Exciting News... our hotel room rates include daily buffet breakfast, resort fee & airport shuttle!
Please see our lodging...
CONFERENCE DESCRIPTION

CONTINUING EDUCATION CREDIT

Our 20 Annual Summer Conference on Obstetrics and Gynecology has been...
CONFERENCE FACULTY

CONFERENCE SCHEDULE

Annekathryn Goodman, MD

Wednesday, June 26

Fellowship Director
Division of Gyne...
CONFERENCE REGISTRATION INFORMATION

TERMS & CONDITIONS

Enrollment for this conference is limited in order to provide the...
CONFERENCE LOCATION
Located in the northwestern corner of Wyoming, just an hour south of
Yellowstone National Park, Jackso...
CONFERENCE & LODGING REGISTRATION FORM
Register on-line at www.symposiamedicus.org

SYMPOSIA MEDICUS
20th Annual Summer Co...
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20th Annual Summer Conference on Obstetrics and Gynecology

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20th Annual Summer Conference on Obstetrics and Gynecology

  1. 1. Exciting News... our hotel room rates include daily buffet breakfast, resort fee & airport shuttle! Please see our lodging information inside the brochure for more details. 20th Annual Summer Conference on OBSTETRICS AND GYNECOLOGY Including topics on: The Short Cervix, Hormones & Moods, Preconception Care, Gynecological Cancers, Fetal Implications of Maternal Disease, and much more… Snow King Resort & Grand View Lodge Jackson Hole, Wyoming JUNE 26-29, 2013 SPONSORED BY “Symposia Medicus conferences have the right mixture of lectures and leisure time. Usually at the end of conferences, I am exhausted – these are so refreshing.” – Pam Lacy, MD 35 “Symposia Medicus’ conferences are useful and adequately paced. They are professional and extremely useful to me. The half day sessions are a great mix of fun and learning.” – Margaret M. Boyd, CNM SINCE 1978 A Non-Profit Corporation for Continuing Medical & Nursing Education Register On-Line... “Symposia Medicus truly has outstanding conferences. Their faculty members are not only great presenters, but are also friendly and easily accessible.” – Theodore R. Smith, Jr., MD for this conference or view other educational conferences at w w w. s y m p o s i a m e d i c u s . o r g 35
  2. 2. CONFERENCE DESCRIPTION CONTINUING EDUCATION CREDIT Our 20 Annual Summer Conference on Obstetrics and Gynecology has been designed for physicians, certified nurse midwives, nurse practitioners, physician assistants, nurses and other health care professionals who face ever-increasing challenges in the clinical diagnoses, treatment options, and new technologies involved in caring for the female patient. The goal of this conference is to present current clinical data on key issues in obstetrics and gynecology, along with treatment options to manage these challenges. Emphasis will be placed on practical application of the evidence-based topics presented. In addition to didactic lectures and smaller group breakouts, ample time has been allotted for participant feedback and interaction. Physicians Symposia Medicus designates this live activity for a maximum of 18 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. th Topics for this year’s conference have been selected based on the educational needs determined, which resulted from the identified professional practice gaps. The gaps were derived from a variety of sources including evaluations and outcomes data from past participants; clinical expert input; Symposia Medicus’ online survey; and other medical and nursing data. Conference format will include didactic lectures, smaller group breakout sessions, case studies, and question and answer sessions. An outstanding faculty has been assembled for this conference. Each member was selected based on individual area of expertise and ability to communicate current, evidence-based and practical information to participants. Application has been made with the American College of Obstetricians & Gynecologists (ACOG) for cognates, Formal Learning. Certified Nurse Midwives The American College of Nurse Midwives accepts Category 1 CME approval from organizations accredited by the ACCME. Physician Assistants The American Academy of Physician Assistants accepts Category 1 CME approval from organizations accredited by the ACCME. Nurse Practitioners/Nurses The ANCC contact hours awarded for completion of this conference are 18. Provider is also approved by the California Board of Registered Nursing, Provider #CEP2335, for 21.6 contact hours. Morning sessions and one afternoon session leave ample time for relaxing, enjoying family and friends, and exploring the lovely town of Jackson, as well as Grand Teton and Yellowstone National Parks. Pharmacology Credit for Prescriptive Authority A maximum of 3.25 hours in pharmacology credit for prescriptive authority may be earned by attending this educational conference. Sessions awarding pharmacology credit for prescriptive authority are denoted with an Rx in the schedule. CONFERENCE OBJECTIVES SMALLER GROUP BREAKOUT SESSIONS As a result of participating in this conference, you should have increased knowledge and enhanced competence to… Smaller group sessions will be held Friday afternoon. These breakout sessions are organized to provide an opportunity for greater participant/faculty interaction, and will give you an opportunity to discuss subjects relating to your particular area of interest. Please indicate your breakout session topic choice on the conference registration form in this brochure. Space is limited so please reserve early. • Assess risks and management strategies associated with the short cervix • Evaluate the Annual Exam from a life cycle perspective, including screening and treatment from the reproductive years to post menopause • Manage female cancer workups and treatment of side effects EDUCATIONAL RESOURCES • Choose appropriate management options for Group B Strep in the pregnant patient Each registrant will receive an extensive conference syllabus that includes materials on each topic presented. The full color syllabus will be available for download approximately two weeks prior to the conference (you’ll receive an email with instructions). If you wish to receive a paper syllabus (black and white type & photos only), please check the box on the registration form in this brochure. • Identify therapeutic interventions to improve maternal cardiac output and oxygen transport to the fetus ACCREDITATION This educational activity was planned and produced in accordance with the ACCME and ANCC Essentials and Standards relating to continuing medical and nursing education. Symposia Medicus is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Symposia Medicus is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Each participant should only claim credit commensurate with the extent of their participation in the activity. If you bring your laptop/tablet to the conference, be aware that there are no electrical outlets at the conference tables. Make sure your laptop/tablet is fully charged each day. If you are unable to attend this conference, extra copies of this syllabus (either paper or digital copy) will be available one week after the conference. The cost is $60 for a paper syllabus and $25 for the digital copy. To place your order, please email publications@symposiamedicus.org. GROUP TOURS / GROUND TRANSPORTATION Tours are planned for participants and guests throughout the conference breaks. Additional information regarding activities, hotel, location and ground transportation will be sent to registrants. Certificates of credit will be given to participants on-site at the conclusion of the conference. Page 2 Conference Brochure #1263, 20th Annual Summer Conference on Obstetrics and Gynecology Symposia Medicus Since 1978 35
  3. 3. CONFERENCE FACULTY CONFERENCE SCHEDULE Annekathryn Goodman, MD Wednesday, June 26 Fellowship Director Division of Gynecologic Oncology Massachusetts General Hospital Associate Professor of Obstetrics, Gynecology & Reproductive Biology Boston, Massachusetts 7:00am Registration & Check-in 8:00 Welcome & Introduction D. Michael Nelson, MD, PhD 8:15 The Short Cervix: The Myth & the Evidence Connie Graves, MD Cornelia (Connie) R. Graves, MD, FACOG Conference Co-Chairperson Medical Director Tennessee Maternal-Fetal Medicine Director of Perinatal Services, Baptist Hospital Clinical Professor, Vanderbilt University Nashville, Tennessee Suzanne McMurtry Baird, DNPc, MSN, RN Assistant Director Clinical Program Development Texas Children’s Hospital Pavilion for Women Houston, Texas D. Michael Nelson, MD, PhD Conference Co-Chairperson Virginia S. Lang Professor of Obstetrics and Gynecology Vice Chairman, Obstetrics and Gynecology Washington University School of Medicine St. Louis, Missouri Ricki Pollycove, MD, MS Founding Director of Education Breast Health Center California Pacific Medical Center San Francisco Past Chief, Division of Gynecology Clinical Faculty, Hormones and Mood Clinic Department of Psychiatry University of California School of Medicine San Francisco, California 9:00 9:45 Questions & Answers Group Discussion Faculty Panel & Audience Adjourn for the Day Friday, June 28 3:30pm Smaller Group Breakouts – Session One A. Bio-identical Hormone Therapy: What Evidence-Based Literature Supports, What Consumers Demand, What Should You Do? Ricki Pollycove, MD, MS B. Questions & Answers Group Discussion Faculty Panel & Audience Perinatal Complications of Bariatric Surgery D. Michael Nelson, MD, PhD 10:15 Break 10:30 The Annual Exam: Standards of Care Beyond the Pap Smear (Rx = 10 minutes) Ricki Pollycove, MD, MS C. Maternal Mortality: Case Studies Suzanne McMurtry Baird, DNPc, MSN, RN 11:15 The Fetal Implications of Maternal Disease (Rx = 15 minutes) Suzanne McMurtry Baird, DNPc, MSN, RN D. Cancer Care: Contemporary Symptom Management Through Ancient Healing Arts Annekathryn Goodman, MD Noon Gynecologic Cancers: Screening & Workup Annekathryn Goodman, MD Questions & Answers Group Discussion Faculty Panel & Audience 1:30 Adjourn for the Day 5:306:30pm Group Reception (Faculty, Participants & Their Guests) 5:00 Break 5:15 12:45pm Smaller Group Breakouts – Session Two (Session One Topics Repeated) 6:45 Adjourn for the Day Saturday, June 29 8:00am Revised Guidelines in the Obstetrical Management of Beta Streptococcus (Rx = 30 minutes) Thursday, June 27 D. Michael Nelson, MD, PhD Managing the Acute Endocrine OB Emergencies of Diabetic Ketoacidosis & Thyroid Storm (Rx = 20 minutes) Connie Graves, MD 8:45 Office Management of Abnormal Uterine Bleeding Annekathryn Goodman, MD 9:30 8:00am Questions & Answers Group Discussion Faculty Panel & Audience Sexuality Through the Life Cycle: Implications with Contraception, Pregnancy, Menopause & Beyond 10:00 Break (Hotel check-out, if applicable) 10:15 Contemporary Management of Preterm Labor (Rx = 30 minutes) Connie Graves, MD 11:00 (Rx = 15 minutes) Consequences of Cancer: Treatment Side Effects (Rx = 20 minutes) Annekathryn Goodman, MD 11:45 The Changing Face of Preeclampsia D. Michael Nelson, MD, PhD 12:30pm Questions & Answers Group Discussion Faculty Panel & Audience Ricki Pollycove, MD, MS 9:30 Questions & Answers Group Discussion Faculty Panel & Audience 10:00 Break 10:15 Critical Thinking: Case Studies in Obstetrics (Rx = 10 minutes) Suzanne McMurtry Baird, DNPc, MSN, RN 11:00 The Antepartum & Intrapartum Management of Thrombophilias to Prevent an Acute Emergency Event (Rx = 15 minutes) Connie Graves, MD 11:45 Page 3 1:15 Preconception Care: The Key to Improving Pregnancy Outcomes D. Michael Nelson, MD, PhD 8:45 Consistent with ACCME and ANCC policy, faculty for this educational activity are asked to disclose any commercial interests that may create or may be perceived as creating a conflict related to the material they will be presenting, as well as limitations on clinical studies presented, and any “off-label” use suggestions for medical products. Additionally, Symposia Medicus Board, Planning Committee, and Staff members have disclosed that they have no significant financial relationships that could pose a conflict of interest to the planning of this conference. This information is intended to assist you in forming your own judgments about content presented. Disclosure information will be included in your syllabus and/or verbally disclosed at the conference. 12:30pm Hormones & Mood Throughout the Life Cycle: PMD, PPD & Post Menopausal Mood Support (Rx = 30 minutes) Ricki Pollycove, MD, MS Conference Brochure #1263, 20th Annual Summer Conference on Obstetrics and Gynecology 1:15 Conference Adjourns Rx = Pharmacology Credit for Prescriptive Authority will be granted for these sessions Symposia Medicus Since 1978 35
  4. 4. CONFERENCE REGISTRATION INFORMATION TERMS & CONDITIONS Enrollment for this conference is limited in order to provide the best possible learning environment. Early registration is advised. TUITION: Physicians Residents, Nurses, PAs & All Others EARLY If postmarked by April 17, 2013 $610 $510 REGULAR If postmarked after April 17, 2013 $710 $610 • Tuition includes continuing education certification, extensive conference syllabus, break refreshments, and group reception. The group reception is for faculty, registrants and their guests. • Tuition may be paid by check, money order, Visa, MasterCard, American Express, or Discover. Hotel Policies • Group Rates above are per room, per night, and do not include state & local taxes, currently 13% (subject to change) • Maximum occupancy stated cannot be exceeded (no exceptions) • Children 6 years and under are complimentary, using existing bedding, when staying with adults (includes buffet breakfast, resort fee, and airport shuttle) • Register on-line at www.symposiamedicus.org or by using the form in this brochure. • Additional occupants (over two in room), 7 years & older, are an additional $10 per person, per night (includes buffet breakfast, resort fee, and airport shuttle) • Telephone registrations can be made Monday-Friday, 8:30am-5:00pm (Pacific Time), by calling (925) 969-1789 or (800) 327-3161. Registrations can also be faxed to (925) 969-1795. • Cribs are complimentary and rollaways are $10 per night, in addition to the $10 occupant charge (subject to change and based on availability) • If paying by check, make payable and send with registration form to Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. • Check-in time is 4:00pm and check-out time is noon. Late check-out can only be confirmed on the date of departure by the front desk. • Conference registration will be confirmed via email and more information on travel, hotel, and activities will be emailed and available on our website as well. • Changes (within 7 days of arrival) or failure to arrive on confirmed date will be charged the entire reserved stay • This conference meets the requirements for CE tax deductibility; however, we suggest you consult your financial authority for more information. • For additional conference or lodging information, call Symposia Medicus at (800) 327-3161 or (925) 969-1789, or visit our website at www.symposiamedicus.org. • For information on air reservations and ticketing assistance, you may either call your travel agent or the airlines direct. Please see the Airline Travel Information portion of this brochure for further information. CONFERENCE LODGING INFORMATION GROUP RATES ARE FOR SINGLE/DOUBLE OCCUPANCY AND INCLUDE DAILY BUFFET BREAKFAST, RESORT FEE, AND SHUTTLE SERVICE TO/FROM THE JACKSON HOLE AIRPORT Group Rates have been arranged at the Snow King Resort and Grand View Lodge. These rates will also be available three days before and three days after the conference, based on availability, if you wish to extend your stay. Two nights’ deposit (room rate only) must accompany your reservation. The balance of your lodging, hotel fees as stated below, and all incidental charges are due to the hotel. The hotel accepts most major credit cards. You can receive these rates by reserving the following ways: Cancellation Policies • Conference cancellations must be confirmed in writing and a 10% of paid tuition processing fee will be assessed. No refunds will be made if cancellation is postmarked after May 22, 2013; however, tuition, less 10% processing fee may be applied to a future Symposia Medicus conference. • Per our hotel contract, hotel reservation cancellations must be made in writing to Symposia Medicus and you will receive a full refund if postmarked by April 24, 2013. Between April 25, 2013 and May 22, 2013, one night’s deposit is forfeited. After May 22, 2013, no hotel refunds can be made. • All cancellations must be made in writing (via email, fax or mail) and postmarked by the dates stated above. • In the unlikely event of conference cancellation by Symposia Medicus, full tuition and, if reservation was made with Symposia Medicus, hotel deposit refunds will be made. SymposiaMedicus will not be responsible for refunding travel or any other expenses. • On-line at our website, www.symposiamedicus.org; OR • Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR AIR TRAVEL INFORMATION • Fax form with Visa, MasterCard, American Express, or Discover to (925) 969-1795; OR You will be flying into Jackson Hole, Wyoming, which is approximately 20 minutes from the resort. Information on ground transportation will be sent to registrants and available online at our website. • By mail, make check payable to Symposia Medicus and send with registration form to 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. Please note that our block of rooms is limited and on a first come, first served basis. PLEASE RESERVE EARLY as rooms may sell out and/or room rates may increase. GROUP RATES INCLUDE DAILY BUFFET BREAKFAST, RESORT FEE, AND SHUTTLE SERVICE TO/FROM THE JACKSON HOLE AIRPORT AND ARE FOR SINGLE/DOUBLE OCCUPANCY PLEASE NOTE: Snow King Hotel Rooms are older (last renovation over 15 years ago) Room Descriptions (Conference room located in Snow King Hotel) Snow King Hotel Room 1 King or 2 Queen beds, room features air conditioner, iron/ironing board and coffee maker. These rooms are older than the Love Ridge Studios / Condos. Symposia Medicus has arranged for discount fares with American and Delta airlines for this conference. Reservations can be made either through your travel agency or through the airlines at the website or Convention Desk numbers listed below. In order to receive the discounted rate, you or your travel agent must refer to the Symposia Medicus Group ID number listed below. Maximum Room Occupancy $160/night American Airlines For discounts on American Airlines flights, please book online at www.aa.com and insert 4263BU into the promotion code box. For questions, please call the American Airlines Convention Desk at (800) 433-1790. Delta Airlines Group Rates (Single/Double Occupancy) For discounts on Delta Airlines flights, please book online at www.delta.com and click the box “from Airport” and another page will appear. At the bottom of that page, click the link “Meeting Event Code” and insert NME7E. For questions, please call the Delta Airlines Convention Desk at (800) 328-1111. 4 Love Ridge Condos are six years old and are a 5-10 minute walk to the conference room. *Love Ridge Studio *Love Ridge 1-Bedroom Condo *Love Ridge 2-Bedroom Condo *Love Ridge 3-Bedroom Condo The two room suite offers a queen bed and separate living area. Includes a fireplace, mini kitchen with microwave, coffee maker, sink and small fridge. There is also a queen-size wall bed. Washer/dryer, work desk and furnished terrace. Large one-bedroom condo with living room, dining room and fully equipped kitchen. Includes a gas fireplace, washer/dryer and desk. The bathroom includes a custom glass shower enclosure and large whirlpool bathtub. Spacious condo featuring a fully equipped kitchen, dining room, gas fireplace, washer/dryer and desk. The master bedroom has a king size bed and master bathroom. The living room connects the second bedroom and bathroom. This three-bedroom condo offers 2,000 square feet of space. It offers a fully equipped kitchen, dining room, living room, two gas fireplaces and a washer/dryer. There are a total of three bathrooms, two with showers and one with a shower and whirlpool tub. $235/night 4 $275/night 4 $395/night 6 CAR RENTAL DISCOUNT For conference discounts, Symposia Medicus has made arrangements with AVIS and Budget Car Rentals. Reservations can be made by phone; please refer to the conference code and the conference/airport location when making your reservations. Please see below: $435/night AVIS 800-331-1600 AWD # B766625 Budget 800-772-3773 BCD # U076767 8 By reserving through Symposia Medicus, the Resort Fee is included in the group rates stated above. Includes: complimentary Wi-Fi throughout the resort, local phone calls, toll-free phone calls, use of 24-hour internet kiosks/color printer, complimentary self parking, pool/whirlpool, sauna/exercise room, game room, on-property transportation, and a round trip airport shuttle. *All Love Ridge units are limited, please reserve early Page 4 Conference Brochure #1263, 20th Annual Summer Conference on Obstetrics and Gynecology Symposia Medicus Since 1978 35
  5. 5. CONFERENCE LOCATION Located in the northwestern corner of Wyoming, just an hour south of Yellowstone National Park, Jackson Hole is a beautiful alpine valley surrounded by snowcapped mountains, high mountain lakes and majestic scenery. Within the valley lies Grand Teton National Park, the National Elk Refuge and the friendly town of Jackson. Set in the shadow of the towering Grand Teton Mountains, Jackson Hole has a unique blend of Western charm and cosmopolitan atmosphere. For those who want a real taste of the Old West, Jackson Hole boasts some of the finest western entertainment and offers everything from an evening horseback ride and steak fry to an outdoor chuck wagon dinner. The picturesque stagecoach ride around the town square and the exciting shootout, held there every evening for the last 56 years, complete this Wild West theme. There are numerous art galleries displaying the works of a large number of well-known artists. You can also enjoy the nightly concerts of the Grand Teton Music Festival at the Festival Hall at Teton Village, where everything from Beethoven to Bartok is performed by some of our nation’s finest musicians. The outdoor adventurer can raft on the Snake River, hike the Grand Tetons or explore Yellowstone National Park with its variety of wildlife and grand scenery. Don’t miss the Jackson Hole Rodeo, one of the area's oldest and most exciting traditions. Our resort, the Snow King Resort & Grand View Lodge, is conveniently located to take advantage of this natural playground. The spacious Love Ridge condos are fully furnished in an elegant western style, with rustic log and stone finishes. Guest rooms offer spectacular views of the town of Jackson, Snow King Mountain, or the Grand Teton Mountain Range. At the resort, enjoy an exhilarating ride on the Alpine Slide, winding down 2,500 feet through woods and wildflowers; play Alpine Miniature Golf, a fun activity for the whole family; or, ride the Scenic Chair lift to the top of Snow King Mountain for an unmatched view of the Tetons and Jackson Hole. Whatever your pleasure, you are sure to find it at the 20 th Annual Summer Conference on Obstetrics and Gynecology in Jackson Hole, Wyoming! 2012 CALENDAR OF FUTURE CONFERENCES (For our complete calendar of conferences, please visit www.symposiamedicus.org) 1236 1241 1243 Challenges in Obstetrics & Gynecology 18th Annual Conference on Care of Women Over 50 18th Annual Conference on Challenges in Gynecology Eastern Caribbean Cruise (Celebrity Cruises – Eclipse) Guanacaste, Costa Rica New York City, New York Nov 9-17 Nov 28-Dec 1 Dec 14-15 2013 CALENDAR OF FUTURE CONFERENCES 1245 1246 1249 1251 1252 1257 1259 1262 1265 1267 1269 1271 1270 1272 1276 1279 1275 1280 1282 20th Annual Office GYN & Women’s Health for the Primary Care Provider 17th Annual Winter OB/GYN Conference 2nd Annual Winter Conference on Women’s Health 20th Annual Spring Conference on High Risk Obstetrics 20th Annual Spring Conference on Women’s Health 14th Annual National Conference on Fetal Monitoring Challenges in Gynecology 14th Annual Summer Conference on Women’s Health Current Issues in Women’s Health Care 14th Annual Conference on Integrative Medicine in Women’s Health 24th Annual National Conference on Women’s Health Care Challenges in Obstetrics & Gynecology 27th Annual Fall Conference on High Risk Obstetrics 31st Annual Fall Conference on Obstetrics 21st Annual Fall Conference on Issues in Women’s Health 14th Annual Fall Conference on High Risk Pregnancy Hot Topics in Pediatric Emergency Medicine & Nursing 19th Annual Conference on Care of Women Over 50 19th Annual Conference on Challenges in Gynecology Rio Mar, Puerto Rico Aruba, Dutch Caribbean Beaver Creek, Colorado St. Martin, Caribbean Big Island, Hawaii Las Vegas, Nevada Las Vegas, Nevada Big Sky, Montana Alaska Cruise (Celebrity Cruises – Solstice) Napa, California Las Vegas, Nevada Mediterranean Cruise (Celebrity Cruises – Reflection) Hilton Head, South Carolina Big Island, Hawaii Guanacaste, Costa Rica Marco Island, Florida Eastern Caribbean Cruise (Celebrity Cruises - Reflection) Playa del Carmen, Mexico New York City, New York Feb 6-9 Feb 6-9 Feb 26-Mar 2 Mar 6-9 Mar 13-16 Apr 18-20 Jun 6-8 Jul 10-13 Jul 26-Aug 2 Sep 11-14 Sep 16-18 Sep 20-30 Sep 26-28 Oct 16-19 Oct 30-Nov 2 Nov 13-16 Nov 16-23 Nov 20-23 Dec 20-21 For more information on any of these conferences, please write to: Symposia Medicus, 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287; call (800) 327-3161 or (925) 969-1789; email us at info@symposiamedicus.org; OR visit our website at www.symposiamedicus.org to view brochures of upcoming conferences. Brochures are available 6-8 months prior to conference. Page 5 Conference Brochure #1263, 20th Annual Summer Conference on Obstetrics and Gynecology Symposia Medicus Since 1978 35
  6. 6. CONFERENCE & LODGING REGISTRATION FORM Register on-line at www.symposiamedicus.org SYMPOSIA MEDICUS 20th Annual Summer Conference on OBSTETRICS AND GYNECOLOGY OR COMPLETE THIS FORM & MAIL OR FAX WITH APPROPRIATE PAYMENT TO: Symposia Medicus Snow King Resort & Grand View Lodge 399 Taylor Blvd., Suite 201 Pleasant Hill, CA 94523-2287 Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795 35 Jackson Hole, Wyoming June 26-29, 2013 PLEASE PRINT LEGIBLY: (Show name and one degree as you would like it printed on your conference materials): Registrant’s Name: ______________________________________________________________________________ Degree: _____________________ First Last E-mail Address (required): _______________________________________________________________________________________ In order to receive registration confirmation, as well as access to CME credit, activity and conference information, the REGISTRANT'S single and unique email address must be provided. Mailing Address: ___________________________________________________________________________________________________________ Street City State Zip If this is a hospital or office address, please show name/suite # here:_____________________________________________________________________ Primary Work: (______) ________________________________________ Home: (______) _____________________________________________ Cell: (______) ________________________________________________ Fax: (______) _______________________________________________ Professional Name of Hospital Specialty: ______________________________________ or Workplace:_______________________________________________________________ Our digital conference syllabus will be available for download on our website approximately two weeks before the conference. Please check here if you prefer a paper syllabus. #1263 FRIDAY BREAKOUT PREFERENCE (Please refer to schedule and select one breakout for each session): Session One: ___A ___B ___C ___D LODGING RESERVATIONS Session Two: ___A ___B ___C ___D Please reserve accommodations at Snow King Resort & Love Ridge Lodge for: Arrival:____________________ ________/________/______ Departure:_______________________ ________/________/______ (DAY of the week) Month Day Year (DAY of the week) Month Day Year GROUP RATES are for single/double occupancy and INCLUDE DAILY BUFFET BREAKFAST, SHUTTLE TO/FROM JACKSON HOLE AIRPORT & RESORT FEE: TYPE OF ROOM (Single/Double Occupancy) Group Rates Maximum Occupancy $160/night 4 $235/night 4 $275/night 4 $395/night 6 $435/night 8 Snow King Hotel Room Rooms are older (last renovation over 15 years ago) *Love Ridge Studio *Love Ridge 1-Bedroom Condo *Love Ridge 2-Bedroom Condo *Love Ridge 3-Bedroom Condo • Group rates shown are per room, per night, and do not include state & local taxes, currently 13% (subject to change) • Maximum occupancy stated cannot be exceeded (no exceptions) • Children 6 years and under are complimentary, using existing bedding, when staying with adults (includes buffet breakfast) • Additional occupants (over two in room), 7 years & older, are an additional $10 per person, per night (includes buffet breakfast, resort fee, and airport shuttle). Not to exceed occupancy. *All Love Ridge Units are very limited, please reserve early Preferred Bed Type (Snow King Hotel Room only ): Names of All Room Occupants (and ages, if children) King/Queen__________ Two Beds __________ (Cannot Guarantee) ____________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ Please circle names of room occupants (other than you) who are registered for this conference Other Comments/Requests ________________________________________________________________________________________________ TWO NIGHTS’ LODGING DEPOSIT - ROOM RATE ONLY TUITION AMOUNT DUE TOTAL (Note: Balance of hotel charges will be due to hotel) $ $ Payment Type: ____ Check (Please Enclose) ____ $ ____ ____ ____ Cardholder Name: ________________________________________________ Signature:______________________________________________________ Billing Address: ________________________________________________________________________________________________________________ (If different from above) Street Card Number City State Zip Expiration Date Security # Month/Year (on front or back of card) / ALL INFORMATION STATED ABOVE WILL REMAIN CONFIDENTIAL TO SYMPOSIA MEDICUS By registering, you agree to the Terms & Conditions as stated in this brochure. Copies of this form can be used for additional registrations • Telephone registrations may be taken with Visa, MasterCard, American Express, or Discover by calling Monday-Friday, 8:30am-5:00pm (Pacific Time) • Phones: (800) 327-3161 or (925) 969-1789, or Fax (925) 969-1795 Visit our website for other educational conferences and/or to register on-line at: www.symposiamedicus.org Page 6 Conference Brochure #1263, 20th Annual Summer Conference on Obstetrics and Gynecology Symposia Medicus Since 1978 35

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