Neonatal Pharmacology 2012
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  • 1. 12th Annual Conference NEONATAL PHARMACOLOGY PRECONFERENCE • JUNE 7 Neonatal Cardiology Washington, DC • June 7-9, 2012 Register early and save! (See page 6 for details) Earn up to 21.5 hoursREGISTER TODAY!www.ContemporaryForums.comwww.onlineCElibrary.com
  • 2. You Are Invited! Conference ObjectivesNew and complex therapeutic interventions bring potential After attending this conference you will be able to better:benefits, as well as new, often unanticipated, complications. Explain the pharmacology and action of selected  As we offer our most vulnerable patients the best, most medications used in neonatal care.contemporary care possible, we need to keep in mind thatmany pharmacologic therapies have not been thoroughly Evaluate alternative treatments when drug shortages  examined in newborns and the risk-benefit ratios are not well occur.established. Outline current pharmacological management of  For example, when influenza outbreaks occur, what new common medical conditions in the NICU.treatments should we consider to protect the susceptible   neuroprotection strategies and outcomes. Listnewborn? Treatment of PDA, and management of seizuresrequire careful consideration of results of research studies. Anticipate potential side effects of neonatal drug   therapy, recognize adverse reactions and discuss theirAntibiotics and antifungals play a major role in reduction management.of disease, but resistance is increasing and new drugsoften lack thorough testing in the NICU population. Earlynutritional support, including micronutrients and breast milkcan significantly improve outcomes. Who Should Attend?In response to these challenges, Contemporary Forumspresents the 12th Annual Neonatal Pharmacology Anyone involved in the care of high-risk newbornsconference designed for NICU professionals including including:neonatologists, nurse practitioners, clinical pharmacists,nurse managers and experienced staff nurses. This year’s  Neonatologistsnew Preconference on Neonatal Cardiology will cover  Nurse Practitionersadvances in medications that are most effective in managingcardiac complications.  Clinical Nurse SpecialistsThis conference will offer cutting edge information from some  Experienced Staff Nursesof the leading clinical scientists in neonatology. You will learn  Educators and Instructorsfrom these experts how to integrate best practices into your  Nurse Managersunit for a broad range of drugs used in neonatal care.  PharmacistsHot Topics addressed at the 2012 conferenceinclude:  Physician Assistants Impact of nutrition on outcomes including   You!! bronchopulmonary dysplasia. Use of vaccines in premature infants. Antibiotic, antifungal and antimicrobial dosing  Exhibits recommendations and outcomes for various clinical conditions. Companies and organizations interested in exhibiting Pharmacologic considerations with therapeutic cooling. professionally relevant products and services can contact the Exhibitor Information: Management of neonatal seizures.  Phone: (925) 361-4807 Medication safety and managing drug shortages.  Email: exhibits@cforums.comIf you are struggling to keep up with recommended Visit: www.ContemporaryForums.com/en/Exhibitorsmedication management for the NICU infant, if you are notsure whether medication delivery in your unit is as safe as itcould be, don’t miss this opportunity to update your clinicalknowledge of neonatal pharmacology. We look forward to Email Updatesseeing you in fabulous Washington, D.C. Kelly C. Wade, MD, PhD, MSCE If you are not currently receiving Online CE Library or Conference Co-Chair conference information and updates via email, please go Matthew M. Laughon, MD, MPH to www.ContemporaryForums.com/en/Email-Updates/. You Conference Co-Chair will then be notified of all conferences as soon as they are announced as well as have access to special promotions. Heather Monk, PharmD All email addresses are for Reed Elsevier use only. Program Consultant Contemporary Forums is a division of Reed Elsevier. Kathryn Clayton, MSN, MBA, ALNC Program Manager Contemporary Forums2 Visit us www.ContemporaryForums.com to register today • Follow us on Facebook and Twitter (#NeoPharm12)
  • 3. Conference FacultyNicholas S. Abend, MD Heather Monk, PharmDAssistant Professor of Neurology and Pediatrics Program ConsultantMedical Director of Clinical Neurophysiology Clinical Specialist in Neonatal/Infant Intensive CareThe Children’s Hospital of Philadelphia The Children’s Hospital of PhiladelphiaUniversity of Pennsylvania School of Medicine Associate Clinical Professor, School of PharmacyPhiladelphia, Pennsylvania Thomas Jefferson University Wilkes University, Wilkes-BarreBeau J. Batton, MD Philadelphia, PennsylvaniaAssistant Professor of Pediatrics University of Charleston, Charleston, West VirginiaDepartment of PediatricsDivision of Neonatology Athina Pappas, MDSouthern Illinois University School of Medicine Assistant Professor of PediatricsSpringfield, Illinois Division of Neonatal-Perinatal Medicine Children’s Hospital of MichiganWilliam E. Benitz, MD Wayne State University of MedicineDirector of Nurseries Detroit, MichiganLucile Packard Children’s Hospital at StanfordPhilip Sunshine, MD, Endowed Professor in Neonatology E. Zachary Ramsey, PharmDStanford University Medical Center, Palo Alto, California Clinical Specialist, Pediatric Cardiology Department of Pharmacy ServicesScott Buck, MD The Children’s Hospital of PhiladelphiaAssociate Professor Adjunct Assistant ProfessorDepartment of Pediatrics, Division of Cardiology Wilkes University School of PharmacyNorth Carolina Children’s Hospital Associate Clinical ProfessorChapel Hill, North Carolina Thomas Jefferson University School of PharmacyC. Michael Cotten, MD, MHS Philadelphia, PennsylvaniaDirector, Neonatal Clinical Research Sarah N. Taylor, MDAssistant Professor, Department of Pediatrics Associate Professor of PediatricsDuke University School of Medicine Division of NeonatologyDurham, North Carolina Medical University of South CarolinaCarl T. D’Angio, MD Charleston, South CarolinaAssociate Professor of Pediatrics and Medical Humanities John N. van den Anker, MD, PhD, FCP, FAAPDirector, Neonatal Clinical Research Vice Chair of Pediatrics for Experimental Therapeutics Director, Pediatric Clinical Research Office Evan and Cindy Jones Professor of Pediatric ClinicalDivision of Neonatology, Golisano Children’s Hospital PharmacologyUniversity of Rochester Medical Center Chief, Division of Pediatric Clinical PharmacologyRochester, New York Children’s National Medical CenterRichard A. Ehrenkranz, MD Professor of Pediatrics, Pharmacology & PhysiologyProfessor of Pediatrics and Obstetrics George Washington University School of MedicineGynecology & Reproductive Sciences and Health SciencesYale University School of Medicine Washington, DCMedical Director, Newborn Special Care Unit Kelly C. Wade, MD, PhD, MSCEYale-New Haven Children’s Hospital Conference Co-ChairNew Haven, Connecticut Attending NeonatologistMatthew M. Laughon, MD, MPH The Children’s Hospital of PhiladelphiaConference Co-Chair Newborn Care at Pennsylvania HospitalAssociate Professor of Pediatrics Assistant Professor of Clinical PediatricsDivision of Neonatal-Perinatal Medicine University of Pennsylvania School of MedicineThe Department of Pediatrics Philadelphia, PennsylvaniaThe University of North Carolina at Chapel HillChapel Hill, North CarolinaStuart Levine, PharmDInformatics SpecialistInstitute of Safe Medication PracticesHorsham, PennsylvaniaPatrick McNamara, MB, FRCPCAssociate Professor of Paediatrics, University of TorontoAssociate Scientist, Physiology and Experimental Medicine ProgramSickKids Research InstituteStaff Neonatologist, Department of NeonatologyHospital for Sick Children, Toronto, Canada A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 3
  • 4. Accreditation PreconferenceA Certificate of Attendance will be available online after Neonatal Cardiologyyou complete the course requirements, enabling you toregister your credit with the appropriate licensing boards or This new Preconference will focus on evidence-based methods of pharmacologic cardiac management in thoseassociations. To apply for credit not listed below, use the infants with precarious cardiac conditions. Many with life-procedure established by the specific organization. threatening conditions will need immediate interventionPhysicians within the first few hours or days of life while others canPreconference: 7 credits be monitored and receive later treatment. Highlights ofMain Conference: 14.5 credits the day will include evaluation and management of blood pressure, pulmonary hypertension, and arrhythmias. AttendContemporary Forums is accredited by the Accreditation this Preconference to learn about the latest in neonatalCouncil for Continuing Medical Education to provide cardiology and current trends in management.continuing medical education for physicians. ContemporaryForums designates this Live Activity for a maximum of 21.5 Objectives:AMA PRA Category 1 CreditsTM. Physicians should claim   xplore treatment options for management of pulmonary Eonly the credit commensurate with the extent of their hypertension for several clinical conditions.participation in the activity.   xamine the use of targeted neonatal echocardiology in EThis continuing medical education activity has been reviewed improving cardiovascular management.by the American Academy of Pediatrics and is acceptable   valuate the efficacy of drugs used to treat PDA and how Efor a maximum of 21.5 AAP credits (7 credits - Preconference, some patients can adapt to this condition.14.5 credits - Main Conference). These credits can be applied   utline steps to manage arrhythmias in the NICU population Otoward the AAP CME/CPD Award available to Fellows andCandidate members of the American Academy of Pediatrics. Thursday, June 7Please call Contemporary Forums regarding additional 7:00 a.m. Preconference Registrationmedical education credit for neonatologists and pediatricians. 8:00 N  uts and Bolts of PressorsPhysician Assistants E. Zachary Ramsey, PharmDPreconference: 7 hours 8:45 B  lood Pressure Management in ExtremelyMain Conference: 14.5 hours Preterm Infants Beau J. Batton, MDThe American Academy of Physician Assistants acceptsCategory 1 CME approval from organizations accredited by 9:30  Questions and Discussionthe ACCME to grant Category 1 hours toward the Physician’s Faculty PanelRecognition Award. PAs may report up to the listed hours of 9:45 Refreshment Breakcredit. 10:00 P  ulmonary Hypertension in the Term Newborn Matthew M. Laughon, MD, MPHNurses and Nurse Practitioners 10:45  Pulmonary Hypertension in the GrowingPreconference: 7 ANCC/8.4 CA BRN contact hours Ex-Preterm with Severe BronchopulmonaryMain Conference: 14.5 ANCC/17.4 CA BRN contact hours DysplasiaContemporary Forums is accredited as a provider of E. Zachary Ramsey, PharmDcontinuing nursing education by the American Nurses 11:30 Q  uestions and DiscussionCredentialing Center’s Commission on Accreditation. Faculty PanelContemporary Forums is approved by the California Board 11:45 Lunch on your ownof Registered Nursing, Provider #04516. (CA BRN contact 1:15 p.m.  anagement of Neonatal Arrhythmias Mhour = 50 minutes) Scott Buck, MD 2:00  Refining Cardiovascular Decision-Making:Pharmacology Credit for Prescriptive Authority Role of Targeted Neonatal EchocardiographyPreconference: 7 hours Patrick McNamara, MB, FRCPCMain Conference: 14.5 hours available 2:45 Q  uestions and Discussion indicates pharmacology content. Because states’ requirements Faculty Panelvary, contact your Board of Nursing for more information. 3:00 Refreshment BreakPharmacists 3:15 P  atent Ductus Arteriosus Case IntroductionPreconference: 7 hours/.7 CEUs Matthew M. Laughon, MD, MPHMain Conference: 14.5 hours/1.45 CEUs available Kelly C. Wade, MD, PhD, MSCE 3:20  Learning to Live with the Patent Ductus Contemporary Forums is accredited by the Arteriosus Accreditation Council for Pharmacy Education William E. Benitz, MD as a provider of continuing pharmacy education. 4:00  Patent Ductus Arteriosus: Physiology MeetsStatements of Credit and the process for obtaining Clinical Carethem will be available online after the completion of the Patrick McNamara, MB, FRCPCconference. This conference has multiple ACPE Universal 4:45  Questions and DiscussionActivity Numbers which will be provided on the schedule Faculty Panelyou receive when you print your Statement of Credit. This 5:00 Adjournconference is a knowledge-based CPE activity. ACPE #263-000-12-275-L01-P (7 contact hours/.7 CEUs)4 Visit us www.ContemporaryForums.com to register today • Follow us on Facebook and Twitter (#NeoPharm12)
  • 5. Main ConferenceFriday, June 8 Saturday, June 9 7:00 a.m.  ain Conference Registration • Exhibits M 7:00 a.m.  xhibits E 8:00 N  utritional Practices and Bronchopulmonary 8:00 U  pdate on Neuroprotection Strategies Dysplasia: Are They Related? Athina Pappas, MD Richard A. Ehrenkranz, MD 8:45 P  harmacologic Considerations During 8:45 H  ow Much Calcium, Phosphorus and Therapeutic Hypothermia Vitamin D is Needed for Preterm Infants? Kelly C. Wade, MD, PhD, MSCE Sarah N. Taylor, MD 9:30 Q  uestions and Discussion 9:30 Q  uestions and Discussion Faculty Panel Faculty Panel 9:45  efreshment Break • Exhibits R 9:45  efreshment Break • Exhibits R 10:15 M  anagement of Neonatal Seizures10:15 E  arly Nutritional Support and Outcomes in Nicholas S. Abend, MD Extremely Preterm Infants 11:00 M  anagement of Peri-Intubation Medications Richard A. Ehrenkranz, MD Heather Monk, PharmD11:00 O  ptimizing Preterm Infant Growth While 11:45 Q  uestions and Discussion Promoting Mothers Milk Faculty Panel Sarah N. Taylor, MD 12:00 p.m. Lunch on your own11:45 Q  uestions and Discussion 1:15 M  edication Safety in the NICU Faculty Panel Stuart Levine, PharmD12:00 p.m.  unch on your own L 2:00 D  rug Shortages 1:15 A  ntibiotics: Association Between Duration Stuart Levine, PharmD of Treatment and Outcomes 2:45 Q  uestions and Discussion C. Michael Cotten, MD, MHS Faculty Panel 2:00 S  uspected or Confirmed Neonatal Sepsis 3:00 Refreshment Break William E. Benitz, MD 3:15 M  edico Legal Considerations: Consent for 2:45 Q  uestions and Discussion Off-Label Use Faculty Panel Heather Monk, PharmD 3:00  efreshment Break • Exhibits R 3:45 V  accinations in Preterm Infants: Theory 3:30 A  ntimicrobial Coverage for NEC Meets Practice C. Michael Cotten, MD, MHS Carl T. D’Angio, MD 4:15 F  luconazole Prophylaxis for High Risk Infants 4:30 N  eonatal Clinical Pharmacology: Does Athina Pappas, MD Development Trump Pharmacogenetics or...? 5:00 Q  uestions and Discussion John N. van den Anker, MD, PhD, FCP, FAAP Faculty Panel 5:15 Q  uestions and Discussion 5:15 Adjourn Faculty Panel ACPE #263-000-12-276-L01-P (7 contact hours/.7 CEUs) 5:30  Adjourn ACPE #263-000-12-277-L01-P (7 contact hours/.7 CEUs) 5:30 - WASHINGTON BY NIGHT TOUR 9:30 p.m. (Reservation and fee required.)  hen the sun goes down, Washington lights up with the W splendor of the lighted dome of the Capitol, the White House and the spectacular Washington Monument. Your tour will include visits to the Lincoln, Vietnam, Korean War, Nurses, and World War II Memorials, as well as the exterior of the White House. You will stop at Union Station for dinner on your own, and have time to appreciate this grand train station and its specialty shops and boutiques. Complete details regarding cost and reservations will  be included with your registration confirmation. If a minimum number of reservations are not received, this event is subject to cancellation. A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 5
  • 6. Registration Information   egistrations must include full tuition payment to be accepted. Registrations faxed without payment will not be R processed. Conference communications are sent via email. When registering please provide attendee’s best email address as some emails are filtered and blocked. Since conference registration and hotel rooms are limited, early registration is advised.  Out of consideration to registrants, children of any age and spouses may not attend the sessions.  Tuition (U.S. Funds) Preconference Main Conference Nurses, Residents,** Pharmacists, Others Physicians Early Registration Fee* (On/before April 25) $230 $465 $565 Regular Registration Fee $265 $495 $595 (After April 25) * Postmarked or phone/fax/online registration and fees received on/before April 25.** Residents: To qualify, submit facility verification of status with registration.Your tuition includes Certificate of Attendance, refreshment breaks, and Online CE Library access for handouts and recorded sessionsfor which you registered. Main Conference registrants have access to all Concurrent Sessions that are recorded and may earn additionalCE credit through the Online CE Library free of charge. See page 7 for Library details. Group Discounts (Mail, fax or call in together. Online registration is not available.) Tuition discounts are given to groups of 3 or more registering for the complete Main Conference. Discounts do not apply to the Preconference. To qualify for the group discount, all registration information must be complete for all group members, payment included and forms sent together. If faxing, list all group members on cover sheet. Subtract the discount from the tuition fee. Groups may not be formed after individual registrations are received. $25 per person discount for 3 or 4 in a group $45 per person discount for 5 or more in a group Method of Tuition Payment  Make payment by check (payable to Contemporary Forums and enclose with Registration Form), Visa, MasterCard, Discover, American Express or Purchase Order. A $30 fee is charged for any returned check. Personal checks are NOT accepted at the conference. Purchase Orders must be received with registration by the conference date and include the P.O. number, invoice address, tuition, approval signature, contact name, email address and phone number. Register Online, or by Phone, Fax or Mail (Payment is required to register.) Register only ONCE, online at www.ContemporaryForums.com, by mail or fax (800) 329-9923, or call (800) 377-7707, Monday-Friday, 8 a.m. – 5 p.m. (Pacific Time). Before calling, complete all registration information. Tax Deductibility Expenses of training, tuition, travel, lodging and meals to maintain or improve professional skills may be TAX DEDUCTIBLE. Consult your tax advisor. Partial Attendance (Online registration is not available.) Call Contemporary Forums for tuition and CE credit for individual days. Group discounts do not apply. Registrations may not be shared. Cancellations  Cancellations may be made by phone or in writing. Cancellations received on/before April 25 receive a full tuition refund. Cancellations received after April 25 are assessed a $20 processing fee. No refunds for cancellations received after the conference begins or for “no shows.” If this meeting is cancelled for any reason, including labor strikes or acts of God, liability is limited to a full refund of registration fees. Program Changes Contemporary Forums reserves the right to make necessary changes in speakers, topics or schedule. The most current program can be found on our website. Questions? Contact Contemporary Forums at (800) 377-7707, Monday - Friday, 8 a.m. - 5 p.m. (Pacific Time) or email info@cforums.com. If you require special arrangements at this conference, call (800) 377-7707, at least 30 days prior to the conference.EASY WAYS TO REGISTER Online (Credit card only) Fax (Credit card or Phone (Credit card only) Mail - Attn: Registrar Visit us at Purchase Order) Monday - Friday Contemporary Forumswww.ContemporaryForums.com (800) 329-9923 (800) 377-7707 6377 Clark Avenue, Ste. 200 24 hours a day 8am - 5pm, Pacific Time Dublin, CA 945686 Visit us www.ContemporaryForums.com to register today • Follow us on Facebook and Twitter (#NeoPharm12)
  • 7. Hotel Accommodations Travel Discounts  he conference will be held at the Renaissance Hotel, T Contemporary Forums has a special discount 999 Ninth Street, N.W., Washington, DC, 20001. A limited agreement with United Airlines unavailable block of rooms is being held for you and your guests at to the general public. To obtain these special special group rates which will be in effect, based on room conference fares call the Special Meeting availability, from June 5 to June 10 for those wishing to Desk at (800) 521-4041, Account Code 510CW. Ticketing extend their stay to enjoy area activities or qualify for and payment can be done directly by you or through you discount airfares. or through your travel agent. To ensure the best flights and times, since seats are limited, make your reservations early.  ates: $249 single/double R Fares are guaranteed at the time of the ticket purchase. Rates are per room and subject to prevailing state and local taxes.  o obtain the special group rates, make your reservation T Hertz is the official car rental agency early and before the “hotel room block release date” for the conference. Special rates will which is May 14. Rooms may sell out before this date so be in effect throughout the conference as well as one week be sure to make your reservation now. After the release before and after. For special rates, call HERTZ at (800) date, rooms and group rates may no longer be available 654-2240 and refer to Contemporary Forums plus the so call the hotel regarding availability. conference discount code CV# 03000259.  o reserve your room online, please visit our website at T www.ContemporaryForums.com for details. CONTEMPORARY FORUMS 2012 CONFERENCE CALENDAR  or room reservations, call (800) 468-3571 and inform F (Partial listing) them that you are attending the Contemporary Forums’ conference on Neonatal Pharmacology. Request a Contraceptive Technology confirmation number and written confirmation of your San Francisco, CA • March 7-10 reservation. Reservations must include a first night’s deposit. Boston, MA • March 28-31  ontact the hotel regarding cancellation policy. For C Obstetric Nursing arrivals after 3 p.m., call the hotel on the day of travel to Las Vegas, NV • April 15-18 reconfirm reservations. Adolescent Health Care  or additional hotel information, call the Renaissance F San Francisco, CA • May 31 - June 2 Hotel at (202) 898-9000. Hot Topics In Primary Care Jackson Hole, WY • July 29 - August 1 Office Gynecology RAVE REVIEWS! Snowmass, CO • August 5-8 Ambulatory OB/GYN Nursing  “This was my first time attending this meeting. I’m so impressed with all the great speakers, and their Boston, MA • September 27-29 Pharmacology for Advanced Practice Clinicians excellent presentations, which included lots of updated information. I will attend again.” San Francisco, CA • September 10-16 Martha Swee, MS • Severna Park, MD Washington, DC • October 8-14 Las Vegas, NV • November 5-11  “Topics were pertinent to my practice. The information really encouraged and supported For a complete list of conferences, please visit us online at www.ContemporaryForums.com some of my thoughts towards changing our current practices for certain clinical situations.” Lauri Wenninger, CNP • Sioux Falls, SD  “Thoroughly enjoyed the content of this conference. I work in a smaller hospital that needs some Online CE Library Conference Attendees adjustments. Great to learn new concepts.” Registration includes: Laura Schulz, R.Ph • Lima, OH • Access recorded sessions for 2 years  “It addressed most of the debatable topics in the NICU and offered solutions that are evidence- •  arn additional CE online for Concurrent Sessions free E • Share online sessions with 3 colleagues based.” Can’t Attend This Live Conference? Analize Barte, RNC • Chicago, IL Pre-purchase online access to recorded Preconference and  Main Conference sessions before 6/7/2012 for only $230. “It was great to network with other neonatal/ • Over 30 hours of ANCC/ACCME credit included clinical providers and learning about their different • Share content with 3 colleagues (CE credit optional) hospital functions, ranging from new NICU’s to • Unlimited online access for 2 years well established units. Now, I can bring back information to help the implementation of our 6 bed Online CE Library Group Access Programs NICU which opened in January 2011. The topics To request group access account pricing and details, visit onlineCElibrary.com provided and discussions were top-notch and all or call (925) 361-4811 have been areas of interest in my own facility.” Kerrie Perkins, BSN, RN • Belton, TX OnlineCElibrary.com A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 7
  • 8. Please Post Prominently or Forward to a Colleague if Unable to Attend U.S. POSTAGE Contemporary PRSRT STDRegistration Form: Neonatal Pharmacology Forums PAIDSend this form with full payment (U.S. Funds) to:Contemporary Forums, Attn: Registrar, 6377 Clark Avenue, Suite 200, Dublin, CA 94568Fax (800) 329-9923, Phone (800) 377-7707, or visit www.ContemporaryForums.comONLINE CE LIBRARY ONLY (Not Attending Conference - Details/Price Page 7) Conference Content and CE Credit via Library Only  (Complete all Registration Information, Professional Profile, and Payment Summary.) Please share with your colleaguesREGISTER TO ATTEND: Preconference: Neonatal Cardiology (June 7) Main Conference (June 8-9)REGISTRATION INFORMATION (Please Print Clearly)*Name, License/Degrees, Place of Employment, City, State appear on your badge.*First Name Social Security # (Last 4 Digits)*Last Name *License/Degrees*Place of Employment 6377 Clark Avenue, Ste. 200 Contemporary Forums*City *State Dublin, CA 94568 *Attendee’s E-mail For confirmation, CE Library. Pleasepresentation and provideto conference, access to your receipt, access to slides prior Certificate of Attendance and Online some emails are filtered and blocked. print clearly your best email address as PDF Code:Home AddressCity State Zip PAYMENT SUMMARY #071312Daytime Phone(s) Early Fee Postmark Deadline: April 25PROFESSIONAL PROFILE Conference Content Via Library Only $Choose ONE category in each section that best applies to you. If you have multipleroles, select the one that occupies the majority of your time. Use “Other” only if none of ORthe choices apply to you. Main Conference Tuition (Attending) $1. LICENSE/PROFESSION 3. YEARS IN NEONATAL CARE Clinical Nurse Specialist 1 Group Discount (See page 6) -$ Nurse Practitioner  2-3 (Registration forms must be sent in together.) Pharmacist/PharmD  4-7 Physician  8-10 Preconference Tuition: +$ Physician Assistant  11+ (Neonatal Cardiology - June 7) Registered Nurse Other:__________ TOTAL PAYMENT ENCLOSED $ 4. CLINICAL SETTING  Hospital Pharmacy2. POSITION/JOB FUNCTION  Check/Money Order Payable to Contemporary Forums OFFICE USE ONLY: C_________ D _________ E _________  Neonatology/NICU Attending Neonatologist  Newborn Care Clinical Nurse Specialist  Pediatrics/PICU Credit Card # Faculty/Educator/Instructor  Other:__________ Medical Director Nurse Practitioner Nursing Management Exp. Date Pharmacist 5. HIGHEST DEGREE HELD Pharmacy Director/Assistant  Diploma/Associate Degree Physician Assistant Print Cardholder’s Name  Bachelors Degree Staff/Charge Nurse  Masters Degree Other:__________  PharmD Billing Address  Doctoral Degree  Medical Degree  Other:__________ City State Zip Payer EmailWe collect this data in order to provide you with information about Contemporary Forums,conferences, and the Online CE Library. If you prefer not to receive further information,please see our Privacy Statement at www.ContemporaryForums.com or call our Privacy Payer Phone #Administrator at (888) 306-2344, or from outside the U.S. at (203) 840-5810.