American Society for Surgery of the Hand (ASSH) 67th Annual Meeting


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American Society for Surgery of the Hand (ASSH) 67th Annual Meeting

  1. 1. 67th Annual Meeting of the American Society for Surgery of the Hand * September 6-8, 2012 Chicago, ILNote: Residents & Fellows Conference and Precourses begin on 9/5/12; the Annual Meeting begins on 9/6/12Register at to insure your place in preferred sessions and receive confirmation immediately.To pay with credit card, fax this form to (847) 384-1435. To pay with check, mail form to ASSH; Department 1005; P.O. Box 6500;Chicago, IL 60680. International attendees: contact for wire transfer instructions.Visit for information on what is included with registration, session descriptions and cancellation policies. Questions? Email orcall (312) 880-1900. Note: Phone registrations are not accepted!Deadline for Early Bird Registration receipt: June 11, 2012First Name Last Name Designation (MD, FACS, CHT, PA, etc.)Badge Nickname E-Mail Address (for registration confirmation) National Provider Identifier (NPI#) – U.S. OnlyIs this a  Work Address  Home Address? (Please check one.)Company or InstitutionMailing AddressCity State/Province Zip/Postal CodeOffice Phone Office Fax Home Phone Cell PhonePlease indicate special accommodations, if any, that you may require during the meeting due to a disability:Please indicate any dietary restrictions:EMERGENCY CONTACT: __________________________________________ Relationship: ________________________________________________Emergency Contact Daytime Phone: _________________________________ Evening Phone: ______________________________________________If you are planning on using the Annual Meeting mobile app, do you still want a printed onsite program?_____Do you have purchasing authority in the exhibit hall? Yes NoIf you received a mailing promoting this meeting, what number (1-20) appears on the lower left corner of the panel that contains your mailing addressinformation? ____Are you a Resident or Fellow in a North American training program? Yes NoIf so, what year does your residency or fellowship end? _______ Training program name: __________________________I understand that the material presented in this continuing medical education/continuing education program (the “Program”) has been made available undersponsorship of the American Society for Surgery of the Hand for educational purposes only. This material is not intended to represent the only; not neces-sarily the best, method or procedure appropriate for the medical situations discussed, but rather is intended to present an approach, view, statement or opi-nion of the faculty which may be of interest to others. As a condition of my participation in the Program, I hereby, (i) waive any claim I may have againstASSH and their officers, directors, employees, or agents, or against the presenters or speakers, for reliance on any information presented in the Program;and (ii) release ASSH their officers, directors, employees, or agents, as well as the presenters and speakers, from and against any and all liability for dam-age or injury that may arise from my participation or attendance at the Program. I further understand and agree that no reproduction of any kind, includingphotographs, audiotapes and videotapes, may be made of the Program. All property rights in material presented, including common law copyright, areexpressly reserved to the presenter or speaker or to the ASSH. ASSH is not responsible for expenses incurred by an individual who is not confirmed andfor whom space is not available. Costs incurred by the registrant, such as airline or hotel fees or penalties, are the responsibility of the registrant. I herebyacknowledge and agree that ASSH or its agents may take photographs of me during the Program and related events and may use those photographs forASSHs purposes, including but not limited to news, advertising and promotional purposes, without compensation to me.By signing below and/or registering for the Program, I consent to the conditions of participation set forth above._______________________________________________________________________________________________________________Signature of the registrant Date1|P age Registration for 2012 ASSH Annual Meeting
  2. 2. REGISTER FOR THE MEETING:Circle your registration and enter price below. If you are attending the Residents andFellows Conference only, or a Pre or Post Course only, skip this section and proceed to Page 3. On or Before Between After FULL REGISTRATION FEES June 11 June 12& August 17 August 17 ASSH Member $725 $825 $875 ASSH Senior/Lifetime Member $260 $260 $260 ASSH International Member $680 $780 $830 Nonmember Physician $925 $1025 $1075 International Nonmember Physician $825 $925 $975 ASSH Affiliate Member $525 $625 $675 Allied Health* $625 $725 $775 Resident , Fellow or Medical Student** $100 $150 $150 SINGLE DAY REGISTRATION (May only purchase one day) Thursday only Friday only Saturday only ASSH Member*** $195 $415 $415 ASSH Senior/Lifetime Member $195 $255 $255 Nonmember Physician $265 $470 $470 International Nonmember Physician $215 $445 $445 Allied Health* $195 $415 $415 Resident, Fellow or Medical Student** $100 $100 $100 Before or Between June 12 After EXHIBIT HALL VISITOR PASS ONLY (NO CME)*** on June 11 & August 17 August 17 3-Day Exhibits Pass (Thurs-Sat) $150 $150 $200 Thursday Only Pass $75 $75 $125 Friday Only Pass $75 $75 $125 Saturday Only Pass $50 $50 $100 REGISTRATION FEE: _______*Allied Health Professional includes therapists, nurses, non-MD researchers. For pre-courses, it includes Affiliate Members. **Reduced pricing applies to residents, fellows and medical students in North American training programs only.***ASSH Active Members: A one-day registration does not fulfill the annual meeting attendance requirement. REGISTER AGUEST:Enter guest name_______________________________________________GUEST FEE ($95 each): ______Guests who are healthcare professionals and who want to receive continuing education credits must register separately. Attach additionalguest names separately. See website for full details of what is included in fee.MEETING ACTIVITIES:Session registration required for all CME activities listed below. Space is limited.THURSDAY, SEPTEMBER 6, 2012ASSH Members Business Meeting – Members Only (11:30 AM- 12:30 PM) Free. Attending? YES NOIndustry Forums IF11-IF20 (11:30 AM – 12:30 PM) Free. 1st Choice: _______ 2nd Choice: ________Instructional Courses IC01 – IC14 (4:30 PM – 6:00 PM) Free. 1st Choice: _______ 2nd Choice: ________Industry Forums IF21-IF22 (6:30-8:00 PM) Free. 1st Choice: _______ 2nd Choice: ________FRIDAY, SEPTEMBER 7, 2012Industry Forums IF23 – IF32(7:00-8:00 AM) Free. 1st Choice: _______ 2nd Choice: ________Clinical Consultation Corners CCC01-CCC02 (7:00-8:00 AM) Free. 1st Choice: _______ 2nd Choice: ________Clinical Consultation Corners CCC03-CCC04 (8:00-9:00 AM) Free. 1st Choice: _______ 2nd Choice: ________Industry Forums IF33-IF42 (12:00-1:00 PM) Free. 1st Choice: _______ 2nd Choice: ________Clinical Consultation Corners CCC05-CCC06 (12:00-1:00 PM) Free. 1st Choice: _______ 2nd Choice: ________Volunteer Service Lunch (12:00-1:00 PM) Free. Attending? YES NONetworking Lunch for Allied Health Professionals (12:00-1:00 PM) Free. Attending? YES NOClinical Consultation Corners CCC07-CCC08 (1:00-2:00 PM) Free. 1st Choice: _______ 2nd Choice: ________Instructional Courses IC15-IC28 (4:30-6:00 PM) Free. 1st Choice: _______ 2nd Choice: ________SATURDAY, SEPTEMBER 8, 2012Instructional Courses IC29-IC38 (7:00-8:00 AM) Free. 1st Choice: _______ 2nd Choice: ________Interactive Case Reviews ICR01-ICR15 (12:15-1:15 PM) Free. 1st Choice: _______ 2nd Choice: ________2|P age Registration for 2012 ASSH Annual Meeting
  3. 3. PRE and POST-CONFERENCE PROGRAMS:Circle and enter the appropriate fees. Allied Non- ASSH Senior Resident or Health or Member Total Member Member Fellow*** Affiliate PhysicianWEDNESDAY, SEPTEMBER 5, 2012 –Beginning in morning Member**Adrian E. Flatt Residents/Fellows Conference – Full Conference (includes $250 $250 $350 $50 $220lunch) (7:45 AM – 4:15 PM)Adrian E. Flatt Residents/Fellows Conference – LUNCH ONLY (11:50 $50 $50 $50 $50 $50AM-12:40 M)Precourse Hands-On Lab: Master Skills Series in Wrist and Hand Recon- $795 $695 $895 $395 N/Astruction (7:00 AM – 12:00 PM) PHYSICIANS ONLYPrecourse 1: New Options in Minimally Invasive Hand Surgery (7:30–11:30 $195 $145 $225 $75 $125AM)Precourse 2: Neurovascular Injuries – Part 1: Entrapment Neuropathies $195 $145 $225 $75 $125(7:30–11:45 AM)Precourse 3: 2012 Coding and Reimbursement Update for Hand Surgeons $195 $145 $225 $75 $125(7:30–11:30 AM)WEDNESDAY, SEPTEMBER 5, 2012 – Beginning in afternoonPrecourse 4: Treatment of Hand and Wrist Injuries in Elite Athletes (12:30- $195 $145 $225 $75 $1254:30 PM)Precourse 5: Neurovascular Injuries – Part 2: Arterial Injuries (12:30-4:30 $195 $145 $225 $75 $125PM)Precourse 6: There is an Elbow. You must fix it. (12:30-4:30 PM) $195 $145 $225 $75 $125Precourse 7: Show Me the Money: Financial Basics for Hand Surgeons $195 $145 $225 $75 $125(12:30-4:30 PM)Resident Educators Workshop (12:30-4:30 PM) FREE. Attending? YES NOTour of New ASSH Central Office Building/Register for bus (One hour FREE. Circle bus time: 2:00 PM 3:00 PM 4:00 PM 5:00 PMtour)Young Members Forum (4:30-5:45 PM) FREE. Attending? YES NOClinical Investigators Workshop (4:30-6:00 PM) FREE. Attending? YES NOBasic Science Investigators Workshop (4:30-6:00 PM) FREE. Attending? YES NOIndustry Forums IF01-IF10 (5:00-6:00 PM) Free. 1st Choice: _______ 2nd Choice: ________Residents and Fellows/Young Members Reception (5:45-7:00 PM) FREE. Attending? YES NOTHURSDAY, SEPTEMBER 6, 2012 – MorningPrecourse 8: Bad to the Bone: Salvage of the Failed Wrist (7:00-11:00 AM) $195 $145 $225 $75 $125Precourse 9: Evidence Based Treatment of Fractures of the Distal Radius $195 $145 $225 $75 $125(7:00-11:30 AM)Precourse 10: Congenital Hand Surgery: Current Concepts and Master $195 $145 $225 $75 $125Techniques (7:00 AM–11:30 AM)SATURDAY, SEPTEMBER 8, 2012 - AfternoonPostcourse: Soft Tissue Reconstruction (1:00-5:00 PM) $195 $145 $225 $75 $125 TOTAL PRE/POST COURSES:3 EASY WAYS TO REGISTER PROFESSIONAL REGISTRATION FEE (p.2) SPOUSE/GUEST FEE (p.2):Mail: Check payments only to: ASSH Department 1005 OPTIONAL ACTIVITIES/TOURS (p. 4): P.O. Box 6500 Chicago, IL 60680 TOTAL FEES:Fax:If paying by credit card, fax to (847) 384-1435.3|P age Registration for 2012 ASSH Annual Meeting
  4. 4. OPTIONAL ACTIVITIES AND TOURS: These optional social activities are open to all attendees and guests. A limited numberof tickets are available. Check your confirmation to determine whether we were able to accommodate your request. TICKETS ARENON-REFUNDABLE. # ofWEDNESDAY, SEPTEMBER 5, 2012 Time Ticket Price TOTAL TicketsTour 1: Frank Lloyd Wright Home and Studio and Oak Park 9:00 AM - 2:00 PM $78Tour (Bus provided)Tour 2:Chicago’s Historic North Shore and the Chicago 9:00 AM – 1:00 PM $70Botanic Gardens (Bus provided)Tour 3: Neighborhood Food Tour (Walking) 11:15 AM – 3:15 PM $120Social Event 1: White Sox vs. Twins (No transportation 1:10 PM Game Time $39provided)THURSDAY, SEPTEMBER 6, 2012Tour 4: The Sanfilippo Estate (Bus provided) 9:00 AM – 2:00 PM $120Tour 5: Chicago Bike Hike (Bike provided) 9:15 AM – 12:45 PM $80Tour 6: Chicago Gangster Tour (Bus provided) 11:00 AM – 1:00 PM $53Social Event 2: Bowling at Lucky Strikes Lanes (Bus 5:45 PM – 9:15 PM $245provided)Social Event 3: Andy’s Jazz – Dinner and Jazz (Bus 7:45 PM – 10:15 PM $195provided)FRIDAY, SEPTEMBER 7, 2012Tour 7: Lifestyles of the Rich and Famous (Bus provided) 12:00 PM – 3:00 PM $150Tour 8: Bottles and Brushes (Walking tour) 12:45 PM – 3:15 PM $150Social Event 4: Buddy Guy’s Legends (Bus provided) 6:15 PM – 9:45 PM $135Social Event 5: Second City (No transportation provided) 8:00 PM $28SATURDAY, SEPTEMBER 8, 2012Tour 9: Tiffany Treasures of Chicago (Bus provided) 9:45 AM – 1:15 PM $125Tour 10: Chicago on Fire! (Travel in fire truck) 1:00 PM – 3:00 PM $45 TOTAL OPTIONAL ACTIVITIES/TOURS:Release and Waiver of ClaimAll individuals participating in an activity must purchase a ticket in advance and complete and sign this release and waiver of claim. Inconsideration of the ASSH and AlliedPRA arrangements of the activity(ies) for which I/my child(ren) have registered, the undersignedwaives any claim that I/my child(ren) and my/their heirs, administrators and assigns, may have against the ASSH and AlliedPRA, theirofficers, directors, members, employees and agents and each of them (the “indemnities”); and agree to save and hold indemnities harmlessfrom any and all liability for any injury, disease, death, or damage which may result from my/their participation in activity(ies) for whichI/they have registered. In the event that I/my child(ren) become ill or sustain injuries while participating in this activity(ies), I herebyauthorize administration at my cost of such first aid or other treatment as may be necessary under the circumstances, including treatment bya physician or hospital. I represent and warrant that I have the authority to grant release and waiver of claim.Participant 1: __________________________________________ Signature: _________________________________________ (Parent or guardian if participant is under 18 year of age)Participant 2: __________________________________________ Signature:__________________________________________ (Parent or guardian if participant is under 18 year of age)Home Address:____________________________________________Phone while at meeting: _________________________Emergency contact name:______________________________ Relationship: _________________ Phone: ___________________4|P age Registration for 2012 ASSH Annual Meeting