American College of PhysiciansFostering Excellence in Internal Medicine 2012 Texas Chapter Scientific Meeting Jointly Sponsored by Scott & White November 3–4, 2012 Omni Hotel Fort Worth, TXTimely Topics in Internal Medicine 2012 Register online now!
GOVERNOR’S LETTERTexas Chapter Dear Colleague, The Texas Chapter of the American College ofMeeting Highlights: Physicians—your partner and champion of internal medicine—is coming to Fort Worth in November! We• Associates’ and medical invite you, your friends, and your colleagues from all students’ clinical vignette across our great state to join us for this exceptional and poster competitions meeting. Scientific updates, procedural workshops, and the latest news and resources from the College will all be• Awards luncheon to recognize a part of the program to provide you with comprehensive our Young Physician Leader of tools for your practice. The 2012 annual meeting is the Year, Advocate of the Year, planned for Saturday and Sunday, November 3 and 4, Texas Chapter Laureates at the beautiful Omni Hotel in Fort Worth. and Volunteerism Award Pre-course sessions will provide the opportunity to obtain recipients credit toward American Board of Internal Medicine• Exhibit hall with the latest in (ABIM) Maintenance of Certification. The ABIM’s products and services for the Self-Evaluation Process Modules on Office-Based medical community Internal Medicine and Hospital-Based Internal Medicine will be offered on Friday, November 2, from 1:00 to• ABIM SEP modules on Office- 5:30 p.m. Seating will be limited to 30 to enable an Based Internal Medicine interactive learning format and audience response system. and Hospital-Based Internal In addition to earning CME credits, you will enjoy the Medicine for recertification opportunity to: • Fulfill the one-hour ethics requirement for renewal of your medical license. • Discuss local and national issues affecting the practice of internal medicine. • Greet old friends and meet new ones. • Bring your family and enjoy all that Fort Worth has to offer. Steven Weinberger, MD, FACP, Executive Vice President and Chief Executive Officer of the American College of Physicians, will attend our meeting to talk aboutScott & White Hospital medicine’s issues from the national perspective. More important, he wants to hear from you and understanddesignates this live activity the unique viewpoint of our Texas Chapter members.for a maximum of 16 AMA The annual meeting provides an Administrator oppor- tunity to make your voice heard by ACP leadership.PRA Category 1 Credits TM. Visit the annual meeting Web page at www.txacp.orgPhysicians should claim to register, or complete the form at the back of thisonly credit commensurate brochure and mail or fax it today.with the extent of their Of course, the Texas ACP meeting is not limited to ACP members. Nonmembers are welcome to join us for thisparticipation in the activity. important clinical update and to learn about the benefits of membership at the same time. We encourage you toThe 16 AMA PRA Category 1 share this information with your colleagues.CreditsTM includes 4 hours Sincerely,total for the optional ABIM Clark R. Gregg, MD, FACP Governor, ACP Texas Northern RegionRecertification SEP modules Robert E. Jackson, MD, FACPand 2 hours for the optional Governor, ACP Texas Southern Regionbreakfasts. Sue S. Bornstein, MD, FACP Governor-elect, ACP Texas Northern Region Felicia Austin, MD, FACP President, ACP Texas Chapter
SCIENTIFIC PROGRAM ANDSPECIAL EVENTSFriday, November 2, 2012 10:15 Break Visit the exhibits and the1:00– ABIM Recertification SEP Module: College display3:00 p.m. Office-Based Internal Medicine (Advance registration required. 10:40– Associates’ Clinical Vignette Additional registration fee 11:50 a.m. Competition applies. Limited to 30 (order to be determined) participants.) Moderator: Stephen J. Sibbitt, MD, FACP Suma Pokala, MD, FACP Curtis R. Mirkes, DO, FACP Bowel-Associated Dermatitis-Arthritis Syndrome in a Nonsurgical Patient3:30–5:30 ABIM Recertification SEP Module: Elan Gada, MD Hospital-Based Internal Medicine (Advance registration required. Aortic Valve Associated Primary Additional registration fee Cardiogenic Lymphoma applies. Limited to 30 Fahmi Farah, MD participants.) A Spongy Heart Stephen J. Sibbitt, MD, FACP Christopher W. Larson, DO Curtis R. Mirkes, DO, FACP Polycythemia Vera-ces Kaushal Patel, MDSaturday, November 3, 2012 Fishing for a Diagnosis7:00 a.m. Registration Arati Rani Chand, MD Continental breakfast with 12:00 Texas Chapter Annual Business the exhibitors Meeting and Awards Luncheon7:00 Women in Medicine Networking Breakfast Plenary Session Moderator: Moderator: Clark R. Gregg, MD, FACP Sue S. Bornstein, MD, FACP 1:30 p.m. On Being a Doctor: The New Doctor: Temple S. Howell-Stampley, The Impact of Generational Shifts MD, FACP and a Changing Medical Educational Environment.7:00 Advancement to Fellowship Winner of the Associate/ Breakfast Medical Student writing Moderators: competition to be announced Clark R. Gregg, MD, FACP 1:45 GERD/Barrett’s Esophagus/ Robert E. Jackson, MD, FACP Esophageal Cancer Stuart Spechler, MDPlenary Session 2:30 Office Evaluation of CommonModerator: Daniel M. Goodenberger, Orthopedic Problems MD, MACP Stephen Brotherton, MD8:00 Welcome 3:15 Break Clark R. Gregg, MD, FACP Visit the exhibits and8:00 Adult Congenital Heart Disease: College display What the Primary Care Provider 3:40 ACP in the Era of Health Care Reform Needs to Know Steven Weinberger, MD, FACP Beth Brickner, MD 4:25 Sarcoidosis: Chasing an Elusive8:45 To Test or Not to Test: Genetic Testing Disease in Adults Steven Weinberger, MD, FACP Dimple Sureka, MD 5:10 Adjourn9:30 Stump the Professor 5:30– Cocktail Reception and Awards Mark Feldman, MD, MACP 7:00 p.m. Presentations
SCIENTIFIC PROGRAM ANDSPECIAL EVENTSSunday, November 4, 2012 Optional Pre-Course Learning7:30 a.m. Registration Sessions Continental breakfast with the exhibitors Friday, November 2, 20127:30–8:30 Advocacy Update 1:00– ABIM Self-Evaluation Process Moderators: 3:00 p.m. Module: Office-Based Internal Jack Myers, MD, FACP Medicine Stephen J. Sibbitt, MD, FACP Alejandro Moreno, MD, MPH, JD, FACP Curtis R. Mirkes, DO, FACP7:30–8:30 Council of Young Physicians 3:30–5:30 ABIM Self-Evaluation Process Breakfast Module: Hospital-Based Internal Medicine Moderators: Stephen J. Sibbitt, MD, FACP Pete Yunyongying, MD, FACP Curtis R. Mirkes, DO, FACP Amy LaViolette, MD, FACP Each module is limited to 30 partici-Plenary Session pants. Advance registration and additional registration fee required.Moderator: Daniel M. Goodenberger, See registration form. MD, MACP Learn in an interactive environment8:30 a.m. Welcome as clinical experts lead discussion of 20 Clark R. Gregg, MD, FACP case-based questions from American8:30 a.m. Gout: Managing an Ancient Disease Board of Internal Medicine’s Self- With Conventional and Newer Agents Evaluation Process (SEP) Modules on Salahuddin Kazi, MD, FACP Office Based Internal Medicine and Hospital Based Internal Medicine.9:15 A Window to the Body: Ocular The primary purpose of the session is Manifestations of Systemic Diseases to facilitate completion of SEP mod- Rafael Ufret-Vincenty, MD ules for Maintenance of Certification10:00 MEN for the Internist (MOC) credit. After ordering the Hans K. Ghayee, DO, ACP modules from ABIM, participants Member will submit answers at the completion10:45 Break of the session for credit toward the Visit the exhibits and the MOC program. College display11:10 Ethics and Law at the End of Life Elizabeth Polanco, MD12:10 p.m. Adjourn
M E E T I N G I N F O R M AT I O NFACULTY Clark R. Gregg, MD, FACP, Governor, ACP Texas NorthernSue S. Bornstein, MD, FACP, Region; Chief of Staff, VeteransPast-President, Governor-elect, ACP Affairs North Texas Health CareTexas Northern Region, ACP Texas System; Professor of Medicine,Chapter, Executive Director, Texas Department of Internal Medicine,Medical Home Initiative, Dallas Division of Infectious Diseases,Beth Brickner, MD, Professor of University of Texas SouthwesternInternal Medicine, Director of the Medical Center at Dallas, Fort WorthAdult Congenital Heart Disease Robert Jackson, MD, FACP,Clinic, University of Texas Governor, ACP Texas SouthernSouthwestern Medical Center, Dallas Region; Clinical Professor ofStephen Brotherton, MD, Bone and Medicine, Weill Cornell MedicalJoint Clinic, Texas Health Care Fort College, HoustonWorth; Adjunct/Clinical Faculty, Salahuddin Kazi, MD, FACP, ChiefTexas Christian University and Health Informatics Officer, VeteransFort Worth Affiliated Hospitals Affairs North Texas Health CareOrthopedic Residency Program; System; Associate Professor of InternalPresident-Elect of the Texas Medical Medicine, Division of Rheumatology,Association, Fort Worth University of Texas SouthwesternArati Rani Chand, MD, ACP Medical Center, DallasAssociate, Winner, Northwest Christopher W. Larson, DO, ACPRegional Associates’ Clinical Vignette Associate, Winner, Far NorthwestCompetition, Texas Tech University Regional Associates’ Clinical VignetteHealth Sciences Center Amarillo, Competition, William BeaumontAmarillo Army Medical Center, El PasoElan Gada, MD, ACP Associate, Amy LaViolette, MD, MPH, FACP,Winner, Northeast Regional Associates’ Assistant Professor, University ofClinical Vignette Competition, Texas Southwestern Seton Family ofUniversity of Texas Southwestern Hospitals, AustinMedical Center, Dallas Curtis R. Mirkes, DO, FACP,Hans K. Ghayee, DO, Assistant Assistant Professor of Medicine,Professor of Medicine, University Associate Residency Programof Texas Southwestern Medical Director, Department of InternalCenter, Dallas Medicine, Scott & White MemorialFahmi Farah, MD, ACP Associate, Hospital, Texas A&M UniversityWinner, Southwest Regional Associates’ Health Science Center College ofClinical Vignette Competition, Texas Medicine, TempleA&M Health Science Center at Scott Alejandro Moreno, MD, MPH, JD,& White, Temple FACP, FCLM, Associate Director,Mark Feldman, MD, MACP, Internal Medicine Residency Program,William Tschumy Chairman of the University of Texas SouthwesternDepartment of Internal Medicine, Residency Programs at Seton FamilyMedical Director for Research, of Hospitals, AustinPresbyterian Hospital of Dallas; John D. ‘Jack’ Myers, MD, FACP,Clinical Professor of Internal Associate Professor of Medicine,Medicine, University of Texas Vice Chair for Educational Affairs,Southwestern Medical Center, Dallas Director, Division of General InternalDaniel M. Goodenberger, MD, Medicine, Scott & White HospitalMACP, Chief, Medical Service, and Clinic, TempleVeterans Affairs North Texas Kaushal Patel, MD, ACP Associate,Health Care System, Professor and Winner, Southeast Regional Associates’Vice-Chair, Internal Medicine, Clinical Vignette Competition,University of Texas Southwestern Baylor College of Medicine, HoustonMedical Center, Dallas
M E E T I N G I N F O R M AT I O NSuma Pokala, MD, FACP, Assistant Special Events for MedicalProfessor of Medicine, Departmentof Internal Medicine, Central Texas Students and AssociatesVeterans Health Care System, TexasA&M University System College of FridayMedicine, Temple 4:00– Medical Students’ and Associates’Elizabeth Polanco, MD, Veterans 6:00 p.m. Poster Set-upAffairs North Texas Health CareSystem, Associate Professor, Internal SaturdayMedicine, University of Texas 7:00– Medical Students’ and Associates’Southwestern Medical Center, Dallas 9:00 a.m. Poster Set-upStephen J. Sibbitt, MD, FACP, 9:00–10:30 Medical Students’ Clinical VignetteAssociate Professor of Medicine, CompetitionDepartment of Internal Medicine, Moderator: Gene Stokes,Chief Medical Officer, Scott & White MD, FACPMemorial Hospital, Texas A&MUniversity Health Science Center 10:35–11:50 Associates’ Clinical VignetteCollege of Medicine, Temple Presentations and Competition (during Plenary Session)Stuart Spechler, MD, Chief,Gastroenterology Section, Veterans Moderator: Suma Pokala,Affairs North Texas Health Care MD, FACPSystem, Professor of Medicine, Patterson 1:30 p.m. On Being a Doctor: The NewChair in Gastroenterology, University Doctor: The Impact of Generationalof Texas Southwestern Medical Shifts and a Changing MedicalCenter, Dallas Educational Environment. TheTemple Howell-Stampley, MD, FACP, winning author of the On Being aAssociate Professor of Internal Medicine, Doctor writing competition forUniversity of Texas Southwestern Medical Student and AssociateMedical Center, Dallas members will give a 10-minute oral presentation during theDimple Sureka, MD, Clinical Plenary Session.Assistant Professor of Genetics, EugeneMcDermott Center for Human Growth 2:00–4:30 Medical Students’ and Associates’& Development, University of Texas Poster Exhibition and CompetitionSouthwestern Medical Center, Dallas Moderators: Karen E.Rafael Ufret-Vincenty, MD, Szauter, MD, FACP, andAssistant Professor, Department of Suma Pokala, MD, FACPOphthalmology, University of Texas 5:30–7:00 Cocktail ReceptionSouthwestern Medical Center, Dallas Winners of the poster andSteven Weinberger, MD, FACP, clinical vignette competi-Executive Vice President and CEO, tions will be announced.American College of Physicians;Adjunct Professor of Medicine, SundayUniversity of Pennsylvania School 11:30 a.m.– Associates’ Luncheon and Doctor’sof Medicine, Philadelphia, PA 2:00 p.m. DilemmaTM CompetitionPete Yunyongying, MD, FACP, Moderators: George E.Veterans Affairs North Texas Health Crawford, MD, FACP, andCare System, Instructor, Internal Suma Pokala, MD, FACPMedicine, University of TexasSouthwestern Medical Center, Dallas
M E E T I N G I N F O R M AT I O NMedical Students’ and AwardsAssociates’ Activities The annual business meeting and awardsMedical students and residents are luncheon on Saturday, November 3,invited to participate in all annual will include recognition of the recipi-meeting events, especially those ents of the Texas Chapter Laureatesactivities designed specifically for Award, Texas Chapter Volunteerismtheir interests. Although registration and Community Service Award,is free, students and residents must Advocate of the Year Award, and theregister for the meeting in advance. Young Physician Leadership Award.Winners of the five regional Associates’ Evergreen Awardclinical vignette competitions will The John Tooker Evergreen Programpresent their cases in the statewide was created in 1993 by the Collegecompetition during the plenary session to recognize and reward outstandingon Saturday morning. The winner will chapter efforts. The John Tookeradvance to ACP’s national competition Evergreen Program provides visibilityin San Francisco in April 2013. to those chapters that have beenMedical students will present clinical successful in implementing programsvignettes in a competition, with the that increase member communicationwinners to receive cash prizes. The and involvement.student who achieves first place will Each year all chapters are invited tobe eligible for the national competition nominate their own programs and toat the 2013 ACP annual meeting. provide details on the goals of theFirst-, and second-place winners will program, how it was implemented,be named in the Medical Students’ and what the results were. The Chaptersand Associates’ poster competitions. Subcommittee has the difficult taskStudents and Associates are also of selecting a small group of winningencouraged to submit original prose chapters, which are recognizedor poetry dedicated to the theme nationally and locally for theirThe New Doctor: The Impact of achievements.Generational Shifts and a Changing We are excited to announce the 2012Medical Educational Environment John Tooker Evergreen Award willfor the On Being a Doctor writing be presented to our chapter for thecompetition. The winning author of Texas Medical Home Initiative.the On Being a Doctor competitionwill share his or her composition in a Chapter Excellence Award10-minute oral presentation during Winnerthe Plenary Session on Saturday. We are proud to announce that theThe thirteenth annual Doctors’ Texas Chapter is the recipient of aDilemmaTM statewide competition 2011 Chapter Excellence Award. Thewill begin with a luncheon on Sunday. Chapter Excellence Award recognizesAll Internal Medicine residency pro- those chapters that excel in reachinggrams in Texas are invited to register the highest standards for managing atheir team in advance and come join chapter, such as communicating toin the fun. members, hosting medical student andVisit the TXACP Web site at associate activities, and recruiting andwww.txacp.org for complete details advancing members.on all of the student and residentevents, or call the Chapter BusinessOffice at 512-370-1508.
M E E T I N G I N F O R M AT I O NAcknowledgments A course evaluation form will provide participants the opportunity to review(as of July 2012) each session and speaker and suggestThis program is supported, in part, by future topics.unrestricted grants from:Gold Level Who Should Attend • General internists• Texas Health Harris Methodist Foundation • Subspecialty internists • Family physiciansCME Development and • Fellows in subspecialty trainingAccreditation • Allied health practitionersThis activity has been planned andimplemented in accordance with the • ResidentsEssential Areas and Policies of the • Medical students interested inAccreditation Council for Continuing internal medicineMedical Education (ACCME) throughthe joint sponsorship of Scott & White Syllabusand the Texas Chapter of the ACP. The syllabus will be available onlineScott & White is accredited by the before the meeting so attendees canACCME to provide continuing print out the syllabus in advance.medical education for physicians. More information will be sent to eachScott & White designates this live attendee after they register regardingactivity for a maximum of 16 AMA the online passphrase and password.PRA Category 1 CreditsTM. Make sure to include a primary e-mail address on the registration form so thatPhysicians should claim only credit this information can be distributed.commensurate with the extent oftheir participation in the activity. Learning ObjectivesThe 16 AMA PRA Category 1CreditsTM includes 4 hours total for At the conclusion of this activity,the optional ABIM Recertification the participant should be able to:SEP modules and 2 hours for the • Analyze the approach to theoptional breakfasts. diagnosis and counseling of theThe ABIM Recertification SEP patient with a heritable diseasemodules on Friday, November 2, from • Review the diagnostic approach to1:00–3:00 p.m. and 3:30–5:30 p.m., the adult patient with suspectedare each approved for an additional congenital heart disease2 AMA PRA Category 1 CreditsTM • Outline the presentation andfor a total of 4 AMA PRA Category evaluation of patients and families1 CreditsTM. with multiple endocrine neoplasiaThe following session is approved for • Describe recent developments inethics credit: “Ethics and law at the palliative careend of life,” Plenary Session, Sunday,November 4, 11:10 a.m. (1 hour). • Identify the relationship between GERD, Barrett’s esophagus, andThe need for this program was esophageal cancer, with greateridentified from the results of a survey understanding of prevention andof evaluations and suggestions from treatmentpast participants, along with inputfrom the chapter’s Education Committee. • Review the approach to the diagnosisThe program will consist of lectures, and treatment of sarcoidosissupplemented with audiovisualpresentations.
M E E T I N G I N F O R M AT I O N• Update diagnostic and therapeutic Parking skills for common outpatient Valet parking is available for orthopedic problems overnight guests at $22 per night.• Discuss the latest treatment of gout Overnight self-parking is $14.• Recognize ocular clues to the Airport Shuttle diagnosis of important systemic The Omni Fort Worth does not offer diseases complimentary shuttle service from the airport, but the hotel conciergeHotel Accommodations is available at 800-258-3826 to assist you in making your arrangements forAs breathtaking as any West Texas a shuttle or limousine services.sunset, the Omni Fort Worth Hoteloffers a taste of Texas hospitality. Driving DirectionsConveniently located at the heart of Visit www.omnihotels.com/Fort Worth’s exciting downtown area, FindAHotel/FortWorth/the hotel is within walking distance from MapAndDirections.aspx, orthe city’s cultural centers, restaurants, call the hotel concierge forand nightlife. Retreat to your luxurious assistance at 800-258-3826.guest room accommodations for arestful night’s sleep after you exploreFort Worth.The host hotel is more than just aconvenient place to stay during theannual meeting. TXACP contractswith a host hotel each year, promisinga minimum number of sleeping roomsto the hotel. In return, the hotel offersTXACP complimentary or reducedmeeting room rental and other servicesthat make the chapter meeting a success.By booking your room at the host hotel,you will help to keep registration costsand member dues low.A special block of rooms has beenreserved at the:Omni Fort Worth1300 Houston StreetFort Worth, TX 76102To make reservations, dial800-THE-OMNI or 800-843-6664and mention that you are attendingthe TXACP meeting to receive thegroup rate.Rates:Single/Double occupancy: $174This rate is available to registrantsuntil the room block is full orThursday, October 11. The specialgroup rate is available one day beforeand one day after the meeting, basedupon availability.
HOW TO REGISTERTo register online for the meeting, go to www.txacp.org, then select “AnnualMeeting.”To register via fax or mail, complete the attached registration form and return itwith your check made payable to Scott & White or with credit card information to: Scott & White Department of Continuing Medical Education 2401 South 31st Street, MS 26–A229 Temple, TX 76508 Phone: 800-724-7280 or 254-724-7609 FAX: 254-724-1753*There is an additional $20 fee for registering onsite at the meeting. Save money by registering early.*Registrations received prior to October 19 will receive confirmation in the mail or by e-mail.*Refunds (minus a $50 administration fee) will be provided to registrants who cancel their registration in writing prior to October 19. No refunds will be provided for cancellations received after October 19.Registration fee includes all scientific plenary sessions and materials, Saturdaycocktail reception, continental breakfasts and refreshment breaks, luncheon onSaturday, and CME certificate. An additional registration fee is required for theABIM SEP Module pre-course.To access online meeting information or to print another registration form for acolleague, go to www.txacp.org, Annual Meeting.For questions about the meeting, contact:Texas Chapter Business OfficePhone: 512-370-1508E-mail: email@example.comFor information on College-related issues, contact your Governor:Clark R. Gregg, MD, FACPTexas Northern RegionPhone: 214-857-1150E-mail: firstname.lastname@example.orgRobert E. Jackson, MD, FACPTexas Southern RegionPhone: 713-791-9305E-mail: email@example.com
HOW TO REGISTER FORABIM SEPObtain credit toward your American Board of Internal Medicine Maintenanceof Certification (MOC) on Friday, November 2, from 1:00–5:30 p.m., in FortWorth at the TXACP annual chapter meeting. TXACP faculty will present twoABIM Self Evaluation Process Modules, 2012 Updates in Office-Based InternalMedicine and Hospital-Based Internal Medicine, as pre-courses to the annualchapter meeting. Each SEP module contains 20 to 25 multiple-choice questionsto be completed through group discussion and with the help of an automatedaudience response system.Upon completion of the session, attendees will be able to submit their answersto ABIM for scoring and points toward the self-evaluation of knowledgerequirement associated with the MOC Program.Advance registration is required and will be limited to 30 participants.The fee for each Learning Session is $75 for ACP members and $125 for non-members. The fee covers the costs for the educational support and refreshmentsprovided at the session and should be paid directly to TXACP.To participate in this session:1) Register in advance by completing the TXACP Annual Meeting registration form in the brochure or online, select the ABIM SEP Modules under “Special Events,” and submit registration fee to TXACP.2) If you are enrolled in the ABIM MOC process you may order your SEP modules from ABIM at www.abim.org/online/ or call 800-441-2246 prior to the session to expedite receiving credit for the SEP modules from ABIM.3) You may bring your modules with you to the Learning Session; note that we will provide all course registrants with a printed version of the SEP modules onsite.4) Submit your answers to ABIM for MOC credit after the Learning Session via the ABIM Web site (for immediate results).For more information about ABIM’s MOC program, visit www.abim.org/moc/or call 800-441-2246.Program CommitteeClark R. Gregg, MD, FACP, Governor, ACP Texas Northern Region,Fort Worth, TXDaniel M. Goodenberger, MD, MACP, Local Program Committee Chair,Dallas, TXSpecial ConsiderationsWe do try to control the temperature in the meeting room, but for your comfort,please bring a jacket.
R E G I S T R AT I O N F O R M CMBAmerican College of Physicians RM1339Texas Chapter Scientific MeetingNovember 3–4, 2012This form may be photocopied.ACP # (found on mailing label)Name t MD t DOAddressCity/State/ZipDaytime PhoneFaxE-mailt Please check here to indicate a permanent change to your preferred address for all College mailings.t Yes, I do wish to receive information from the meeting exhibitors.Registration Fees:Check one category that best applies. Registration fee includes continentalbreakfast, lunch, all scientific sessions and materials, and a CME certificate.ACP Categories:t Master t Fellow t Member ................................................................... $195t Associate (Resident Member)............................................................... No Feet Medical Student Member ..................................................................... No Feet Affiliate Member (Allied Health Professional) ........................................ $195Nonmember Categories:t Nonmember Physician ............................................................................. $245t Nonmember Resident ........................................................................... No Feet Nonmember Medical Student .............................................................. No Feet Nonmember Allied Health Professional .................................................. $245Special Events and Fees:t ABIM SEP Module IM – Office Based 2012, 1:00 p.m., November 2 (Member rate) ....................................................................... $75t ABIM SEP Module IM – Office Based 2012, 1:00 p.m., November 2 (Nonmember rate)............................................................... $125t ABIM SEP Module IM – Hospital Based 2012, 3:30 p.m., November 2 (Member rate)........................................................................ $75t ABIM SEP Module IM – Hospital Based 2012, 3:30 p.m., November 2 (Nonmember rate)............................................................... $125t Advancement to Fellowship Breakfast, 7 a.m., November 3 ................. No feet Women in Medicine Breakfast, 7 a.m., November 3 ............................. No feet Council of Young Physicians Breakfast, 7:30 a.m., November 4 .......... No Feet Advocacy Update Breakfast, 7:30 a.m., November 4............................ No Feet Guest Luncheon Ticket, Noon, November 3 ............................................ $ 35 GRAND TOTAL $ ______________
R E G I S T R AT I O N F O R M CMB Please bill my: Account Number: __________________________________________________ Name on Card: ___________________________________ Exp. Date: ________ MM / YY Signature: ____________________________________________________ _____ Total $ ______________ With credit card payment, register online at www.txacp.org, or fax completed form to 254-724-1753. By mail, make your check payable to Scott & White and send to: Scott & White Department of Continuing Medical Education 2401 South 31st Street, MS 26–A229 Temple, TX 76508 Questions about registering? Please call Scott & White at 800-724-7280 or 254-724-7609 Special Considerations: t Check if you are disabled and require assistance. Attach a written description of needs and submit with your registration or contact Texas Chapter of ACP by October 19. t Check if you require a vegetarian diet.Cut Here¡
190 N. Independence Mall West NONPROFIT Philadelphia, PA 19106-1572 ORG. U.S. POSTAGE PAID ACP 2012 Texas Chapter of the ACP Scientific Meeting Jointly Sponsored by Scott & White November 3–4, 2012 Omni Hotel Fort Worth, TXCHS2001