American Society

of

Diagnostic & Interventional Nephrology

PHOENIX, ARIZONA
FEBRUARY 21-23, 2014 • JW MARRIOTT DESERT R...
PH OE NIX, A Z

ASDIN 10th Annual Scientific Meeting
Meeting Highlights

• Advanced Techniques Pre-Course (separate regist...
PH OE NIX, A Z

Advanced Techniques Pre-Course • Friday, February 21st
(Separate registration required)

Registration is l...
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Administrator/Manager Pre-Course • Friday, February 21st

(Separate registration required)

Friday, Februa...
PH OE NIX, A Z

ASDIN Scientific Meeting Schedule
Friday, February 21, 2014
7:00 am – 10:00 am	

Pre-Course Registration

...
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ASDIN Scientific Meeting Schedule
10:00 am - 10:20 am	

NON-PHYSICIAN/ASSOCIATES
BREAKOUT SESSIONS
SATURDA...
PH OE NIX, A Z

ASDIN Scientific Meeting Schedule
1:00 pm - 2:00 pm

Nuts and Bolts of Endovascular
Interventions: How the...
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ASDIN Scientific Meeting Schedule
Sunday, February 23, 2014
7:00 am - 7:30 am		

Breakfast (within Exhibit...
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Additional Meeting Information
Onsite Registration/Check-in
You may pick up your badge and other registrat...
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Meeting Registration/Accommodations
Meeting Registration ONLY
	
$425	 Member – Physicians
	
$675	 Non-Memb...
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American Society of Diagnostic and Interventional Nephrology(ASDIN) 10th Annual Scientific Meeting 2014

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American Society of Diagnostic and Interventional Nephrology(ASDIN) 10th Annual Scientific Meeting 2014

  1. 1. American Society of Diagnostic & Interventional Nephrology PHOENIX, ARIZONA FEBRUARY 21-23, 2014 • JW MARRIOTT DESERT RIDGE ADVANCED TECHNIQUES PRE-COURSE • FEBRUARY 21ST ADMINISTRATOR/MANAGER PRE-COURSE • FEBRUARY 21ST Meeting Directors: David Fox, MD, FACS Haimanot Wasse, MD, MPH, FASN
  2. 2. PH OE NIX, A Z ASDIN 10th Annual Scientific Meeting Meeting Highlights • Advanced Techniques Pre-Course (separate registration required) • Full-Day Pre-Course Program especially for Administrators and Managers (separate registration required) • State-of-the-art non-traditional sessions covering a range of interventional topics • General Sessions featuring multi-specialty faculty • oster, abstract and video presentations P (visit www.asdin.org for Call for Abstracts and Call for Video information) • Peer-to-peer networking • Exhibits Special Sessions B reakout Sessions: Renal Denervation Peripheral Arterial Intervention Non-Physician Associates Program Abstract Presentations (Podium and Poster) First Annual Video Competition Who Should Attend? • Clinical nephrologists interested in optimizing patient care • Established and aspiring interventional nephrologists • Interventional radiologists • Vascular access surgeons • Residents fellows-in-training • Nephrology or advanced-practice nurses involved in dialysis patient care or vascular access management • Vascular access coordinators, administrators, and coding/billing supervisors/specialists • Radiological technologists About ASDIN... Founded in 2000, ASDIN’s mission is to promote the appropriate application of new and existing procedures in order to improve the care of patients with kidney disease. These procedures include, but are not limited to, insertion of tunneled hemodialysis and peritoneal dialysis catheters, endovascular procedures, and diagnostic sonography. The Society works closely with other societies and with nephrology training programs to achieve its goals. All physicians (nephrologists and others), administrators, technologists, and nurses involved with the care of nephrology patients are invited to join and become active in the Society. Activities of the Society include: • Establishment of practice standards • Certification of physicians in specific procedures • Accreditation of training programs in specific procedures • Development of training tools and techniques • Sponsoring symposia and training courses • Dissemination of information through periodic meetings and through print and other media 2 American Society of Diagnostic Interventional Nephrology • www.ASDIN.org
  3. 3. PH OE NIX, A Z Advanced Techniques Pre-Course • Friday, February 21st (Separate registration required) Registration is limited to the first 80 registrants. No CME offered for the Pre-Course. Pre-Course Co-Chairs: Dirk Hentschel, MD, Brigham and Women’s Hospital, Renal Division, Boston, MA Ivan Maya, MD, Nephrology Associates of Central Florida, Lake Mary, FL Friday - February 21, 2014 • 7:00 am - 4:30 pm 7:00 am - 7:50 am Registration (Pre-Registration required) 7:50 am - 8:00 am Introduction Dirk Hentschel, MD and Ivan Maya, MD 8:00 am - 8:30 am Tunneled Catheters - How to Get Unstuck Thomas Vesely, MD, Vascular Access Services LLC, St. Louis, MO 8:30 am - 9:00 am “Unassisted” Evaluation of Access Dysfunction (Eyes, Ears, and Fingers) Tushar Vachharajani, MD, FASN, FACP, WG (Bill) Hefner VA Medical Center, Salisbury, NC 9:00 am - 9:30 am Complications During Endovascular Access Procedures and Bail-out Strategies Abigail Falk, MD, FSIR, Fresenius Vascular Care, New York, NY 9:30 am - 9:50 am Break 9:50 am - 10:20 am Preserving of Vascular Real Estate Peter Wayne, MD, Surgical Care Associates, Louisville, KY 10:20 am - 10:50 am PD Catheter Insertion and Removal Stephen Ash, MD, FACP, Clarion Arnett Health, Lafayette, IN 10:50 am - 11:20 am Access Flow and Renal Artery Stenosis Evaluation by Ultrasound Adina Voiculescu, MD, Brigham and Women’s Hospital, Renal Division, Boston, MA 11:20 am - 11:50 am Renal Artery Interventions - Stenosis and Denervation Alexander S. Yevzlin, MD, University of Wisconsin, Madison, WI 11:50 am – 1:15 pm Lunch (on your own) 1:15 pm - 4:30 pm Hands-on Workshops Coils Deployment Fistula Evaluation by Physical Exam Ultrasound Foreign Body Retrieval “Live” Video Cases PD Catheter Insertion and Removal Tunneled Catheter Insertion Vascular Access Alternatives (PICCs, Ports Intra-osseous Devices) American Society of Diagnostic Interventional Nephrology • www.ASDIN.org 3
  4. 4. PH OE NIX, A Z Administrator/Manager Pre-Course • Friday, February 21st (Separate registration required) Friday, February 21, 2014 • 7:30 am - 5:00 pm Moderators: Robin Simmons RN, BS, Kansas Vascular Access Center, Wichita, KS Syd Stevens, CPC, CIMC, Midwest Nephrology Consultants, PA, Kansas City, MO Don’t miss this opportunity to join your Interventional Physicians and Associate Staff this year in Phoenix and to network with your colleagues from across the nation in a special pre-course designed especially for you! This year’s course will cover timely information – all specially tailored for everyone involved in access center management – both clinical and administrative. Not just a “view from 30,000 feet” but a hands-on, interactive experience presented by a diverse, professional group of presenters. Share this with your management team members and plan to attend! 7:30 am - 8:30 am Registration 8:30 am - 10:15 am Current Accountable Care Issues - Where Are We Really Headed? Robert Provenzano, MD, FACP, FASN, Vice President of Medical Affairs, DaVita, Detroit, MI 10:15 am – 10:30 am Break 10:30 am - 12:00 noon Legal Considerations of a Sale or Joint Venture Acquisition of Your Access Center Richard D. Sanders, Esquire, Managing Partner, The Sanders Law Firm, P.C., Atlanta, GA 12:00 noon - 1:00 pm Lunch (included in registration) 1:00 pm - 2:15 pm Today’s Work Force: Challenges in a Multi-Generational Work Place K athy Slemp, PhD, SPHR, Human Resource Management, College of Adult and Professional Studies, Friends University, Wichita, KS 2:15 pm - 3:30 pm Peritoneal Dialysis-An Untapped Revenue Source for Your Access Center and Nephrology Practice 3:30 pm - 3:45 pm Break 3:45 pm - 5:00 pm Putting Your Access Center in the Spotlight: The ABC’s of How to Market Effectively Gracie Royle, RN, President, Avanti Vista, Wichita, KS 4 American Society of Diagnostic Interventional Nephrology • www.ASDIN.org
  5. 5. PH OE NIX, A Z ASDIN Scientific Meeting Schedule Friday, February 21, 2014 7:00 am – 10:00 am Pre-Course Registration 7:50 am – 4:30 pm Advanced Techniques Pre-Course 8:00 am – 5:00 pm Administrator/Manager Pre-Course 1:00 pm – 5:00 pm Exhibitor Move-In 3:00 pm – 7:00 pm S cientific Meeting Registration 8:00 am - 9:00 am Economics of Vascular Access Moderator: Anil Agarwal, MD, FACP, FASN, FNKF Passing the Buck? New Payment Structure and Their Impact on Access Reimbursement Timothy A. Pflederer, MD, Renal Intervention Center, Morton, IL 5:30 pm – 7:00 pm Welcome Reception/Exhibit Hall Declining Reimbursement and the Outpatient Access Center Model: An Update - Aris Q. Urbanes, MD Saturday, February 22, 2014 Hospital Based Access Care: Are We Coming Full Circle? Timothy A. Pflederer, MD 7:00 am – 7:30 am Continental Breakfast (within Exhibit Hall) 7:00 am – 3:30 pm Exhibits Open 7:00 am – 5:00 pm Registration Open 7:30 am – 7:35 am Introduction - Program Chairs: D avid Fox, MD, FACS, North Shore LIJ-Lenox Hill Hospital, New York, NY and Haimanot Wasse, MD, MPH, FASN, Emory University, Atlanta, GA 7:35 am – 7:45 am Welcome and President’s Address A ris Q. Urbanes, MD, ASDIN President, Lifeline Vascular Access, Grosse Pointe Park, MI 7:45 am - 8:00 am Gerald Beathard Annual State of the Art Lecture Changing Times: Challenges and Opportunities in the Current Economic Climate Robert Provenzano, MD, FACP, FASN, Vice President of Medical Affairs, DaVita, Detroit, MI Freestanding vs. Hospital Outpatient Access Center: How Do They Compare? - Gerald Beathard, MD, PhD, FASN, Lifeline Vascular Access, Houston, TX 9:00 am - 9:45 am Practical Matters: Strategies to Weather the Change in Outpatient Access Care Moderators: Tushar Vachharajani, MD, FASN, FACP and Timothy A. Pflederer, MD Cost Saving Techniques for an Outpatient Center: From Devices to Needles - Jeffrey Hoggard, MD, FACP, FASN, Capital Nephrology Associates, PA, Raleigh, NC Negotiating with Vendors: Advice for the Little Guy Eric Ladenheim, MBA, MD, Ladenheim Dialysis Access Centers, Fresno, CA Maximizing the Efficiency of Your Center: Operational Approaches - Kaveh Kian, MD, MRCP, Denver Nephrologists, PC, Denver, CO 9:45 am - 10:00 am Point/Counterpoint Access Selection Moderator: Micah Chan, MD, MPH, FACP Access Selection in the Context of ESRD Network Mandates vs. What About the Patient’s Best Interest? Lawrence M. Spergel, MD, Dialysis Management Medical Group, Sonoma, CA and Anil Agarwal, MD, FACP, FASN, FNKF, The Ohio State University, Columbus, OH American Society of Diagnostic Interventional Nephrology • www.ASDIN.org 5
  6. 6. PH OE NIX, A Z ASDIN Scientific Meeting Schedule 10:00 am - 10:20 am NON-PHYSICIAN/ASSOCIATES BREAKOUT SESSIONS SATURDAY FEBRUARY 22ND 10:20 am - 12:00 noon Associate Membership is the fastest growing segment of ASDIN! Join your physician team at this year’s Annual Scientific Meeting, where you can hear the latest in scientific findings and treatment advances as well as network with your colleagues from centers across the country. In addition to offering CE credit for the main meeting general sessions, ASDIN also offers special programing for our Associates. Share this information with others on your team and represent your center! This is a great opportunity to work closely outside of the procedure room with your physicians and talk about strategic directions for your facility. Moderators: Kevin Graham, MBA, LVN, CHDN, CASC, FACMPE, Lifeline Vascular Access, College Station, TX and James Michael Moore, RT(R)(CV), Lifeline Vascular Access, Fairmont, WV Sterilization - Resources, Tools, Staff Competency Ralph McCardle, RT(R), Lifeline Vascular Access, Morgantown, WV Monitoring the Conscious Sedation Patient Managing Through Recovery Monet Carnahan, RN, Fresenius Medical Care, Nashville, TN Adverse Events in the Access Center - Management Follow-up Jill Humes, BSN, RN, Renal Intervention Center, Morton, IL Break (within Exhibit Hall) 10:20 am - 11:20 am Topics and Controversies in AV Fistula Creation Moderators: David Fox, MD, FACS and Jeffrey Hoggard, MD, FACP, FASN Dual Access in ESRD Patients Undergoing RRT Transition Matthew J. Oliver, MD, MSH, FRCP(C), Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON An AVF Should be Attempted in the Patient with PAD and History of Steal vs. Don’t Bother: Place a Tapered AVG Marc Glickman, MD, FACS, Sentara Heart Hospital, Norfolk, VA and Larry A. Scher, MD, Montefiore Medical Center, Bronx, NY Vascular Access Creation/Revision Under General or Regional Anesthesia vs. Vascular Access Creation/Revision Performed Using Local Anesthesia Should be the Standard David Fox, MD, FACS and Rick Mishler, MD, FACP, Arizona Kidney and Hypertension Disease Center, Phoenix, AZ 11:20 am - 11:55 am Controversies in Fistula Maturation Moderators: Haimanot Wasse, MD, MPH, FASN and Abigail Falk, MD, FSIR When is an AVF Mature? Longitudinal Assessment of AVF With Ultrasound - Sandra Donnelly, MD, University of Toronto, Toronto, ON Collateral Side Branches: Occlusion and Ligation Work vs. Collateral Side Branches: Don’t Occlude or Ligate Jeffrey H. Lawson, MD, PhD, Duke University School of Medicine, Durham, NC and Larry A. Scher, MD 11:55 am - 1:00 pm Lunch (within Exhibit Hall) Venous Ablation in the Access Center Leslie Enfinger, NP, Albany Vascular Specialist Center, Albany, GA Contrast Media - Management Considerations Melissa Hicks, RT (R) (VI) (ARRT), University of Louisville Hospital Interventional Nephrology Center, Louisville, KY Benefits of PACS in an Access Center Richard Taylor, ScImage, Los Altos, CA 6 American Society of Diagnostic Interventional Nephrology • www.ASDIN.org
  7. 7. PH OE NIX, A Z ASDIN Scientific Meeting Schedule 1:00 pm - 2:00 pm Nuts and Bolts of Endovascular Interventions: How the Experts Do It Moderator: Aris Q. Urbanes, MD Removing the Stuck Tunneled Catheter - Sanjay Misra, MD, Department of Radiology, Mayo Clinic, Rochester, MN How Do I Declot a HeRO Device? - Vandana Dua Niyyar, MD, FASN, Emory University, Atlanta, GA Retrieving the Migrating Stent - Abigail Falk, MD, FSIR, American Access Care, New York, NY Dealing with Venous Rupture - Theodore F. Saad, MD, Nephrology Associates, PA, Newark, DE 2:00 pm - 2:30 pm Management of Thrombosed and Infected Access 3:10 pm - 4:15 pm Technology Update: Renal Sympathetic Denervation for Resistant Hypertension Moderators: Kenneth Abreo, MD and Prabir Roy-Chaudhury, MD, PhD Moderators: Dirk Hentschel, MD and Jeffrey Hoggard, MD, FACP, FASN Rationale, Patient Profile and Application in CKD Patients Micah Chan, MD, MPH, FACP, University of Wisconsin, Madison, WI AVF: Thrombectomy of the Immature vs. the Mature AVF Gerald Beathard, MD, PhD, FASN Renal Denervation is a Tool in the Toolbox for Those Who Routinely Manage All Hypertension - The Case for IN Alexander S. Yevzlin, MD, University of Wisconsin, Madison, WI Management of the Infected AVG - Marc Glickman, MD, FACS 2:30 pm - 2:45 pm ASDIN Awards Presentation 2:45 pm - 3:10 pm Break (within Exhibit Hall) Renal Denervation is a Specialized Intervention with Unique Profile of Risks - The Case for IR - Sanjay Misra, MD Renal Denervation - the Case for Interventional Cardiology John C. Gurley, MD, University of Kentucky, Lexington, KY Technology Update - Panel Discussion - Micah Chan, MD, MPH, FACP /Alexander S. Yevzlin, MD/Sanjay Misra, MD/ John C. Gurley, MD 4:20 pm - 5:05 pm Breakout Programming Renal Denervation - Indications and Technique Micah Chan, MD, MPH, FACP Peripheral Arterial Intervention - Sanjay Misra, MD 5:15 pm - 6:00 pm Abstract Presentations Moderators: Amy Dwyer, MD and Jamie Ross, MD 6:00 pm - 6:30 pm ASDIN Business Meeting American Society of Diagnostic Interventional Nephrology • www.ASDIN.org 7
  8. 8. PH OE NIX, A Z ASDIN Scientific Meeting Schedule Sunday, February 23, 2014 7:00 am - 7:30 am Breakfast (within Exhibit Hall) 10:30 am - 11:30 am 7:00 am - 10:30 am Exhibits Open Trials Update 7:00 am – 12:15 pm Registration Moderators: Arif Asif, MD, FASN, FNKF and Vandana Dua Niyyar, MD, FASN Update on the REVISE Trial -Thomas Vesely, MD 7:30 am - 8:15 am Advanced Techniques Moderators: George Nassar, MD and Alexander S. Yevzlin, MD Trans-Radial Access Intervention Kevin “Chaim” Herman, MD, Interventional Institute, Holy Name Medical Center, Teaneck, NJ “Inside-Out” Recanalization of Central Vein Obstruction John C. Gurley, MD Percutaneous Renal Biopsy in the Outpatient Setting Ivan Maya, MD, FACP, Nephrology Associates of Central Florida, Lake Mary, FL 7:30 am - 8:30 am Video Session Moderator: Yael Vin, MD, MPH 8:15 am - 8:30 am Abstract Awards 8:30 am - 10:00 am Issues in Dialysis Access Management Moderators: Marc Glickman, MD and Theodore F. Saad, MD Update on the RESCUE Trial - Alexander S. Yevzlin, MD Update on the RENOVA Trial -Theodore F. Saad, MD Update on the Hemodialysis Fistula Maturation Study Prabir Roy-Chaudhury, MD, PhD, University of Cincinnati, Cincinnati, OH 11:30 am - 12:00 noon Topics in Peritoneal Dialysis Moderators: Ivan Maya, MD, FACP and Steven Wu, MD Does PD Catheter Placement by IN Increase PD Cather Use in ESRD? - Matthew J. Oliver, MD, MSH, FRCP(C) Troubleshooting the Dysfunctional PD Catheter Stephen Ash, MD, FACP, Hemocleanse, Lafayette, IN PD Catheter Placement in Urgent and Emergent Peritoneal Dialysis - Bharat Sachdeva, MD, LSU Health Sciences Center, Shreveport, LA Closing Remarks and Adjournment Conscious Sedation in the Outpatient Center: Use Anesthesiology vs. We Can Do it Ourselves - Gerald Beathard, MD, PhD, FASN and Arif Asif, MD, FASN, FNKF, Albany Medical Center, Albany, NY Basilic Vein Transpositions are Always the Best Option in the Obese vs. Grafts are Better in the Obese David Fox, MD, FASN and Jeffrey H. Lawson, MD, PhD In Vitro Models of Long-Term Catheter Use Thomas Vesely, MD, Vascular Access Services, LLS, St. Louis, MO Buttonhole Technique - Sandra Donnelly, MD 10:00 am - 10:30 am 8 Break (within Exhibit Hall) American Society of Diagnostic Interventional Nephrology • www.ASDIN.org
  9. 9. PH OE NIX, A Z Additional Meeting Information Onsite Registration/Check-in You may pick up your badge and other registration materials, or register on-site at the Scientific Meeting Registration Desk located in the Foyer (outside the Grand Canyon Ballroom) during these times. Friday, February 21 7:00 am – 10:00 am* Friday, February 21 3:00 pm – 7:00 pm Saturday, February 22 7:00 am – 4:00 pm Sunday, February 23 7:00 am – 12:15 pm *Special registration for Pre-Course Programs only Additional Information Visit www.asdin.org for up-to-date program information. For more information, please contact the ASDIN office at 601-924-2220. Program updates and other pertinent information will be posted on the ASDIN website periodically. Continuing Education and CME Visit the ASDIN website or call ASDIN for the most up-todate CME and Continuing Education information. CE for Nurses This continuing nursing offering is provided by the American Society of Diagnostic and Interventional Nephrology. Provider approved by the California Board of Registered Nursing, Provider Number CEP15468 for a maximum of 10.75 contact hours. One contact hour equals Representatives from a wide range of companies will one hour of program attendance. be available to update participants on current and future products and services during dedicated Exhibit Hall hours. Scan code above with your smart Meals phone using any free downloadable QR • riday: Complimentary Opening Reception in the Exhibit F Reader app to go Hall from 5:30 pm - 7:00 pm directly to the ASDIN • aturday: Complimentary continental breakfast, two S Scientific Meeting refreshment breaks and boxed lunch in the Exhibit Hall Website • unday: Complimentary breakfast refreshment break S in the Exhibit Hall Exhibit Hall Information Exhibit Hall will be open the following hours: Friday, February 21 5:30 pm – 7:00pm Saturday, February 22 7:00 am – 3:30 pm Sunday, February 23 7:00 am – 10:30 am Videos ASDIN will host our first-ever Video Podium Presentation on Sunday, February 23 from 7:30 am – 8:30 am. Dr. Yael Vin will moderate the session. For videos that do not make the podium, we will be continuing our video presentations in the Grand Canyon Foyer on Saturday, February 22 and Sunday, February 23. More information on the Call for Videos may be found on the ASDIN website – www.asdin.org. Abstracts Poster presentations will take place within the Exhibit Hall on Saturday, February 22. Oral abstract presentations will take place on Saturday, February 22 from 5:15 pm – 6:00 pm. FIND US ON FACEBOOK: ASDIN FOLLOW US ON TWITTER: @ASDINNEWS American Society of Diagnostic Interventional Nephrology • www.ASDIN.org 9
  10. 10. PH OE NIX, A Z Meeting Registration/Accommodations Meeting Registration ONLY $425 Member – Physicians $675 Non-Member – Physicians $250 Member – Associates or Fellows Advanced Techniques Pre-Course ONLY (2/21) $300 Member $425 Non-Member Meeting Accommodations The JW Marriott Desert Ridge Resort Spa, 5350 East Marriott Drive in Phoenix, AZ is the meeting headquarters. The desert mountain resort has Arizona’s largest ballroom, a pampering spa, outstanding restaurants and championship golf. Administrator/Manager Pre-Course ONLY (2/21) $250 $300 Member Non-Member COMBINED – Meeting Advanced Techniques Pre-Course $725 $550 $975 $675 Member – Physicians Member – Fellows/Associates Non-Member – Physicians Non-Member – Fellows/Associates COMBINED – Meeting Administrator Pre-Course $350 $475 Member Non-Member Registration Go to www.asdin.org to register online or to download a registration form. Regular registration rates are valid only through January 24, 2014. Special ASDIN Group Rates: $240 for single/double occupancy; $20 each additional person. Local and state taxes and occupancy rates apply. To make reservations, call the JW Marriott at 1-800-835-6206 and mention ASDIN as group code. Or, reserve your room online through the conference page on the ASDIN website – www.asdin.org. The ASDIN discount is available until 5 pm CST on January 29, 2014 or until all rooms are sold, whichever is earlier. After January 29, 2014, rates and availability are at Late Registration the discretion of the hotel. Rooms are also available at the A $75 late fee will apply after January 24, 2014 including on-site discounted rate three days pre and post event dates based registration. upon availability. Refund Policy To receive a full refund, cancellations for the meeting must be received in writing on or before January 24, 2014. After that date, no refunds will be granted. 10 American Society of Diagnostic Interventional Nephrology • www.ASDIN.org
  11. 11. PH OE NIX, A Z Scientific Meeting Registration Form Full Name___________________________________________    NPI # (Physician only)__________________________________  Preferred First Name for Badge__________________________ Credentials__________________________________________ $425 $675 $250 $375 Company Name_______________________________________  $300  $425 Title_________________________________________________ Member – Physicians Non-Member – Physicians Member – Associates or Fellows Non-Member – Associates or Fellows Member Non-Member Address_____________________________________________   State/Province_________________________________________   ZIP/Postal Code_______________________________________ City________________________________________________ $725 $550 $975 $675 Country (if not U.S.)___________________________________  $250  $300 Phone_______________________________________________ Member – Physicians Member – Associates or Fellows Non-Member – Physicians Non-Member – Associates or Fellows Member Non-Member Fax_________________________________________________ Member Email________________________________________________  $350  $475 Non-Member Please indicate primary specialty affiliation:  Interventional Nephrologist Meal Preference:  Non-Interventional Nephrologist  Check here if vegetarian lunch required  Interventional Radiologist  Surgeon $75 late fee applies after January 24, 2014  Other (please specify)_________________________ Total Payment: $____________ Primary reason for meeting attendance?  Check made payable to ASDIN  Location  Collegial Networking  Credit Card:  AMEX  VISA  MasterCard  Exhibits  Value of registration fee  CME  Overall topics and faculty Card #:___________________________________________________  Other (please specify)_________________________ Card Security Code:________ Exp. date (mm/yy):________________ Practice Setting (check all that apply)  Hospital-based Access Center Cardholder’s Name (printed):___________________________________  Ambulatory Surgery Center Signature:__________________________________________________  Hospital  Free-standing Access Center Billing Address:____________________________________________  University-based Access Center  Other (please specify) ______________________ City/St/Zip:_______________________________________________ Is this your first time attending an ASDIN Meeting?  Yes  No ASDIN Exhibitors will be utilizing lead retrieval software to better track their interaction with our ASDIN attendees. Each Scientific Meeting registrant's badge will include a unique 8-digit ID number on the badge. When this number is provided to an exhibitor with the iLeads software, your name, address, phone number and email will be captured by the software. In addition, each attendee who provides his 8-digit ID number to an exhibitor will receive an email following the meeting which will outline the booths that they visited.  To opt out of this program, please mark check box Send completed form to: ASDIN  134 Fairmont Street, Suite B  Clinton, MS 39056 Email: info@asdin.org  Fax: 601-924-0720 For additional information: Phone: 601-924-2220  www.asdin.org Please see ASDIN website for refund policy and additional program information. ASDIN and its designated agent(s) are expressly authorized and granted the right to photograph Registrant and to use photographs of Registrant for promotional materials related to ASDIN and/or the ASDIN Scientific Meeting. Please contact the ASDIN office to opt out of this photography release. American Society of Diagnostic Interventional Nephrology • www.ASDIN.org 11

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