13th Annual Neonatal Pharmacology

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13th Annual Neonatal Pharmacology

  1. 1. Healthcare Conferences • Continuing Education • Networking • Expert FacultyRegister earlyand save $$$Earn up to 21.5 hours!Register Todaywww.ContemporaryForums.comwww.onlineCElibrary.comEarn up to 21 hoursLa Jolla, CA • June 6-8, 2013NEONATALPHARMACOLOGYPreconference: June 6Advances in Neonatal NutritionNCC CertifiedRNs & NPsIncludes TopicsRequired forCertificationMaintenance
  2. 2. Visit us at www.ContemporaryForums.com to register today! Follow us on Facebook and Twitter (# NeoPharm13)2As we offer our vulnerable patients the best, most contemporary care possible, we need to keep in mind that manypharmacologic therapies have not been thoroughly examined in newborns and risk-benefit ratios are not well established.Although new and complex therapeutic interventions bring potential benefits, they can also create new, often unanticipated,complications.When influenza outbreaks occur, what new treatments should we consider to protect the susceptible newborn? Treatmentof the PDA, low blood pressure and encephalopathy may occur without careful consideration of what data have beendeveloped through peer reviewed studies.Antibiotics play a major role in the reduction of disease, but resistance is increasing and new drugs often lack thoroughtesting in the NICU populations who remain at risk for known as well as unanticipated toxicities. A better understanding ofpharmacologic therapies can help us avoid undesirable consequences and improve drug therapy in the neonatal population.In response to these challenges, Contemporary Forums presents the 13thAnnual Neonatal Pharmacology conferencedesigned for NICU professionals including physicians, nurse practitioners, clinical pharmacists, nurse managersand experienced staff nurses. This conference offers cutting edge information from some of the leading clinicians andresearchers in neonatology. You will learn from these experts how to integrate best practices into your unit for a broad rangeof neonatal drugs, as well as managing care in the light of drug shortages.If you are struggling to keep up with the recommended medication management for the NICU infant, if you are not surewhether medication delivery in your unit is as safe as it could be, don’t miss this opportunity to update your clinicalknowledge of neonatal pharmacology. We look forward to seeing you in La Jolla!Conference Highlights include: New neuroprotective strategies for encephalopathy, and management of neonatal abstinence syndrome and seizures. Preconference on Advances in Neonatal Nutrition focusing on nutritional risks, micro-nutrition, issues in TPNadministration, and maximizing growth through use of breast or donor milk. Management and treatment of sepsis in the neonate. Maximizing medication availability during drug shortages. Methods to improve NICU medication safety. Core Competency Areas and Content Topics for NCC Certification Maintenance in your specialty are included in thisconference.Don’t miss this opportunity to update your knowledge of recommended medication management for the NICU infant. Joincolleagues from across the U.S. and come away refreshed and renewed to put your passion into your practice!A Special InvitationConference ObjectivesThis program will enable the experienced clinician tobetter: Evaluate the safety and efficacy of cardiovascularpharmacotherapies. Outline new antibiotic dosing and safety protocols forthe NICU population. Anticipate potential side effects of neonatal drugtherapy, recognize adverse reactions and discuss theirmanagement. Evaluate alternative treatments when drug shortages occur. List neuroprotective strategies and outcomes.Kelly C. Wade, MD, PhD, MSCEConference ChairJason B. Sauberan, PharmDProgram ConsultantKathryn Clayton, MSN, MBA, ALNCProgram ManagerContemporary ForumsWho Should Attend?Anyone involved in the care of high-risk newbornsincluding: Neonatologists Nurse Practitioners Clinical Nurse Specialists Experienced Staff Nurses Educators and Instructors Nurse Managers Pharmacists Physician Assistants You!
  3. 3. A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 3Conference FacultyDavid H. Adamkin, MDProfessor of PediatricsDirector, Division of Neonatal MedicineRounsavall Endowed Chair of NeonatologyCo-Director, Neonatal Fellowship ProgramCo-Director, Neonatal Nutrition ResearchUniversity of Louisville School of MedicineLouisville, KentuckyEdmund Capparelli, PharmDClinical ProfessorSchool of Medicine and Skaggs School of Pharmacyand Pharmaceutical SciencesUniversity of California San DiegoSan Diego, CaliforniaJared Cash, PharmD, BCPSPharmacy Manager, Medication SafetyPrimary Children’s Medical CenterIntermountain HealthcareSalt Lake City, UtahRonald I. Clyman, MDProfessor of PediatricsSenior Staff, Cardiovascular Research InstituteUniversity of California San FranciscoSan Francisco, CaliforniaAdam R. Frymoyer, MDInstructor, General Pediatrics and NeonatologyLucille Packard Children’s HospitalStanford University School of MedicinePalo Alto, CaliforniaEstelle B. Gauda, MDProfessor of PediatricsJohns Hopkins Medical InstitutionsDepartment of Pediatrics, Division of NeonatologyBaltimore, MarylandHannah C. Glass, MDCM, MASAssistant Professor, Neurology PediatricsCo-Director, Neuro-Intensive Care NurseryUniversity of California San Francisco BenioffChildren’s HospitalSan Francisco, CaliforniaWilliam V. Good, MDSenior ScientistSmith-Kettlewell Eye Research InstituteSan Francisco, CaliforniaJae H. Kim, MD, PhDNeonatologist and Pediatric GastroenterologistMedical Director, Supporting Premature Infant Nutrition (SPIN)Associate Professor of PediatricsDivisions of Neonatal Medicine and PediatricGastroenterology, Hepatology NutritionUniversity of California San DiegoSan Diego, CaliforniaTina A. Leone, MDAssistant Clinical Professor of PediatricsDivision of NeonatologyColumbia University Medical CenterAttending NeonatologistMorgan Stanley Children’s Hospital ofNew York-PresbyterianNew York, New YorkJason B. Sauberan, PharmDProgram ConsultantNeonatal-Perinatal Clinical PharmacistUniversity of California San Diego Medical CenterAssistant Clinical Professor, UCSD Skaggs School ofPharmacy and Pharmaceutical SciencesSan Diego, CaliforniaMark H. Sawyer, MDProfessor of Clinical PediatricsDivision of Infectious DiseasesPrincipal InvestigatorPartnership of Immunization ProvidersUniversity of California San Diego School of MedicineSan Diego, CaliforniaRichard J. Schanler, MDAssociate Chairman, Department of PediatricsInterim Director, Neonatal ServicesCohen Children’s Medical Center of New York andNorth Shore Long Island Jewish Health SystemProfessor, Hofstra North Shore-LIJ School of MedicineHempstead, New YorkLisa M. Stellwagen, MD, FAAPMedical Director, Newborn ServiceLactation Director, Supporting Premature Infant Nutrition (SPIN)Clinical Professor of PediatricsDivision of NeonatologyUniversity of California San Diego Medical CenterSan Diego, CaliforniaKelly C. Wade, MD, PhD, MSCEConference ChairAttending NeonatologistThe Children’s Hospital of PhiladelphiaNewborn Care at Pennsylvania HospitalAssistant Professor of Clinical PediatricsAssociate Director of Nurseries, Academics and PolicyUniversity of Pennsylvania School of MedicinePhiladelphia, PennsylvaniaKristi Watterberg, MDProfessor of PediatricsPrincipal Investigator at New Mexico, NICHDNeonatal Research NetworkDirector, Signature Program in Child Health ResearchUniversity of New MexicoAlbuquerque, New MexicoIf you are not currently receiving conference and/or onlineCE library information and updates via email, please goto www.ContemporaryForums.com and join our mailinglist or update your email address. You will then be notifiedof all conferences as soon as they are announced aswell as have access to all special promotions. All emailaddresses are for Contemporary Forums use only.Email UpdatesExhibitsTo enhance your educational experience, we are invitingrepresentatives from professionally relevant companies,organizations and hospitals to exhibit equipment, supplies,services and career opportunities. The schedule providesparticipants time for one-on-one discussion with exhibitors.For exhibit space availability or additional information:Phone: (925) 361-4807Email: exhibits@cforums.comVisit: http://contemporaryforums.com/exhibitors.html
  4. 4. Visit us at www.ContemporaryForums.com to register today! Follow us on Facebook and Twitter (# NeoPharm13)4Nurses and Nurse PractitionersPreconference: 7 ANCC/8.4 CA BRN contact hoursMain Conference: 14 ANCC/16.8 CA BRN contact hoursContemporary Forums is accredited as a provider ofcontinuing nursing education by the American NursesCredentialing Center’s Commission on Accreditation.Contemporary Forums is approved by the CaliforniaBoard of Registered Nursing, Provider #04516.This program is approved for a maximumof 21 NAPNAP contact hours (7 contacthours – Preconference, 14 contact hours– Main Conference) of which a maximum of 8.25 containpharmacology ( ) content per the National Associationof Pediatric Nurse Practitioners (NAPNAP) ContinuingEducation Guidelines. Contemporary Forums, NAPNAPApproved Provider, Agency #12.NCC Certified Nurses and Nurse PractitionersContemporary Forums is a continuing educationorganization recognized by the National CertificationCorporation. This conference covers a variety of the CoreCompetency Areas and Content Topics required for theNCC’s Certification Maintenance in your specialty.Pharmacology Credit for Prescriptive AuthorityPreconference: 2.5 hoursMain Conference: 10.5 hours availableindicates pharmacology content. Because states’requirements vary, contact your Board of Nursing for moreinformation.PhysiciansPreconference: 7 creditsMain Conference: 14 creditsContemporary Forums is accredited by the AccreditationCouncil for Continuing Medical Education to providecontinuing medical education for physicians.Contemporary Forums designates this Live Activity for amaximum of 21 AMA PRACategory 1 CreditsTM. Physiciansshould claim only the credit commensurate with the extentof their participation in the activity.This continuing medical education activity has beenreviewed by the American Academy of Pediatrics and isacceptable for a maximum of 21 AAP credits. These creditscan be applied toward theAAP CME/CPDAward available toFellows and Candidate Members of the American Academyof Pediatrics.In accordance with CA Assembly Bill No. 1195, conferencefaculty have been advised to include content relatedto cultural and linguistic competency in the practice ofmedicine within their presentations, where appropriate.AccreditationPhysician AssistantsPreconference: 7 hoursMain Conference: 14 hoursThe American Academy of Physician Assistants acceptsCategory 1 CME approval from organizations accreditedby the ACCME to grant Category 1 hours toward thePhysician’s Recognition Award. PAs may report up to thelisted hours of credit.PharmacistsPreconference: 7 hours/.7 CEUsMain Conference: 14 hours/1.4 CEUs availableContemporary Forums is accredited by theAccreditation Council for Pharmacy Educationas a provider of continuing pharmacy education.This conference has multiple ACPE Universal ActivityNumbers and is a knowledge-based CPE activity.Contemporary Forums will utilize CPE Monitor for trackingand reporting of all ACPE accredited sessions. Pharmacistswill need to create their e-profile at www.MyCPEmonitor.netin order to obtain their NABP e-Profile ID (ePID). To receiveCE credit you must provide your ePID and birth date whenyou complete your online post-conference evaluations.A Certificate of Attendance will be available online after you complete the course requirements, enabling you to registeryour credit with the appropriate licensing boards or associations. To apply for credit not listed below, use the procedureestablished by the specific organization.CAN’T ATTEND THIS LIVE CONFERENCE?Pre-order online access before 6/15/13 for only $230• Access to recorded Preconference and Main Conference sessions• Over 30 hours of ANCC/ACCME credit included• Unlimited online access to multimedia presentations for 1 yearONLINE GROUP ACCESSPROGRAMS AVAILABLETo request group account detailsand pricing visitOnlineCElibrary.com orcall (925) 361-4811OnlineCElibrary.com
  5. 5. A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 5Optimalnutritionalsupportoftheneonateremainsachallengeand continues to evolve. Research confirms that effects rangefrom short-term growth to long-term neurodevelopmentalconsequences. This Preconference will provide insightsinto evidence-based nutritional management and emergingstrategies that will help provide the best possible outcomesfor these fragile neonates.This Preconference will enable you to: List the nutritional risks of late preterm infants. Identify the importance of specific vitamins and mineralsand how best to provide the recommended amounts. Evaluate TPN components and potential complicationsof long-term use. Describe strategies to maximize post-dischargenutritional management.7:00 a.m. Preconference Registration • Continental Breakfast8:00 Top 10 Gaps in Neonatal NutritionJae H. Kim, MD, PhD ( = .25 hr.)ACPE #0263-000-13-307-L01-P8:45 TPN in the Very Low Birth Weight: Is It Worth It?David H. Adamkin, MD ( = .25 hr.)ACPE #0263-000-13-308-L01-P (1 contact hr.)9:30 Questions and DiscussionFaculty Panel9:45 Refreshment Break10:00 Vitamin D Needs for NewbornsRichard J. Schanler, MD ( = .25 hr.)ACPE #0263-000-13-309-L01-P10:45 Two Strategies to Improve Growth andOutcomes in VLBW Infants: Protein andPost Discharge NutritionDavid H. Adamkin, MD ( = .25 hr.)ACPE #0263-000-13-310-L01-P (1 contact hr.)11:30 Questions and DiscussionFaculty Panel11:45 Lunch on Your Own1:15 p.m. Supporting Premature Infant Nutrition: TheUniversityofCaliforniaSanDiegoSPINProgramLisa M. Stellwagen, MD, FAAPACPE #0263-000-13-311-L01-P2:00 Meeting Nutritional Needs with Human Milkin Preterm InfantsRichard J. Schanler, MD ( = .25 hr.)ACPE #0263-000-13-312-L01-P (1 contact hr.)2:45 Questions and DiscussionFaculty Panel3:00 Refreshment Break3:15 Update on Maternal Medications in Breast MilkJason B. Sauberan, PharmD ( = .75 hr.)ACPE #0263-000-13-313-L01-P4:00 Nutritional Risk of the Late Preterm InfantJae H. Kim, MD, PhD ( = .25 hr.)ACPE #0263-000-13-314-L01-P (1 contact hr.)4:45 Questions and DiscussionFaculty Panel ( = .25 hr.)5:00 AdjournPreconferenceAdvances in Neonatal NutritionThursday, June 6= Pharmacology Credit for Prescriptive Authority.ACPE = Credit for Pharmacists. Sessions each provide.75 Contact Hour/.075 CEU except where noted.Friday, June 7Main Conference7:00 a.m. Main Conference Registration • Exhibits •Continental Breakfast8:00 Neonatal Seizure Management: CurrentEvidence and ControversiesHannah C. Glass, MDCM, MAS ( = .25 hr.)ACPE #0263-000-13-315-L01-P8:45 Novel Therapies for the Treatment ofNeonatal Abstinence SyndromeEstelle B. Gauda, MD ( = .5 hr.)ACPE #0263-000-13-316-L01-P (1 contact hr.)9:30 Questions and DiscussionFaculty Panel ( = .25 hr.)9:45 Refreshment Break • Exhibits10:15 Therapeutic Hypothermia forNeonatal EncephalopathyHannah C. Glass, MDCM, MASACPE #0263-000-13-317-L01-P11:00 Drug Dosing During HypothermiaKelly C. Wade, MD, PhD, MSCE ( = .75 hr.)ACPE #0263-000-13-318-L01-P (1 contact hr.)11:45 Questions and DiscussionFaculty Panel ( = .25 hr.)12:00 p.m. Lunch on Your Own1:30 Who, What, How Long for Early OnsetSepsis in the Neonate?Adam R. Frymoyer, MD ( = .75 hr.)ACPE #0263-000-13-319-L01-P2:15 Improved Treatment of Viral andFungal InfectionsKelly C. Wade, MD, PhD, MSCE ( = .75 hr.)ACPE #0263-000-13-320-L01-P (1 contact hr.)3:00 Questions and DiscussionFaculty Panel ( = .25 hr.)3:15 Refreshment Break • Exhibits3:45 Hitting the Target: Vancomycin Dosingin the NeonateAdam R. Frymoyer, MD ( = .75 hr.)ACPE #0263-000-13-321-L01-P4:30 Avastin®for Retinopathy of PrematurityWilliam V. Good, MD ( = .5 hr.)ACPE #0263-000-13-322-L01-P (1 contact hr.)5:15 Questions and DiscussionFaculty Panel ( = .25 hr.)5:30 Adjourn
  6. 6. Visit us at www.ContemporaryForums.com to register today! Follow us on Facebook and Twitter (# NeoPharm13)6Saturday, June 87:00 a.m. Exhibits • Continental Breakfast8:00 Generating Rational Dosing for Neonates:Lessons Learned from Anti-Infective TrialsEdmund Capparelli, PharmD ( = .75 hr.)ACPE #0263-000-13-323-L01-P8:45 Pre-Medication for IntubationTina A. Leone, MD ( = .25 hr.)ACPE #0263-000-13-324-L01-P (1 contact hr.)9:30 Questions and DiscussionFaculty Panel ( = .25 hr.)9:45 Refreshment Break • Exhibits10:15 Management of HypotensionTina A. Leone, MD ( = .25 hr.)ACPE #0263-000-13-325-L01-P11:00 PDA: A Re-Examination of Our CurrentApproach to TreatmentRonald I. Clyman, MD ( = .25 hr.)ACPE #0263-000-13-326-L01-P (1 contact hr.)11:45 Questions and DiscussionFaculty Panel ( = .25 hr.)12:00 p.m. Lunch on Your Own1:30 Immunization of Preterm Infants in the NICUMark H. Sawyer, MD ( = .5 hr.)ACPE #0263-000-13-327-L01-P2:15 Medication Famine: Drug Shortagesin the NICUJared Cash, PharmD, BCPS ( = .75 hr.)ACPE #0263-000-13-328-L01-P (1 contact hr.)3:00 Questions and DiscussionFaculty Panel ( = .25 hr.)3:15 Refreshment Break3:30 Inborn Errors of Medication: NICUMedication SafetyJared Cash, PharmD, BCPS ( = .75 hr.)ACPE #0263-000-13-329-L01-P4:15 Benefits and Hazards of PostnatalGlucocorticoid Therapy in Preterm InfantsKristi Watterberg, MD ( = .75 hr.)ACPE #0263-000-13-330-L01-PP (1 contact hr.)5:00 Questions and DiscussionFaculty Panel ( = .25 hr.)5:15 AdjournContemporary Forums has a special discountagreement with United Airlines unavailableto the general public. To obtain these specialconference fares visit www.united.com, insert Offer CodeZNCS108722. Ticketing and payment can be done directlyby you or through your travel agent. To ensure the best flightsand times, since seats are limited, make your reservationsearly. Fares are guaranteed at the time of the ticket purchase.Hertz is the official car rental agency forthe conference. Special rates will be ineffect throughout the conference as well as one week beforeand after. For special rates, call HERTZ at (800) 654-2240and refer to Contemporary Forums plus the conferencediscount code CV#03000260. The conference will be held at the Hyatt Regency LaJolla, 3777 La Jolla Village Drive, San Diego, CA 92122.A limited block of rooms is being held for you and yourguests at special group rates which will be in effect, basedon room availability, from June 3 to June 9 for thosewishing to extend their stay to enjoy area activities orqualify for discount airfares. Rates: $199 single/double Rates are per room and subject to prevailing state and local taxes. To obtain the special group rates, make your reservationearly and before the “hotel room block release date”which is May 3. Rooms may sell out before this date sobe sure to make your reservation now. After the releasedate, rooms and group rates may no longer be availableso call the hotel regarding availability. To reserve your room online, please visit our website atwww.ContemporaryForums.com for details. For room reservations, call (888) 421-1442 and informthem that you are attending the Contemporary Forums’conference on Neonatal Pharmacology. Request aconfirmation number and written confirmation of yourreservation. Reservations must include a first night’sdeposit. Contact the hotel regarding cancellation policy. For arrivalsafter 4 p.m., call the hotel on the day of travel to reconfirmreservations. For additional hotel information, call the Hyatt RegencyLa Jolla at (858) 552-1234.Hotel AccommodationsTravel DiscountsRave ReviewsMain Conference - continuedThe National Conference of Neonatal NursingJune 23-26 • San Francisco, CAPharmacology for Advance Practice CliniciansAugust 19-25 • San Francisco, CASeptember 30-October 6 • Washington, DCNovember 11-17 • Las Vegas, NVThe Fetus and Newborn: State-of-the-Art CareNovember 6-9 • Washington, DCDevelopmental Interventions in Neonatal CareNovember 6-9 • New Orleans, LACONTEMPORARY FORUMS2013 CONFERENCE CALENDAR(Partial listing)For complete conference information, visit www.ContemporaryForums.com,call toll-free at (800) 377-7707 or email:info@cforums.com.Contemporary Forums is a division of American Career College.“Thoroughly enjoyed the content of this conference. I workin a smaller hospital that needs some adjustments. Greatto learn new concepts.”Laura Schulz, RPh • Lima, OH“It addressed most of the debatable topics in the NICU andoffered solutions that are evidence-based.”Analize Barte, RNC • Chicago, IL
  7. 7. A Leader in Quality Continuing Education for Healthcare Professionals for 30 years 7 Registrations must include full tuition payment to be accepted. Registrations faxed without payment will not be 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)EASY WAYS TO REGISTERMail - Attn: RegistrarContemporary Forums6377 Clark Avenue, Ste. 200Dublin, CA 94568Fax (Credit card orPurchase Order)(800) 329-992324 hours a dayPhone (Credit card only)Monday - Friday(800) 377-77078am - 5pm, Pacific TimeOnline (Credit card only)Visit us atwww.ContemporaryForums.comRegistration Information: Neonatal Pharmacology 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. 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. 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 notapply to the Preconference. To qualify for the group discount, all registration information must be complete for all groupmembers, payment included and forms sent together. If faxing, list all group members on cover sheet. Subtract thediscount 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 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 tuitionrefund. Cancellations received after April 25 are assessed a $20 processing fee. No refunds for cancellations receivedafter the conference begins or for “no shows.” If this meeting is cancelled for any reason, including labor strikes or actsof 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.* 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 daily continental breakfast and refreshment breaks, Certificate ofAttendance, and access to posted presentationhandouts before and after the conference.Early Registration Fee*(On/before April 25)Regular Registration Fee(After April 25)$225$230$265$475 $575$525 $615Preconference Conference Content viaOnline Library OnlyPhysiciansNurses, Residents**,Pharmacists, OthersMain Conference
  8. 8. Registration Form: Neonatal PharmacologyOFFICEUSEONLY:C_________D_________E_________PROFESSIONAL PROFILEChoose 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 noneof the choices apply to you.Please Post Prominently or Forward to a Colleague if Unable to AttendSend 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.com1. LICENSURE/PROFESSION❒ Clinical Nurse Specialist❒ Nurse Practitioner❒ Pharmacist/PharmD❒ Physician❒ Physician Assistant❒ Registered Nurse❒ Other:__________2. POSITION/JOB FUNCTION❒ Attending Neonatologist❒ Clinical Nurse Specialist❒ Faculty/Educator/Instructor❒ Medical Director❒ Nurse Practitioner❒ Nursing Management❒ Pharmacist❒ Pharmacy Director/Assistant❒ Physician Assistant❒ Staff/Charge Nurse❒ Other:__________3. YEARS IN NEONATAL CARE❒ 1❒ 2-3❒ 4-7❒ 8-10❒ 11+4. CLINICAL SETTING❒ Hospital Pharmacy❒ Neonatology/NICU❒ Newborn Care❒ Pediatrics/PICU❒ Other:__________5. HIGHEST DEGREE HELD❒ Diploma/Associate Degree❒ Bachelors Degree❒ Masters Degree❒ PharmD❒ Doctoral Degree❒ Medical Degree❒ Other:__________ContemporaryForums6377ClarkAvenue,Ste.200Dublin,CA94568PRSRTSTDU.S.POSTAGEPAIDContemporaryForumsCode:PleasesharewithyourcolleaguesREGISTER TO ATTEND:❒ Preconference: Advances in Neonatal Nutrition (June 6)❒ Main Conference (June 7-8)ONLINE CE LIBRARY ONLY: (Not Attending Conference - Details/Price Page 4)❒ Conference Content via Library Only (Complete all Registration Information, Professional Profile, and Payment Summary.)*First Name Social Security # (Last 4 Digits)*Place of Employment*City *StateCity State ZipDaytime Phone(s)*Attendee’s E-mail Required: For confirmation, receipt, access to presentation slides prior to conference andaccess to your Certificate of Attendance. Please print clearly and provide your best email address as someemails are filtered and blocked.Home Address*Last Name *License/DegreesREGISTRATION INFORMATION (Please Print Clearly)*Name, License/Degrees, Place of Employment, City, State appear on your badge.Early Fee Postmark Deadline: April 25PAYMENT SUMMARY #64❒ Check/Money Order Payable to Contemporary ForumsCredit Card #Print Cardholder’s NameBilling AddressCity State ZipExp. DatePayer EmailPayer Phone #Conference Content via Library Only $ORMain Conference Tuition (Attending) $Group Discount (See page 7) - $(Registration forms must be sent in together.)Preconference Tuition: + $(Advances in Neonatal Nutrition - June 6)TOTAL PAYMENT ENCLOSED $PDFWe collect this data in order to provide you with information about ContemporaryForums, conferences, and the Online CE Library. If you prefer not to receive furtherinformation, please see our Privacy Statement at www.ContemporaryForums.com.

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