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24th Annual Winter Conference on Emergency Medicine

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24th Annual Winter Conference on Emergency Medicine

  1. 1. Exciting News…our hotel room rates include daily buffet breakfast! Please see our lodging information inside the brochure for more details. 24th Annual Winter Conference on EMERGENCY MEDICINE Including topics on: Infectious Disease, Pediatric Dermatologic & Ophthalmologic Emergencies, Toxicology, Airway Management, Ultrasound, and much more . . . HAPUNA BEACH PRINCE HOTEL Big Island, Hawaii FEBRUARY 13-16, 2013 SPONSORED BY “Ive attended 15 Symposia Medicus conferences and the presentations remain excellent and the locations of the trips are always fun. Always the best out of what I have attended.” -David Wagoner, MD 35 “I continue to be impressed year after year. Remarkable speakers. Symposia Medicus definitely provides the full package.” -Zoryana Thompson, PA-C “Symposia Medicus truly has outstanding conferences. Their faculty SINCE 1978 members are not only great presenters, but friendly and easily accessible.” A Non-Profit Corporation for -Theodore R. Smith, Jr., MDContinuing Medical & Nursing Education for this conference or view other educational conferences at Register On-Line... w w w. s y m p o s i a m e d i c u s . o r g
  2. 2. CONFERENCE DESCRIPTION CONTINUING EDUCATION CREDITOur 24 th Annual Winter Conference on Emergency Medicine is designed to Physiciansprovide emergency and primary care physicians, nurses, nurse practitioners, Symposia Medicus designates this live activity for a maximum of 18 AMA PRAphysician assistants, as well as out-of-hospital providers, with state-of-the-art Category 1 Credits™. Physicians should claim only the credit commensurateinformation on a wide variety of topics in emergency medicine. Emphasis will with the extent of their participation in the activity.be placed on practical application of the evidence-based topics presented.In addition to didactic lectures, ample time has been allotted for participant Application has been made with the American College of Emergencyfeedback and interaction. Physicians for ACEP Category 1 credit.Topics for this year’s conference have been selected based on professional Application for CME credit has been filed with the American Academy ofpractice gaps identified that resulted from extensive target audience needs Family Physicians. Determination of credit is pending.assessment data. The needs assessment data were derived from a variety ofsources including evaluations and outcomes data from past participants; Physician Assistantsclinical expert input; Symposia Medicus’ online survey; and, other medical The American Academy of Physician Assistants accepts Category 1 CMEand nursing data. approval from organizations accredited by the ACCME.Conference format will include didactic lectures, smaller group breakouts, Nurse Practitioners/Nursescase studies, and question and answer sessions. The ANCC contact hours awarded for completion of this conference are 18.An outstanding faculty has been assembled for this conference. Faculty mem- Provider is also approved by the California Board of Registered Nursing,bers are committed to providing participants with current data. Each member Provider #CEP2335, for 21.6 contact hours.was selected based on individual area of expertise and ability to communicateevidence-based and practical information to participants. Pharmacology Credit for Prescriptive Authority A maximum of 3.5 hours in pharmacology credit for prescriptive authorityYou are sure to enjoy our 24 th Annual Winter Conference on Emergency may be earned by attending this educational conference. Sessions awardingMedicine while sharing ideas and experiences with colleagues from across pharmacology credit for prescriptive authority are denoted with an Rx in thethe country in the beautiful setting of Hawaiis "Big Island." schedule.CONFERENCE OBJECTIVES SMALLER GROUP BREAKOUT SESSIONSAfter participating in this conference, you should have an increased Smaller group sessions will be held Friday afternoon. These breakout sessionsknowledge of and be more competent to… are organized to provide an opportunity for greater participant/faculty interaction, and will give you an opportunity to discuss subjects relating to• Effectively manage emergencies in pediatric asthma using an your particular area of interest. Please indicate your breakout session topic evidence-based approach choice on the conference registration form in this brochure. Space is limited so please reserve early.• Diagnose the cause of non-specific abdominal pain• Apply up-to-date clinical interventions for the treatment of infectious EDUCATIONAL RESOURCES diseases, including MRSA Each registrant will receive an extensive conference syllabus that includes• Identify and treat emergency dermatologic dilemmas materials on each topic presented. The syllabus is available on electronic media or paper (black and white type/photos only). The full color electronic• Incorporate findings of recent toxicology literature into your practice 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, please check the box on the registration form inACCREDITATION this brochure.This educational activity was planned and produced in accordance with the If you bring your laptop/tablet to the conference, be aware that there are noACCME and ANCC Essentials and Standards relating to continuing medical electrical outlets at the conference tables. Make sure your laptop/tablet isand nursing education. fully charged each day.Symposia Medicus is accredited by the Accreditation Council for If you are unable to attend this conference, extra copies of this syllabus (eitherContinuing Medical Education (ACCME) to provide continuing medical paper or electronic version) will be available one week after the conference.education for physicians. The cost is $60 for a paper syllabus and $25 for the electronic version. To place your order, please email publications@symposiamedicus.org.Symposia Medicus is accredited as a provider of continuing nursing educationby the American Nurses Credentialing Center’s Commission on Accreditation. GROUP ACTIVITIES / GROUND TRANSPORTATIONEach participant should only claim credit commensurate with the extent oftheir participation in the activity. Activities are planned for participants and guests throughout the conference breaks. Additional information regarding activities, hotel, location and groundCertificates of credit will be given to participants on-site at the conclusion of transportation will be sent to registrants.the conference.Page 2 Conference Brochure #1247, 24th Annual Winter Conference on Emergency Medicine Symposia Medicus 35 Since 1978
  3. 3. CONFERENCE FACULTY CONFERENCE SCHEDULEFredrick M. Abrahamian, DO, FACEP Wednesday, February 13 Friday, February 15Conference Co-Chairperson 7:00am Registration & Check-in 3:30pm Smaller Group Breakouts –Clinical Professor of Medicine Session OneUCLA School of Medicine 8:00 Welcome & IntroductionDirector of Education Vena Ricketts, MD A. Interesting Cases in Pediatric Emergency MedicineDepartment of Emergency Medicine 8:15 EKG Pearls for Your Everyday Practice Cole Condra, MD, MScOlive View - UCLA Medical Center Fredrick Abrahamian, DOLos Angeles, California B. Recent Toxicology Literature 9:00 Evidence-Based Management of Pediatric that Will Affect Your Practice Acute Asthma Exacerbations Frank LoVecchio, DO, MPHCole Condra, MD, MSc, FAAP, FACEP (Rx = 15 minutes)Department of Pediatric Emergency Medicine Cole Condra, MD, MSc C. Interactive Discussion ofMercy Childrens Hospital Medical-Legal CasesClinical Assistant Professor of Pediatrics 9:45 Questions & Answers Fredrick Abrahamian, DO Group DiscussionUniversity of Missouri-Columbia Faculty Panel & Audience D. Critical Care in the EDSt. Louis, Missouri Robert Vissers, MD 10:15 BreakVena Ricketts, MD, FACEP 5:00 Break 10:30 Airway Management of the CriticallyConference Co-Chairperson Ill Patient 5:15 Smaller Group Breakouts –Professor of Medicine Robert Vissers, MD Session TwoUCLA School of Medicine (Session One Topics Repeated)Assistant Chief 11:15 Newer Drugs of Abuse (Rx = 15 minutes) Frank LoVecchio, DO, MPH 6:45 Adjourn for the DayDepartment of Emergency MedicineOlive View - UCLA Medical Center Noon Electrolyte Emergencies (Rx = 15 minutes)Los Angeles, California Vena Ricketts, MD Saturday, February 16 12:45pm Questions & Answers 8:00am Management of Community-Robert Vissers, MD, FACEP, FRCPC Group Discussion Associated Methicillin-ResistantChief, Emergency Medicine Faculty Panel & Audience Staphylococcus aureus Skin & SoftEmanuel Hospital Tissue Infections (Rx = 40 minutes)Adjunct Associate Professor 1:30 Adjourn for the Day Fredrick Abrahamian, DOEmergency Medicine 5:30- Group Reception 8:45 Common Pediatric OrthopedicOregon Health Sciences University 7:00pm (Faculty, Participants & Their Guests) EmergenciesPortland, Oregon Cole Condra, MD, MSc Thursday, February 14 9:30 Questions & AnswersFrank LoVecchio, DO, MPH, FACEP, ABMT Group DiscussionCo-Medical Director 8:00am A Systematic Approach to Faculty Panel & AudienceBanner Good Samaritan Ophthalmologic EmergenciesRegional Poison Center (Rx = 10 minutes) 10:00 Break (Hotel check-out, if applicable) Vena Ricketts, MDVice Chairman and Research Director 10:30 Endocrine Emergencies:Maricopa Medical Center 8:45 Masquerade Party: Unmasking Systemic DKA & More!Department of Emergency Medicine Causes of Abdominal Pain (Rx = 20 minutes) Vena Ricketts, MD Robert Vissers, MDAssociate Professor 11:15 An Update on Community &University of Arizona 9:30 Questions & Answers Healthcare-Associated PneumoniaPhoenix, Arizona Group Discussion (Rx = 30 minutes) Faculty Panel & Audience Fredrick Abrahamian, DO 10:00 Break Noon Evidence-Based Management ofConsistent with ACCME and ANCC policy, Pediatric Head Traumafaculty for this educational activity are asked to 10:15 Dermatology in the ER: Visual Diagnosis Cole Condra, MD, MScdisclose any commercial interests that may (Rx = 20 minutes)create or may be perceived as creating a Vena Ricketts, MD 12:45pm Questions & Answersconflict related to the material they will be Group Discussionpresenting, as well as limitations on clinical 11:00 Overview of Animal Bites & Faculty Panel & Audiencestudies presented, and any “off-label” use Envenomationssuggestions for medical products. Additionally,Symposia Medicus Board, Planning Committee, Frank LoVecchio, DO, MPH 1:30 Conference Adjournsand Staff members have disclosed that theyhave no significant financial relationships that 11:45 Effective Procedural Sedation in thecould pose a conflict of interest to the planning Emergency Department (Rx = 45 minutes)of this conference. This information is intended Robert Vissers, MDto assist you in forming your own judgments Rx = Pharmacology Credit for Prescriptive Authorityabout content presented. Disclosure 12:30pm Questions & Answers will be granted for these sessionsinformation will be included in your syllabus Group Discussionand/or verbally disclosed at the conference. Faculty Panel & Audience 1:15 Adjourn for the DayPage 3 Conference Brochure #1247, 24th Annual Winter Conference on Emergency Medicine Symposia Medicus 35 Since 1978
  4. 4. CONFERENCE REGISTRATION INFORMATION TERMS & CONDITIONS• Enrollment for this conference is limited in order to provide the best possible learning Hotel Policies environment. Early registration is advised. • Above group rates do not include the following mandatory charges (subject to change):• TUITION: EARLY REGULAR - Occupancy and sales tax of 13.416% per room, per night If postmarked by If postmarked after - Mandatory porterage charge of $8.00 plus 4.166% tax per person, round trip (18 years December 5, 2012 December 5, 2012 and older) Physicians $610 $710 Residents, Nurses, PAs & All Others $510 $610 • Housekeeping gratuity is optional. However, $2.50 per room, per day is suggested.• Tuition includes continuing education certification, extensive conference syllabus, break • Maximum room occupancy is three adults, two adults and two children, or three adults and one refreshments, and group reception. The group reception is for faculty, registrants and their child. (For occupancy purposes, children are 17 and under). guests. • Mandatory additional person charges (see below) include daily buffet breakfast, tax & gratuity:• Tuition may be paid by check, money order, Visa, MasterCard, Discover, or - Children ages 5 and under are free American Express. - Children ages 6-12 are $15 each, per night - Persons 13 years and older are $25 each, per night• Register on-line at www.symposiamedicus.org or by using the form in this brochure. • Rollaway beds are $35 per night (subject to availability) – one per guestroom is allowed.• 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 • Check-in time is 3:00pm and check-out time is noon. Requests for late checkout should be (925) 969-1795. directed to the front desk the day prior to departure, and are subject to availability and charges.• If paying by check, make payable and send with registration form to Symposia Medicus, • Group rates may be available at the Hapuna’s sister hotel, the historic Mauna Kea Hotel, located 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. next door. Please call us for more information.• Conference registration will be confirmed via email and more information on travel, hotel, and • A 30-minute break has been allotted in our conference schedule on the last day for those of you activities will be sent. who need to check out.• This conference meets the requirements for CE tax deductibility; however, we suggest you Cancellation Policies consult your financial authority for more information. • Conference cancellations must be confirmed in writing and a 10% of paid tuition processing fee• For additional conference or lodging information, call Symposia Medicus at (800) 327-3161 will be assessed. No refunds will be made if cancellation is postmarked after January 9, 2013; or (925) 969-1789, or visit our website at www.symposiamedicus.org however, tuition, less 10% processing fee may be applied to a future Symposia Medicus conference.• 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 • Per our hotel contract, hotel reservation cancellations must be made in writing to Symposia this brochure for further information. Medicus and you will receive a full refund if postmarked by December 12, 2012. Between December 13, 2012 and January 9, 2013, one night’s deposit is forfeited. After January 9, 2013, no hotel refunds can be made.CONFERENCE LODGING INFORMATIONGROUP RATES ARE FOR SINGLE AND DOUBLE OCCUPANCY AND INCLUDE DAILY BUFFET • All cancellations must be made in writing and postmarked by the dates stated above.BREAKFAST • In the unlikely event of conference cancellation by Symposia Medicus, full tuition and, ifGroup Rates have been arranged at the Hapuna Beach Prince Resort. These rates will also be reservation was made with Symposia Medicus, hotel deposit refunds will be made.available three days before and three days after the conference, based on availability, if you Symposia Medicus will not be responsible for refunding travel or any other expenses.wish to extend your stay.Two nights’ deposit (room rate only) must accompany your reservation. The balance of your AIR TRAVEL INFORMATIONlodging, hotel fees as stated below, and all incidental charges are due to the hotel. The hotelaccepts most major credit cards. You will fly into the Kona Airport, which is approximately 27 miles from the Hapuna Beach Prince Hotel.You can receive these rates by reserving the following ways: Symposia Medicus has arranged for discount fares with Alaska, American, Hawaiian and Delta• On-line at our website, www.symposiamedicus.org; OR Airlines for this conference. Reservations can be made either through your travel agency or through the airlines Convention Desk at the website or numbers listed below.• Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR In order to receive the discounted rate, you or your travel agent must refer to the Symposia• Fax form with Visa, MasterCard, Discover, or American Express to (925) 969-1795; OR Medicus Group ID number listed below.• By mail, make check payable to Symposia Medicus and send with registration form to Alaska Airlines For discounts on Alaska Airlines flights, please book online at 399 Taylor Blvd., Suite 201, Pleasant Hill, CA 94523-2287. Convention Desk: www.alaskaair.com and insert ECMU46 into the e-certificate code box. For questions, please call the Alaska Airlines Convention Desk atPlease note that our block of rooms is limited and on a first come, first served basis. (800) 445-4435.PLEASE RESERVE EARLY as rooms may sell out and/or room rates may increase. American Airlines For discounts on American Airlines flights, please book online atGROUP RATES ARE FOR SINGLE AND DOUBLE OCCUPANCY AND INCLUDE DAILY BUFFET Convention Desk: www.aa.com and insert 9423BL into the promotion code box.BREAKFAST For questions, please call the American Airlines Convention Desk at (800) 433-1790. Room Type Group Rates Descriptions (Single/Double) Delta Airlines For discounts on Delta Airlines flights, please book online at Convention Desk: www.delta.com and click the box "from Airport" and another page will Terrace View $199/night Views of the manicured grounds and appear. At the bottom of that page, click the link "Meeting Even Code" Rooms at this rate are tropical landscaping. and insert #NME7E. For questions, please call the Delta Airlines Conventionvery limited, reserve early. Desk at (800) 328-1111. Partial Ocean View $229/night Views of the manicured grounds, tropical Hawaiian Airlines For discounts on Hawaiian Airlines flights, please book online at landscaping, with partial ocean view. Convention Desk: https://www.hawaiianair.com/affiliate/affiliate.aspx?affcode=SYMPOSIA MED Ocean View $249/night Views of the manicured grounds, tropical landscaping, with ocean view. CAR RENTAL DISCOUNT Premium Ocean View $269/night Highest floors in main building with panoramic view of the beach and ocean. Also, view of the Symposia Medicus has arranged conference discounts with AVIS and Budget Car Rentals. manicured grounds and tropical landscaping. Reservations can be made by phone; please refer to the conference code and the conference/airport location when making your reservations. Please see below: Ocean Front $309/night In the building closer to the beach, with views of the beach and ocean. AVIS 800-331-1600 AWD # B766625 All guestrooms are approximately 630 sq. ft. and feature private lanai; mini-refrigerator; Budget 800-772-3773 BCD # U076767 coffee maker with Kona blend coffee replenished daily; two Japanese yukatas (robes); two pairs of indoor slippers; complimentary shampoo/conditioner/body lotion; hair dryer; television; complimentary safe; and nightly turn down service. By reserving with Symposia Medicus, valet parking is discounted to $10.00/day and self parking is complimentary. Also, high speed internet access and admission to the Fitness Center are complimentary.Page 4 Conference Brochure #1247, 24th Annual Winter Conference on Emergency Medicine Symposia Medicus 35 Since 1978
  5. 5. CONFERENCE LOCATION Aloha! Hawaii’s Big Island isn’t just big, it’s still growing. The Big Each guest room at the Hapuna Beach Prince Hotel has a private, Island of Hawaii is the youngest island in the Hawaiian chain and is furnished lanai, with picturesque views of lush gardens, partial ocean, also by far the biggest, providing a vast canvas of environments to or full ocean views. Superb breakfast buffets are served in an discover a variety of unrivaled natural wonders. This is the home of indoor-outdoor area, while lunch and dinner options include a seafood one of the world’s most active volcanoes (Kilauea); the tallest sea grill, a steakhouse and sushi bar, and a poolside bar. Our group room mountain in the world at more than 30,000 feet (Mauna Kea); the rates include full buffet breakfast, as well as complimentary largest by volume volcano in the world (Mauna Loa); and, the largest internet, self parking, and admission to the fitness center for park in the state (Hawaii Volcanoes National Park). All but two of the each day of your stay. world’s climate zones generate everything from lush rain forests to volcanic deserts, snow-capped mountaintops to beautiful black sand Water activities are plentiful at the Hapuna Beach Prince Hotel, from beaches. swimming, snorkeling, and scuba diving, to sailing, whale watching or deep-sea fishing. Pamper yourself at the Paul Brown Salon and Situated on the sunny Kohala Coast, the Hapuna Beach Prince Hotel Spa or spend an afternoon golfing on the 18-hole golf course has defined Big Island luxury since its opening in 1994. Perfectly designed by Arnold Palmer and Ed Seay. Enjoy dining at the many nestled into the bluffs above the #1-rated Hapuna Beach, the hotel varied restaurants located near the hotel. Kids will love sandcastle features a contemporary Hawaiian style where guests experience building or Lei making at the Prince Keiki Kids Club. the true essence of rejuvenation. The Hapuna Beach Prince Hotel is adjacent to its sister property, the Mauna Kea Beach Hotel. Guests at The Hapuna Beach Prince Hotel’s beautiful and relaxing setting, Hapuna Beach Prince Hotel are able to use and charge to their room combined with our exciting 24 th Annual Winter Conference on the services and amenities at Mauna Kea. Emergency Medicine, makes this an opportunity not to be missed. 2012 Calendar of Future Conferences (For our complete calendar of conferences, please visit www.symposiamedicus.org) 1235 28th Annual Fall Conference on Pediatric Emergencies Maui, Hawaii Oct 24-27 1230 Current Issues in Women’s Health Care Mediterranean Cruise (Celebrity Cruises - Silhouette) Sep 29-Oct 11 1236 Challenges in Obstetrics & Gynecology Eastern Caribbean Cruise (Celebrity Cruises - Eclipse) Nov 9-17 1238 23rd Annual Conference on Hot Topics in Primary Care Medicine Aruba, Dutch Caribbean Nov 7-10 1240 13th Annual Fall Conference on Emergency Medicine Rio Mar, Puerto Rico Nov 14-17 1242 4th Annual Conference on Emergencies in Pediatrics New York City, New York Dec 14-15 1244 16th Annual Conference on Emergencies in Primary Care New York City, New York Dec 14-15 2013 Calendar of Future Conferences 1245 20th Annual Office GYN & Womens Health for the Primary Care Provider Rio Mar, Puerto Rico Feb 6-9 1254 12th Annual Spring Conference on Hot Topics in Primary Care Aruba, Dutch Caribbean Apr 10-13 1256 17th Annual Spring Conference on Pediatric Emergencies Maui, Hawaii Apr 17-20 1264 9th Annual Summer Conference on Emergency Medicine Hilton Head, South Carolina Jul 17-20 1265 Current Issues in Womens Health Care Alaska Cruise (Celebrity Cruises - Solstice) Jul 26-Aug 2 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 #1247, 24th Annual Winter Conference on Emergency Medicine Symposia Medicus 35 Since 1978
  6. 6. CONFERENCE & LODGING REGISTRATION FORM SYMPOSIA MEDICUS 24th Annual Winter Conference on Register on-line at www.symposiamedicus.org OR COMPLETE THIS FORM & MAIL OR FAX WITH APPROPRIATE PAYMENT TO: EMERGENCY Symposia Medicus MEDICINE 399 Taylor Blvd., Suite 201 Hapuna Beach Prince Resort 35 Pleasant Hill, CA 94523-2287 Big Island, Hawaii Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795 FEBRUARY 13-16, 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, activities and conference information, the REGISTRANTS 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 conference e-syllabus will be available for download on our website approximately two weeks before the conference. Please check here if you prefer a paper syllabus. #1247 FRIDAY BREAKOUT PREFERENCE (Please refer to schedule and select one breakout for each session): Session One: ___A ___B ___C ___D Session Two: ___A ___B ___C ___D LODGING RESERVATIONS Please reserve accommodations at the Hapuna Beach Prince Resort for: Arrival:____________________ ________/________/______ Departure:_______________________ ________/________/______ (DAY of the week) Month Day Year (DAY of the week) Month Day Year GROUP RATES include daily buffet breakfast for single/double occupancy: • Group rates do not include the following mandatory charges (subject to change): Room Type Group Rates - Occupancy and sales tax of 13.416% per room, per night (Single/Double) - Mandatory porterage charge of $8.00 plus 4.166% tax per person, round trip (18 years and older) Terrace View $199/night Rooms at this rate are very limited, reserve early • Maximum room occupancy is three adults or two adults and two children. Three adults and one child is OK. (For occupancy purposes, children are 17 and under). Partial Ocean View $229/night • Mandatory additional person charges (see below) include daily buffet breakfast, tax & gratuity: Ocean View $249/night - Children ages 5 and under are free Premium Ocean View $269/night - Children ages 6-12 are $15 each, per night - Persons ages 13 and older are $25 each, per night Ocean Front $309/night • Rollaway beds are $35 per night (subject to availability) – one per guestroom is allowed Preferred Bed Type (cannot guarantee): King/Queen ______ Two Beds _____ Names of All Room Occupants (and ages, if children) ____________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ Please circle names of room occupants (other than you) who are registered for this conference Other Comments/Requests ________________________________________________________________________________________________ TUITION AMOUNT DUE TWO NIGHTS’ LODGING DEPOSIT - ROOM RATE ONLY 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 City State Zip Card Number 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, Discover, or American Express 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.orgPage 6 Conference Brochure #1247, 24th Annual Winter Conference on Emergency Medicine Symposia Medicus 35 Since 1978

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