCo-Director, Maternal-Fetal Medicine 9:00 Managing Acute Emergencies Encountered When Administering Tocolytic Agents 12:15pm Lunch BreakUtah Valley Regional Medical CenterProvo, Utah (MgSO4, Indocin, Procardia) (Rx = 25 minutes) Connie Graves, MD 1:30 VBAC in 2012 Mark Alanis, MD, MSCRMichael R. Foley, MD, FACOG 9:45 BreakChief Medical Officer 2:15 High Risk Obstetrics Case Studies:Scottsdale Healthcare 10:00 Questions & Answers Litigation Hot SpotsScottsdale, Arizona Group Discussion Patricia Witcher, RNC-OB, MSNClinical Professor Faculty Panel & AudienceUniversity of Arizona 3:00 BreakSchool of Medicine 10:30 Stabilizing the Fetus During ObstetricTucson, Arizona Emergencies: Observation Versus 3:15 Antepartum Testing in High Risk Intervention (Rx = 15 minutes) Pregnancy: Choices in Acute OBConnie R. Graves, MD, FACOG Patricia Witcher, RNC-OB, MSN Emergency Needing Immediate ActionConference Chairperson (Rx = 10 minutes)Medical Director 11:15 The Severely Obese Gravida: Antepartum, David Miller, MDTennessee Maternal-Fetal Medicine Intrapartum & Postpartum ManagementDirector of Perinatal Services Mark Alanis, MD, MSCR 4:00 Questions & AnswersBaptist Hospital Group Discussion Noon Questions & Answers Faculty Panel & AudienceClinical ProfessorVanderbilt University Group Discussion Faculty Panel & Audience 4:45 Adjourn for the DayNashville, Tennessee 12:30 Lunch BreakDavid A. Miller, MD, FACOG Saturday, September 29Professor of Obstetrics, Gynecology 1:45 DIC in Pregnancy: Making it& Pediatrics Understandable 7:30am Continental BreakfastDivision of Maternal-Fetal Medicine Michael Foley, MDKeck School of Medicine 8:00 Understanding Cardiac Disease inUniversity of Southern California 2:30 Deep Venous Thrombosis (Rx = 30 minutes) Pregnancy: A Simple & Practical ApproachChildren’s Hospital Los Angeles Connie Graves, MD Michael Foley, MDMedical DirectorCHLA-USC Institute for 3:15 Break 8:45 Intrauterine Resuscitation: What’s theMaternal and Fetal Health Evidence? (Rx = 20 minutes)Los Angeles, California 3:30 Preterm Labor: Are We Ready for Patricia Witcher, RNC-OB, MSN Progesterone? (Rx = 15 minutes)Patricia M. Witcher, RNC-OB, MSN Donna Dizon-Townson, MD 9:30 Break (Hotel check-out, if applicable)Clinical Nurse SpecialistLabor and Delivery, Northside Hospital 4:15 Questions & Answers 10:00 Questions & Answers Group Discussion Group DiscussionAtlanta, Georgia Faculty Panel & Audience Faculty Panel & AudienceConsistent with ACCME and ANCC policy, 5:00 Adjourn for the Day 10:30 Hypertensive Emergencies in Pregnancy:faculty for this educational activity are asked An Innovative Approach to an Old Problemto disclose any commercial interests that may (Rx = 15 minutes)create or may be perceived as creating a Friday, September 28 Michael Foley, MDconflict related to the material they will bepresenting, as well as limitations on clinical 11:15 Ultrasound Diagnosis of Placenta 7:30am Continental Breakfaststudies presented, and any “off-label” use Accreta & Previasuggestions for medical products. Additionally, Mark Alanis, MD, MSCRSymposia Medicus Board, Planning Committee, 8:00 Intrapartum Fetal Heart Rate Monitoring:and Staff members have disclosed that they Using Standardized Management to Dealhave no significant financial relationships that with Acute Emergencies Noon Acute Respiratory Emergencies Duringcould pose a conflict of interest to the planning David Miller, MD Pregnancy (Rx = 15 minutes)of this conference. This information is intended Connie Graves, MDto assist you in forming your own judgments 8:45 Gestational Diabetes: An Updateabout content presented. Disclosure Donna Dizon-Townson, MD 12:45 Questions & Answersinformation will be included in your syllabus Group Discussionand/or verbally disclosed at the conference. 9:30 Break Faculty Panel & Audience 9:45 Questions & Answers 1:30pm Conference Adjourns Group Discussion Faculty Panel & Audience Rx = Pharmacology Credit for Prescriptive Authority will be granted for these sessionsPage 3 Conference Brochure #1232, 26th Annual Fall Conference on High Risk Obstetrics Symposia Medicus Since 1978
  4. 4. CONFERENCE REGISTRATION INFORMATION TERMS & CONDITIONSEnrollment for this conference is limited in order to provide the best possible learning • Above Group Rates do not include the following (subject to change):environment. Early registration is advised. - State and local taxes, currently 17%, plus $0.81 commerce fee, per room, per dayTUITION EARLY REGULAR • Maximum occupancy in room is 3 adults, or 2 adults and 2 children, or 3 adults and If postmarked by If postmarked after 1 child July 19, 2012 July 19, 2012 • Children 12 and under are free in room with adultPhysicians $610 $710Residents, Nurses, PAs & All Others $510 $610 • Third adult or child (over 12 years) is an additional $25 each, per night • Cribs and roll-away beds are available at no additional charge (subject to availability)• Tuition includes continuing education certification, extensive conference syllabus, continental breakfast and refreshments on Thursday, Friday, and Saturday. • Check-in time is 3:00pm and check-out time is Noon. A late check-out may be requested with the front desk the evening prior to departure (subject to availability).• Tuition may be paid by check, money order, Visa, MasterCard, or Discover. Charges may apply. • A 30-minute break has been allotted in our conference schedule on the last day for• Register on-line at www.symposiamedicus.org. those of you who need to check out.• Telephone registrations can be made Monday-Friday, 8:30am-5:00pm (Pacific Time), by calling (925) 969-1789 or (800) 327-3161. Registrations can also be CANCELLATION POLICIES faxed to (925) 969-1795. • 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• If paying by check, make payable and send with registration form to Symposia after August 23, 2012; however, tuition, less 10% processing fee may be applied to a Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. future Symposia Medicus conference.• Conference registration will be confirmed in writing and more information on travel, • Per our hotel contract, hotel reservation cancellations must be made in writing to hotel, and activities will be sent. Symposia Medicus and you will receive a full refund if postmarked by July 26, 2012. Between July 27, 2012 and August 23, 2012, one night’s deposit is forfeited. After• This conference meets the requirements for CE tax deductibility; however, we suggest August 23, 2012, no hotel refunds can be made. you consult your financial authority for more information. • All cancellations must be made in writing and postmarked by the dates stated above.• For additional conference or lodging information, call Symposia Medicus at • In the unlikely event of conference cancellation by Symposia Medicus, full tuition and (800) 327-3161 or (925) 969-1789, or visit our website at (if applicable) hotel deposit refunds will be made. Symposia Medicus will not be www.symposiamedicus.org. responsible for refunding travel or any other expenses.• For information on air reservations and ticketing assistance, you may either call AIR TRAVEL INFORMATION your travel agent or the airlines direct. Please see the Airline Travel Information portion of this brochure for further information. The closest airport to our conference hotel is John Wayne Airport (Orange County), which is an approximate 25 minute drive to the hotel; however, you can also fly into Long Beach Airport or Los Angeles International Airport. Long Beach is approximately 35 minutes from the hotel and Los Angeles is approximately 45 minutes from the hotel.CONFERENCE LODGING INFORMATION Symposia Medicus has arranged for discount fares with Alaska, American, Delta andGroup Rates have been arranged at the Anaheim Marriott. These rates will also be United Airlines for this conference. Reservations can be made either through your travelavailable three days before and three days after the conference, based on agency or through the airlines Convention Desk at the website or numbers listed here.availability, if you wish to extend your stay. In order to receive the discounted rate, you or your travel agent must refer to theTwo nights’ deposit (room rate only) must accompany your reservation. The balance of Symposia Medicus Group ID number listed below.lodging payment, as well as any incidental charges, is due to the hotel upon checkout.The hotel accepts most major credit cards. Airlines to John Wayne Airport (Orange County) and Los Angeles International Airport (Conference Discounts available):You can receive these rates by reserving the following ways: Alaska Airlines For discounts on Alaska Airline flights, please book• On-line at our website, www.symposiamedicus.org; OR Convention Desk: online at www.alaskaair.com and insert ECMG128 into the e-certificate code box. For questions, please call the• Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; Alaska Airline Convention Desk at (800) 445-4435. OR American For discounts on American Airline flights, please book• Fax form with Visa, MasterCard, or Discover to (925) 969-1795; OR Convention Desk: online at www.aa.com and insert 7292AZ into the promotion code box. For questions, please call the• By mail, make checks payable to Symposia Medicus and send with registration form to American Airlines Convention Desk at (800) 433-1790. 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. Delta For discounts on Delta Airlines flights, please book online atPlease note that our block of rooms is limited and on a first come, first served basis. Convention Desk: www.delta.com and click the box “from Airport” and anotherPLEASE RESERVE EARLY as rooms may sell out and/or room rates may increase. page will appear. At the bottom of that page, click the link “Meeting Event Code” and insert NM9H2. For questions, Group Rates please call the Delta Airlines Convention Desk at 800-328-1111. Room Type (Single/Double) Description United Airlines For discounts on United Airlines flights, please book online at Standard Room $155/night 300 sq. ft. room featuring either king or Convention Desk: www.ual.com and insert ZMTN245355 in the offer code box. double beds. Each room has air conditioning, For questions, please call the United Airlines Convention Desk 37” HD flat screen television, marble bathroom, at (800) 521-4041. chair with ottoman, safe in room, Airlines to Long Beach Airport (Conference Discounts available): hair dryer and ironing board. Internet is available at a discounted Alaska Airlines For discounts on Alaska Airline flights, please book rate of $1/day. Convention Desk: online at www.alaskaair.com and insert ECMG128 into the e-certificate code box. For questions, please call the Concierge Room $195/night Same features as standard rooms, but Alaska Airline Convention Desk at (800) 445-4435. includes access to the concierge lounge. Access includes complimentary hot breakfast United Airlines For discounts on United Airlines flights, please book online at buffet, midday snack, hors d’oeuvres, dessert Convention Desk: www.ual.com and insert ZMTN245355 in the offer code box. and late night snack. Please note, the For questions, please call the United Airlines Convention Desk concierge lounge is closed on Friday & at (800) 521-4041. Saturday. However, you will receive breakfast coupons (maximum of up to 4) that you can CAR RENTAL DISCOUNT redeem at Cafe Del Sol restaurant on Symposia Medicus has arranged conference discounts with AVIS and Budget Car Friday and Saturday. The restaurant Rentals. Reservations can be made by phone; please refer to the conference code and provides a full breakfast buffet. the conference/airport location when making your reservations. Please see below: Internet is available on a complimentary basis. AVIS 800-331-1600 AWD # B766625 BUDGET 800-772-3773 BCD # U076767 Some suites may be available. Please call us for availability and rates.Page 4 Conference Brochure #1232, 26th Annual Fall Conference on High Risk Obstetrics Symposia Medicus Since 1978
  5. 5. CONFERENCE LOCATION This exciting conference will be held at the Anaheim Marriott. Whether you want rest and relaxation, or entertainment and excitement, this location has it all. The hotel is only two blocks away from Disneyland and California Adventure, where you can experience everything these world-renowned theme parks have to offer. Knott’s Berry Farm, America’s first theme park, is less than 7 miles away. If you love baseball, Anaheim is home to the Angels. Nearby is Angel Stadium, where visitors can enjoy a game of baseball or tour this historic facility. Anaheim’s Garden Walk features some of the best shopping & dining in Southern California. If you’re looking for a day trip, take a 45-minute drive to downtown Los Angeles and experience the bustle of the second largest city in the U.S. You can walk down Rodeo Drive and search for movie stars, or explore the Hollywood Walk of Fame and see iconic signatures of Hollywood greats. Golfing, bike trails and horseback riding are also located nearby. Beach lovers can experience the beauty & excitement of Laguna and Newport Beach, just 20 minutes from the Marriott. The Anaheim Marriott features a swimming pool, whirlpool and a complimentary fitness center open 24 hours. Each guest room has luxurious beds with down comforters, high-speed internet access, and 37 inch HD flat screen televisions, among many other amenities available. The hotel boasts JW’s, one of the best steakhouses in Anaheim, featuring an intimate, unique setting offering prime meats and world-class wines. You’re sure to find many thrilling adventures in this exciting destination for our 26 th Annual Fall Conference on High Risk Obstetrics. 2012 CALENDAR OF FUTURE CONFERENCES (For our complete calendar of conferences, please visit www.symposiamedicus.org) 1208 16th Annual Winter OB/GYN Conference Maui, Hawaii Feb 8-11 1207 19th Annual Office GYN & Women’s Health for the Primary Care Provider Big Island, Hawaii Feb 15-18 1212 Winter Conference on Hot Topics in Women’s Health Breckenridge, Colorado Feb 29-Mar 3 1213 19th Annual Spring Conference on High Risk Obstetrics Maui, Hawaii Mar 7-10 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 1226 13th Annual Summer Conference on Women’s Health Atlantis Resort, Bahamas Aug 1-4 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 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 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 #1232, 26th Annual Fall Conference on High Risk Obstetrics Symposia Medicus Since 1978
  6. 6. CONFERENCE & LODGING REGISTRATION FORM Symposia Medicus Register on-line at www.symposiamedicus.org 26 th Annual Fall Conference on OR complete this form and mail or fax with appropriate payment to: High Risk Obstetrics Symposia Medicus Anaheim Marriott 399 Taylor Blvd., Suite 201 Anaheim, California Pleasant Hill, CA 94523-2287 September 27-29, 2012 Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795 PLEASE TYPE OR PRINT (Show name and one degree as you would like it printed on your conference materials): Registrant’s Name: ______________________________________________________________________________ Degree: _____________________ First Last Email 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: ___________________________________________________________________ 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. #1232 Please check here if you’d like your syllabus on flash drive. No paper syllabus will be given if you choose flash drive. LODGING RESERVATIONS Please reserve accommodations at the Anaheim Marriott for: Arrival:____________________ ________/________/______ Departure:_______________________ ________/________/______ (DAY of the week) Month Day Year (DAY of the week) Month Day Year GROUP RATES • Group Rates do not include the following (subject to change): ROOM TYPE (Single/Double) - State and local taxes, currently 17%, plus $0.81 commerce fee, per room, per day • Maximum occupancy in room is 3 adults, or 2 adults and 2 children, or 3 adults and 1 child Standard Room $155/night • Children 12 and under are free in room with adult • Third adult or child (over 12 years) is an additional $25 each, per night Concierge Room $195/night • Cribs and roll-away beds are available at no additional charge (subject to 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 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 #1232, 26th Annual Fall Conference on High Risk Obstetrics Symposia Medicus Since 1978