Advances in Diagnostic Radiology with Advanced Radiology Life Support (ARLS) Course
DEPARTMENT OF RADIOLOGYAdvances in DiagnosticRadiology withAdvanced Radiology LifeSupport™ (ARLS) CourseApril 21, 2013 – Advanced Radiology Life Support™ (ARLS)April 22-26, 2013 – Advances in Diagnostic RadiologyThe Ritz-Carlton, Dove MountainMarana, Arizona 4 Self-Assessment Modules (SAMs) Available!REGISTER TODAY!http://www.mayo.edu/cme/radiology.html
GENERAL INFORMATIONAdvances in Diagnostic Radiology withAdvanced Radiology Life Support™ (ARLS) CourseDATE AND LOCATIONAdvanced Radiology Life Support™ (ARLS) will be held Sunday, April 21, 2013.Advances in Diagnostic Radiology will be held Monday, April 22 throughFriday, April 26, 2013.Meeting headquarters will be located at The Ritz-Carlton, Dove Mountainin the scenic town of Marana, Arizona (30 minutes outside of Tucson). Thisunforgettable luxury hotel is set high in the Sonoran Desert and featurespicturesque views of the Arizona desert and the majestic backdrop of thenearby Tortolita Mountains.Visit http://www.ritzcarlton.com/en/Properties/DoveMountain/Default.htmfor more information.TRAVELThe Ritz-Carlton, Dove Mountain is located approximately 30 miles(50 minutes) from the Tucson International Airport (TUS). The Ritz-Carlton,Dove Mountain does not provide complimentary airport shuttle service, butother transportation options are available. Nine major rental car companiesare represented at TUS and are located adjacent to the main terminal. A one-way taxi fare to The Ritz-Carlton, Dove Mountain is approximately $75.00USD. Rate is subject to change.Course attendees may also find it convenient to utilize Phoenix Sky HarborInternational Airport (PHX), located approximately 100 miles from The Ritz-Carlton, Dove Mountain. PHX is served by most major airlines and rental carcompanies.Travel arrangements are the sole responsibility of the individual registrant.LODGING ACCOMMODATIONSThe Ritz-Carlton, Dove Mountain is a refined desert oasis that reflectsthe local landscape and culture of Tucson and the Sonoran Desert. Guestaccommodations feature a taste of Southwestern flair by incorporating a mixof modern comforts and authentic, hand-crafted architectural details. Guestswill enjoy a vast array of luxurious amenities, including the Jack NicklausSignature Golf course, The Ritz-Carlton Spa®, Dove Mountain, as well as theadded convenience of the city of Tucson less than 30 minutes away.Days filled with adventure await guests as they experience 20 miles of deserthiking and biking trails, three swimming pools, including a 235 foot waterslide, and four Plexicushion tennis courts. The Dove Mountain Rangersprogram will also entertain younger guests ages 5-12 with supervisedprograms that combine both physical and creative activities.
LODGING ACCOMMODATIONS - continuedThe Ritz-Carlton, Dove Mountain15000 North Secret Springs DriveMarana, Arizona, 85658520-572-3000Guest rooms have been reserved for attendees and their guests with aspecial course rate:Run of House: $239 per nightPlease note that the resort activity package is included in the room rate.Porterage and housekeeping gratuities are at the individual’s discretion.There is no charge for persons sharing a room, but the maximum occupancyis 4 people per room. Taxes are not included in the above mentioned rate.Special group rates are offered April 17, 2013 through April 30, 2013 basedon availability. Reservations can be made by calling 800-686-2747 andrequesting the Reservations Department. Please identify yourself as aparticipant in the Mayo Clinic Advances in Diagnostic Radiology course whenmaking your reservation.Reservations may also be made online at: http://www.ritzcarlton.com/en/Properties/DoveMountain. The group code is: MAYMAYA.In order to receive the special rate, reservations must be made prior toMarch 26, 2013. Reservations will be taken following this date based onspace and rate availability.Hotel check-in time is 4:00 p.m. on the day of arrival, and check-out time isbefore 12:00 p.m. on the day of departure.Lodging arrangements are the sole responsibility of the individual registrant.Mayo Clinic Department of Radiology CME Office is not responsible forexpenses incurred by an individual who is not confirmed and for whomspace is not available at the meeting. Costs incurred by the registrant suchas airline or hotel fees or penalties are the responsibility of the registrant.
PARKINGOvernight valet parking is $15.00 per night, and daily valet parking is $5.00.Self-parking is complimentary but availability is very limited.SOCIAL PROGRAMSWelcome Reception – Monday evening, April 22, 2013Attendees and guests are cordially invited to join course faculty forthe Welcome Reception on Monday evening, April 22, 2013 at The Ritz-Carlton, Dove Mountain. This casual reception welcomes you to Arizona,officially opens the course, and offers you the perfect opportunity to makeconnections with existing and new colleagues. Pre-registration is requested.RECREATION/LEISURE ACTIVITIESGOLF – Legendary champion Jack Nicklaus took advantage of the HighSonoran Desert setting to integrate strategy, variety and fair shot values intohis Signature Design luxury golf course at The Ritz-Carlton Golf Club, DoveMountain in Arizona.Nicklaus created 27 holes with unique challenges and distinct character,blending naturally among noble saguaros and the surrounding TortolitaMountain Range. This luxury golf resort has elevations ranging from 2,300to 3,200 feet to challenge even the most seasoned pro. Enjoy executing thesame golf shots that require the imagination and creativity from the world’sleading champions at this breathtaking resort. Nicklaus purposefullydesigned this luxury golf course to be challenging yet enjoyable to play timeand time again. Call 520-572-3500 to reserve your tee time.SPA – Step into a world of comfort and escape to the solitude of The Ritz-Carlton Spa®, Dove Mountain – a breathtaking luxury spa resort in Arizona.This Tucson spa resort is a rare place on earth where guests will enjoyeco-holistic therapies based upon balancing elements, while healing sacredstones preserve the heritage and time-honored traditions of the SonoranDesert. Let the healing touch of professional therapists melt away the caresand distractions of life. Call 520-572-3000 to make your appointment.
REGISTRATIONTo register online, visit http://www.mayo.edu/cme/radiology.html or complete theattached registration form and return by mail or fax (507-266-3061).The registration fees for ARLS and Advances in Diagnostic Radiology coursesinclude:• Course Tuition• Comprehensive Course Syllabus on Flash Drive• Continental Breakfasts and Break Refreshments (meeting participants only)• Welcome ReceptionAlthough it is not Department of Radiology CME policy to limit the numberof registrants for a course, conference room facilities may necessitate closingof enrollment; therefore, early registration is advised. A letter of confirmationwill be sent upon receipt of payment and completed registration. Please presentthe confirmation letter when checking in at the meeting registration desk.For additional information, contact:Mayo Clinic Department of RadiologyContinuing Medical Education OfficeMayo, W-2200 First Street SWRochester, MN 55905Website: www.mayo.edu/cme/radiology.htmlE-mail: firstname.lastname@example.orgPhone: 866-246-1581Fax: 507-266-3061CANCELLATION POLICYIf you cancel your participation in this course, your registration fee, lessa $75 administrative fee, will be refunded when written notification isreceived by Department of Radiology CME Office beforeApril 7, 2013 (email@example.com or fax#: 507-266-3061). No refundswill be made on or after April 7, 2013. Canceled registrations are non-transferable.Mayo Clinic Department of Radiology CME Office and/or Mayo School ofCPD reserve the right to cancel or postpone any course due to unforeseencircumstances. In the unlikely event Mayo Clinic Department of RadiologyCME Office and/or Mayo School of CPD must cancel or postpone thiscourse, Mayo Clinic Department of Radiology CME Office will refundthe registration fee, but is not responsible for any related costs, charges, orexpenses to participants, including fees assessed by airline/travel/lodgingagencies.GRANTS AND EXHIBITSAt the time of this printing, a complete listing of commercial support(financial or in-kind) was not available. Appropriate acknowledgment willbe given to all supporters at the time of the meeting.
COURSE INFORMATIONAdvanced Radiology Life Support™ (ARLS)COURSE DESCRIPTIONThe Advanced Radiology Life Support™ (ARLS) course is designed to focuson the unique, life-threatening emergencies that occur within a radiologydepartment. It is designed to teach prompt recognition and treatment ofcontrast reactions. The ARLS course will discuss management of the sedatedpatient and the proper management of an airway in an emergency situation.The administration of contrast in patients with renal insufficiency includingcontrast induced nephropathy and nephrogenic systemic fibrosis will bediscussed. Basic concepts of advanced life support will also be reviewed.This course is fashioned after the Advanced Cardiac Life Support (ACLS)course that has been successfully teaching physicians, nurses, and alliedhealth personnel patient management during cardiac arrest.The ARLS and sedation materials included in this course were used totrain physicians, nurses, and allied health personnel at the Mayo Clinic tomeet Joint Commission Standards or to prepare for Joint Commission sitevisits. This training program may help to prepare your program for similarevaluations.Attendees will have an opportunity to participate in two self-assessmentmodules (SAMs) during the course. The self-assessment modules have beendesigned to meet the standards of the American Board of Radiology (ABR)for self-assessment modules (SAMs).COURSE LEARNING OBJECTIVESUpon conclusion of this workshop, participants should be able to:• Review types of contrast agents• Identify all serious contrast reactions• Describe appropriate treatment regimens for specific types of contrast reactions• Review risk factors for and potential impact of contrast induced nephropathy• Review risk factors for and potential impact of nephrogenic systemic fibrosis (NSF)• Discuss most effective strategies for contrast administration in renal disease• Describe proper use and administration of moderate sedation and analgesic medications• Demonstrate the proper management of an airway in an emergency situationAttendance at this workshop does not indicate nor guarantee competence orproficiency in the performance of any procedures which may be discussedor taught in this workshop.
COURSE INFORMATIONAdvanced Radiology Life Support™ (ARLS)INTENDED AUDIENCEAdvanced Radiology Life Support™ (ARLS) is designed for all medicalpersonnel involved in the administration of contrast material. This coursehas been attended by radiology physicians, residents and fellows, nursingpersonnel, technologists, and others.CREDITCollege of Medicine, Mayo Clinic, is accredited by the Accreditation Councilfor Continuing Medical Education to provide continuing medical educationfor physicians.College of Medicine, Mayo Clinic, designates this live activity for amaximum of 4.75 AMA PRA Category 1 Credits™. Physicians should claimonly the credit commensurate with the extent of their participation in theactivity. This course content includes three (3.0) hours of Sedation andAirway Management Training.Other Health Care ProfessionalsA record of attendance will be provided to other health care professionalsfor requesting credits in accordance with state nursing boards, specialtysocieties, or other professional associations.FACULTYCourse DirectorsPatrick W. Eiken, M.D.Chad J. Fleming, M.D.Mayo Clinic FacultyPatrick W. Eiken, M.D.Chad J. Fleming, M.D.Robert P. Hartman, M.D.Sherrie L. Prescott, R.N.Eric E. Williamson, M.D.FACULTY DISCLOSUREAs a provider accredited by ACCME, College of Medicine, Mayo Clinic(Mayo School of Continuous Professional Development) must ensurebalance, independence, objectivity and scientific rigor in its educationalactivities. Course director(s), planning committee, faculty, and all otherswho are in a position to control the content of this educational activity arerequired to disclose all relevant financial relationships with any commercialinterest related to the subject matter of the educational activity. Safeguardsagainst commercial bias have been put in place. Faculty also will discloseany off-label and/or investigational use of pharmaceuticals or instrumentsdiscussed in their presentation. Disclosure of this information will bepublished in course materials so those participants in the activity mayformulate their own judgments regarding the presentation.
PROGRAM SCHEDULEAdvanced Radiology Life Support™ (ARLS)Sunday, April 21, 20137:00 a.m. ARLS Registration and Continental Breakfast for Course Participants 7:45 a.m. Introduction / Course Overview Chad J. Fleming, M.D. 7:50 a.m. Contrast Media Robert P. Hartman, M.D. 8:20 a.m. Recognition and Treatment of Contrast Reactions Patrick W. Eiken, M.D. 8:50 a.m. Sedation and Analgesia Chad J. Fleming, M.D. 9:20 a.m. Break 9:30 a.m. Contrast Induced Nephropathy: Risk Factor Screening Chad J. Fleming, M.D.10:15 a.m. Nephrogenic Systemic Fibrosis: An Update Eric E. Williamson, M.D.11:00 a.m. SAM Exam and Course Review and Reflection (Two Self-Assessment Modules (SAMs) will be available during this session.)11:15 a.m. Station Practicals ARLS Faculty A. Airway Management B. Treatment Scenarios12:45 p.m. ARLS Course Concludes
COURSE INFORMATIONAdvances in Diagnostic RadiolgyCOURSE DESCRIPTION &INTENDED AUDIENCEAdvances in DiagnosticRadiology is a postgraduatecourse designed to update thediagnostic radiologist in newtrends, relevant techniques,and advanced applications indiagnostic imaging. The latestadvances will be emphasizedand related to common problemsencountered in clinical practice.A variety of didactic lectures andaccessible faculty members willenhance learning throughoutthe week. Interesting casesfrom Mayo Clinic files will bepresented in an “unknown case”format, and the participant willhave access to these cases andanswers upon completion of thecourse. All faculty members are in practice at Mayo Clinic and will drawfrom personal research activities as well as clinical experience at Mayo Clinic.Attendees will have an opportunity to participate in two American Board ofRadiology Self-Assessment Modules (SAMs). The self-assessment moduleshave been designed to meet the standards of the American Board ofRadiology (ABR) for self-assessment modules (SAMs).COURSE LEARNING OBJECTIVESUpon conclusion of this program, participants should be able to:• Recognize the common imaging findings of infiltrating lobular carcinoma• Identify the fundamental concepts used in planning musculoskeletal biopsies• Differentiate between Stener and non-Stener injuries of the thumb• Differentiate the differential diagnosis of calcified pancreatic masses• Choose the appropriate contrast material for specific body MR indications• Identify the most common thoracic aortic emergencies• Describe imaging characteristics of benign and malignant renal masses on CT and MRI• Incorporate appropriate advanced MR imaging techniques in your MR body protocolsAttendance at this Mayo course does not indicate nor guarantee competenceor proficiency in the performance of any procedures which may bediscussed or taught in this course.
COURSE INFORMATIONAdvances in Diagnostic RadiolgyCREDITCollege of Medicine, Mayo Clinic, is accredited by the Accreditation Councilfor Continuing Medical Education to provide continuing medical educationfor physicians.College of Medicine, Mayo Clinic, designates this live activity for a maximumof 23.5 AMA PRA Category 1 Credits™, which includes 5.0 mammographycredits. Physicians should claim only the credit commensurate with theextent of their participation in the activity.Other Health Care Professionals: A record of attendance will be providedto other health care professionals for requesting credits in accordance withstate nursing boards, specialty societies, or other professional associations.FACULTYCourse DirectorsJerome F. Breen, M.D.Mark J. Kransdorf, M.D.Mayo Clinic Faculty Bradley D. Lewis, M.D.Larry A. Binkovitz, M.D. Roxanne Lorans, M.D.Jeffrey R. Bond, M.D. Robert W. Maxwell, M.D.Jerome F. Breen, M.D. Michelle D. McDonough, M.D.Mellena D. Bridges, M.D. Patricia J. Mergo, M.D.Joseph M. Collins, M.D. Jeffrey J. Peterson, M.D.Vivek Gupta, M.D. Michael C. Roarke, M.D.Robert P. Hartman, M.D. Catherine C. Roberts, M.D.C. Michael Johnson, III, M.D. Alvin C. Silva, M.D.Mark J. Kransdorf, M.D. Terri J. Vrtiska, M.D.FACULTY DISCLOSUREAs a provider accredited by ACCME, College of Medicine, Mayo Clinic(Mayo School of Continuous Professional Development) must ensurebalance, independence, objectivity and scientific rigor in its educationalactivities. Course director(s), planning committee, faculty, and all otherswho are in a position to control the content of this educational activity arerequired to disclose all relevant financial relationships with any commercialinterest related to the subject matter of the educational activity. Safeguardsagainst commercial bias have been put in place. Faculty also will discloseany off-label and/or investigational use of pharmaceuticals or instrumentsdiscussed in their presentation. Disclosure of this information will bepublished in course materials so those participants in the activity mayformulate their own judgments regarding the presentation.
PROGRAM SCHEDULEAdvances in Diagnostic RadiolgyMonday, April 22, 20136:30 a.m. Registration and Continental Breakfast for Meeting Participants7:25 a.m. Introduction Jerome F. Breen, M.D.7:30 a.m. Peripheral Vascular CTA: Current Practices Terri J. Vrtiska, M.D.8:00 a.m. Pattern Approach to HRCT in Interstitial Lung Disease Patricia J. Mergo, M.D.8:30 a.m. Postoperative CTA: What Your Vascular Surgeon Needs To Know Terri J. Vrtiska, M.D.9:00 a.m. CT Urography Diagnosis of Urothelial Lesions Robert P. Hartman, M.D.9:30 a.m. Panel Discussion – Course Faculty 9:45 a.m. Break10:00 a.m. Trachea and Airways Patricia J. Mergo, M.D. 10:30 a.m. Carotid Ultrasound: Basics and Beyond Bradley D. Lewis, M.D. 11:00 a.m. CT and MR Diagnosis of Renal Lesions Robert P. Hartman, M.D.11:30 a.m. Ultrasound of Deep Venous Thrombosis Bradley D. Lewis, M.D. 12:00 p.m. Panel Discussion – Course Faculty 12:15 p.m. Session Adjourns for the DayTuesday, April 23, 2013Self-Assessment Module (SAM) Offered6:30 a.m. Continental Breakfast for Meeting Participants7:30 a.m. Breast Imaging Cases of the Day Michelle D. McDonough, M.D. 8:00 a.m. Mammographic Missed Cancers: What We Can Learn Roxanne Lorans, M.D. 8:30 a.m. Indications for Breast MRI Michelle D. McDonough, M.D. 9:00 a.m. Breast Disease on Ultrasound Roxanne Lorans, M.D.9:30 a.m. Panel Discussion – Course Faculty 9:45 a.m. Break10:00 a.m. Screening Breast MRI Michelle D. McDonough, M.D.10:30 a.m. Male Breast Disease Roxanne Lorans, M.D. 11:00 a.m. Imaging, Assessment and Biopsy of the Axilla – SAM I Robert W. Maxwell, M.D.
PROGRAM SCHEDULEAdvances in Diagnostic RadiolgyTuesday, April 23, 2013 - continued11:35 a.m. Infiltrating Lobular Carcinoma: Tips for Detecting the Invisible Tumor – SAM I Robert W. Maxwell, M.D. 12:10 p.m. SAM Test and Discussion Robert W. Maxwell, M.D.12:30 p.m. Panel Discussion – Course Faculty12:45 p.m. Session Adjourns for the DayWednesday, April 24, 20136:30 a.m. Continental Breakfast for Meeting Participants7:30 a.m. Body Imaging Cases of the Day Jerome F. Breen, M.D.8:00 a.m. Solid Pancreatic Neoplasms Joseph M. Collins, M.D.8:30 a.m. Improving Your Body MR Practice: Advanced Techniques Mellena D. Bridges, M.D.9:00 a.m. Cystic Pancreatic Neoplasms Joseph M. Collins, M.D.9:30 a.m. Panel Discussion – Course Faculty 9:45 a.m. Break10:00 a.m. Dual-Energy CT in Abdominal Imaging Alvin C. Silva, M.D.10:30 a.m. Non-Atherosclerotic Vascular Disease C. Michael Johnson, III, M.D.11:00 a.m. MR Elastography: What Is It and How Can It Help Alvin C. Silva, M.D.11:30 a.m. Vasculitis C. Michael Johnson, III, M.D.12:00 p.m. Panel Discussion – Course Faculty12:15 p.m. Session Adjourns for the Day Thursday, April 25, 20136:30 a.m. Continental Breakfast for Meeting Participants7:30 a.m. Body MR Imaging Cases of the Day Mellena D. Bridges, M.D.8:00 a.m. New PET/SPECT Techniques for Clinical Imaging of Neurodegenerative Disease I Michael C. Roarke, M.D. 8:30 a.m. Improving Your Body MR Practice: New Contrast Agents Mellena D. Bridges, M.D.9:00 a.m. New PET/SPECT Techniques for Clinical Imaging of Neurodegenerative Disease II Michael C. Roarke, M.D.9:30 a.m. Panel Discussion – Course Faculty
PROGRAM SCHEDULEAdvances in Diagnostic RadiolgyThursday, April 25, 2013 - continued9:45 a.m. Break10:00 a.m. Current Status of Neuroimaging of Epilepsy & Seizure Vivek Gupta, M.D.10:30 a.m. Advanced Pediatric Abdominal MR: Enterography, Elastography and Cholangiopancreatography Larry A. Binkovitz, M.D. 11:00 a.m. Emerging Trends in Neuroimaging of Acute Ischemic Stroke Vivek Gupta, M.D. 11:30 a.m. Pediatric Ultrasound: Emergency Studies for the General Radiologist Larry A. Binkovitz, M.D.12:00 p.m. Panel Discussion – Course Faculty12:15 p.m. Session Adjourns for the DayFriday, April 26, 2013Self-Assessment Module (SAM) Offered6:30 a.m. Continental Breakfast for Meeting Participants7:30 a.m. Musculoskeletal Imaging Cases of the Day Mark J. Kransdorf, M.D. 8:00 a.m. Musculoskeletal Application of PET Jeffrey J. Peterson, M.D.8:30 a.m. MR of Upper Extremity Neuropathy: Why, Where and What to Look For Jeffrey R. Bond, M.D. 9:00 a.m. Differential Diagnosis of Soft Tissue Masses on MRI Catherine C. Roberts, M.D.9:30 a.m. Panel Discussion – Course Faculty 9:45 a.m. Break10:00 a.m. “Digital” MRI Jeffrey R. Bond, M.D. 10:30 a.m. MR Imaging of Bone Marrow Catherine C. Roberts, M.D.11:00 a.m. Musculoskeletal Interventions: Arthrography Techniques – SAM II Jeffrey J. Peterson, M.D.11:35 a.m. Biopsy of Musculoskeletal Tumors – SAM II Mark J. Kransdorf, M.D.12:10 p.m. SAM Test and Discussion Jeffrey J. Peterson, M.D. and Mark J. Kransdorf, M.D.12:30 p.m. Panel Discussion – Course Faculty 12:45 p.m. Course Concludes
Mayo Clinic Department of RadiologyFuture CME Meetings Mayo Clinic Diagnostic Imaging Update and Self- Assessment with optional Advanced Radiology Life Support™ (ARLS) Course July 28 – August 2, 2013 The Ritz-Carlton, Laguna Niguel Dana Point, California Advanced Radiology Life Support™ (ARLS) Course February 23 and September 14, 2013 Mayo Clinic, Siebens Medical Education Building Rochester, Minnesota Minnesota Breast Imaging Review Course October 12-13, 2013 Hilton Minneapolis Minneapolis, Minnesota Neuroradiology: Practice to Innovation November 11-15, 2013 The Ritz-Carlton, Grand Cayman Grand Cayman, Cayman Islands Tutorials in Diagnostic Radiology January 19-23, 2014 The Fairmont Kea Lani Maui, HawaiiSelf-Study CME Courses Advanced Radiology Life Support™ (ARLS) Course on DVD 4.75 AMA PRA Category 1 Credits™ To order or for more information, please call 866-246-1581. Radiologist Training for Interpretation of Molecular Breast Imaging 1.75 AMA PRA Category 1 Credits™ To order or for more information, please visit http://www.mayo.edu/cme/radiology. State-of-the-Art Small Bowel Imaging: Review and Hands-on Tutorial Course Presented on Laptop Workstation To order or for more information, please call 866-246-1581.
Advances in Diagnostic Radiology with 2013R950 2012R795Advanced Radiology Life Support™ (ARLS) CourseApril 21, 2013 – Advanced Radiology Life Support™ (ARLS) CourseApril 22-26, 2013 – Advances in Diagnostic Radiology CourseThe Ritz-Carlton, Dove Mountain • Marana, ArizonaRegister online at: http://www.mayo.edu/cme/radiology.htmlMail form and payment to: Telephone: 866-246-1581Mayo Clinic Department of Radiology CME Office or 507-284-3317Mayo, West-2 FAX: 507-266-3061200 First Street SW E-mail: firstname.lastname@example.orgRochester, MN 55905 Website: http://www.mayo.edu/cme/radiology.html (Please print or type all information. You may duplicate this form for multiple registrations.)Name______________________________________________________________________________ First Name Middle Name or Initial Last NameDegree MD PhD DO PA NP Other_____________________________Institution __________________________________________________________________________Medical Specialty____________________________________________________________________E-mail Address _____________________________________________________________________How did you learn about this course? Email Marketing Full-Course Brochure Mailing RSNA Other:_________________ Website (please identify):___________________________________________________________Address____________________________________________________________________________City__________________________________________State/PV______________________________ZIP/Postal Code_______________________________Country_______________________________Home Telephone (______)__________________ Business Telephone (______)_________________ Please check if you have special accommodation or dietary needs and indicate specific need(s): ________________________________________________________________________Complimentary Welcome Reception – Monday, April 22, 2013 Yes, I will attend: # attending ______ No, I will not attendAdvances in Diagnostic Radiology Registration Fee:Physicians/Scientists $1100 $________________Residents, Physician Assistants and Nurse Practitioners $1000 $________________ I would like a paper syllabus reserved for me. $75 $________________ No, I do not want a paper syllabus reserved for me. I will use the complimentary syllabus provided on flash drive to view and print presentations.Advanced Radiology Life Support™ (ARLS) Registration Fee:Physicians/Scientists, Residents, Physician Assistants,Nurse Practitioners, and Allied Health Personnel $400 $________________A complimentary syllabus on flash drive is provided for this course. A paper syllabus is not available.Total Payment Enclosed: $________________PAYMENT METHOD (US FUNDS ONLY) * WIRE TRANSFERS WILL BE ASSESSED A $25 USD FEE. Check (payable to Mayo Clinic) – OR – Credit Card: Visa MasterCard DiscoverCard Number Expires Mo/Yr 3-digit Security CodeSignature Date