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Big Sky Montana Symposia Medicus

VIEWS: 6 PAGES: 6

									  Exciting News…our hotel room rates include daily buffet breakfast!
                           Please see our lodging information inside the brochure for more details.




                                 13th Annual
                            Winter Conference on

    PEDIATRICS
         Including topics on: Dermatology, Autism, Gastroenterology,
           Orthopedics, Obesity & Diabetes, Psychopharmacology,
          Attention Deficit Hyperactivity Disorder, and much more…


                                         BIG SKY RESORT
                   Big Sky, Montana
                      (Near Yellowstone National Park)

          FEBRUARY 19-23, 2013

            SPONSORED BY
                                                             “I loved the spectacular Big Sky scenery, great skiing,
                                                               and conference presentations! I will attend another
                                                                  Symposia Medicus CME event in the future.”
                                                                               – Jill Ryland, MD
               35                                      “I consistently seek to attend Symposia Medicus conferences. The
                                                   subjects taught are always relevant and the speakers are knowledgeable.”
                                                                            – Cynthia Wallace, MSN

                                                       “Symposia Medicus’ speakers are up-to-date, interesting, and the
             SINCE 1978                                   information they present is relevant to my daily practice.”
                                                                            – Robert Gilliam, MD
      A Non-Profit Corporation for
Continuing 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
CONFERENCE DESCRIPTION                                                                  CONTINUING EDUCATION CREDIT
         th
Our 13 Annual Winter Conference on Pediatrics has been designed to                      Physicians
provide physicians, nurse practitioners, physician assistants and nurses in             Symposia Medicus designates this live activity for a maximum of 16.25
Pediatrics and Primary Care with up-to-date and evidence-based clinical                 AMA PRA Category 1 Credits™. Physicians should claim only the credit
data in Pediatrics. The primary goal of this conference is to enhance                   commensurate with the extent of their participation in the activity.
knowledge and competency of attendees. Emphasis will be placed on
practical application of the evidence-based topics presented. In addition to            This continuing medical education activity has been reviewed by the
didactic lectures, ample time has been allotted for participant feedback and            American Academy of Pediatrics and is acceptable for a maximum of
interaction.                                                                            16.25 AAP credits. These credits can be applied toward the AAP CME/CPD
                                                                                        Award available to Fellows and Candidate Members of the American
Topics for this year’s conference have been selected based on professional              Academy of Pediatrics.
practice gaps identified in Pediatrics that resulted from extensive target
audience needs assessment data. The needs assessment data were derived                  Application for CME credit has been filed with the American Academy of
from a variety of sources including evaluations and outcomes data from                  Family Physicians. Determination of credit is pending.
past participants; clinical expert input; Symposia Medicus’ online survey;
and other medical and nursing data.                                                     Application has been made to the American College of Emergency
                                                                                        Physicians for ACEP Category I credit.
Conference format will include didactic lectures, case studies, and question
and answer sessions.                                                                    Physician Assistants
                                                                                        The American Academy of Physician Assistants accepts Category 1 CME
An outstanding faculty has been assembled for this conference. Faculty                  approval from organizations accredited by the ACCME.
members are committed to providing participants with current data. Each
member was selected based on individual area of expertise and ability to                Nurse Practitioners/Nurses
communicate evidence-based and practical information to participants.                   The ANCC contact hours awarded for completion of this conference are
                                                                                        16.25.
You are sure to enjoy our 13 th Annual Winter Conference on Pediatrics
while sharing ideas and experiences with colleagues from across the                     Provider is also approved by the California Board of Registered Nursing,
country in the beautiful setting of Big Sky.                                            Provider #CEP2335, for 19.5 contact hours.

                                                                                        Pharmacology Credit for Prescriptive Authority
CONFERENCE OBJECTIVES                                                                   A maximum of 2.75 hours in pharmacology credit for prescriptive authority
                                                                                        may be earned by attending this educational conference. Sessions awarding
After participating in this conference, you should have an increased                    pharmacology credit for prescriptive authority are denoted with an Rx in
knowledge of and be more competent to…                                                  the schedule.
• Select the type of medication and route of delivery appropriate for
  pediatric acne patients, based on age, severity of disease, and other                 EDUCATIONAL RESOURCES
  factors
                                                                                        Each registrant will receive an extensive conference syllabus that includes
• Diagnose and treat pediatric knee and ankle injuries                                  materials on each topic presented. The syllabus is available on electronic
                                                                                        media or paper (black and white type/photos only). The full color
• Evaluate medical problems commonly found in children on the autism                    electronic syllabus will be available for download approximately
  spectrum                                                                              two weeks prior to the conference (you’ll receive an email with
                                                                                        instructions). If you wish to receive a paper syllabus, please check the
• Identify the surgical management of newborns with a sexual                            box on the registration form in this brochure.
  differentiation disorder
                                                                                        If you bring your laptop/tablet to the conference, be aware that there are no
• Manage patients who are at risk for, or diagnosed with, celiac disease                electrical outlets at the conference tables. Make sure your laptop/tablet is
                                                                                        fully charged each day.

ACCREDITATION                                                                           If you are unable to attend the conference, extra copies of this syllabus
                                                                                        (either paper or electronic media) will be available one week after the
This educational activity was planned and produced in accordance with the               conference. The cost is $60 for a paper syllabus and $25 for the
ACCME and ANCC Essentials and Standards relating to continuing medical                  electronic media. To place your order, please email
and nursing education.                                                                  publications@symposiamedicus.org.
Symposia Medicus is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical
education for physicians.
                                                                                        WINTER ACTIVITIES/SKI LIFT TICKET DISCOUNTS/
                                                                                        GROUND TRANSPORTATION
Symposia Medicus is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center’s Commission on                   Winter activities are planned for participants and their guests throughout the
Accreditation.                                                                          conference breaks, and discounts will be offered on ski lift tickets and
                                                                                        ski rental equipment. Additional information regarding these tickets and
Each participant should only claim credit commensurate with the extent of               discounts, as well as ground transportation, will be sent to registrants.
their participation in the activity.

Certificates of credit will be given to participants on-site at the conclusion of
the conference.

Page 2        Conference Brochure #1248, 13 th Annual Winter Conference on Pediatrics                                                  Symposia Medicus        35
                                                                                                                                                Since 1978
CONFERENCE FACULTY                                    CONFERENCE SCHEDULE
Steven J. Anderson, MD                                Tuesday, February 19                                 9:15   Questions & Answers
                                                                                                                  Group Discussion
Clinical Professor
                                                        5:30- Registration/Check-in                               Faculty Panel & Audience
Department of Pediatrics
                                                        7:00pm During Group Reception
University of Washington                                                                                  10:15   Adjourn Morning Session
Private Practice
Sports Medicine                                       Wednesday, February 20
Seattle, Washington                                                                                       Friday, February 22
                                                        6:30am Continued Registration & Check-in
William F. Balistreri, MD                                                                                  4:00pm Celiac Disease:
Conference Co-Chair                                     7:00       Conference Introduction                        Diagnosis & Management
Professor of Pediatrics & Medicine                                 William Balistreri, MD                         William Balistreri, MD
University of Cincinnati,
                                                        7:15       Advances in Pediatric Dermatology:      4:45   Evaluation & Treatment of
College of Medicine
                                                                   What’s New? (Rx = 15 minutes)                  Common Ankle Injuries in the
Director, Division of Pediatric
                                                                   Lawrence Eichenfield, MD                       Pediatric Practice (Rx = 10 minutes)
Gastroenterology, Hepatology & Nutrition                                                                          Steven Anderson, MD
Children’s Hospital Medical Center
                                                        8:00       Obesity & Type II Diabetes
Cincinnati, Ohio                                                   in Children (Rx = 10 minutes)           5:30   Autism Facts & Fiction:
                                                                   Barry Reiner, MD                               Working with Informed Parents
Lawrence F. Eichenfield, MD                                                                                       (Rx = 10 minutes)
Conference Co-Chair                                     8:45       Obesity: GI Aspects of the Epidemic            Alison Schonwald, MD
Professor of Clinical Pediatrics                                   William Balistreri, MD
and Medicine (Dermatology)                                                                                 6:15   Questions & Answers
Chief, Pediatric and Adolescent                         9:30       Questions & Answers                            Group Discussion
Dermatology                                                        Group Discussion                               Faculty Panel & Audience
University of California,                                          Faculty Panel & Audience
                                                                                                           7:15   Adjourn Afternoon Session
San Diego School of Medicine and
                                                       10:30       Adjourn Morning Session
Rady Children’s Hospital and Health
Center                                                                                                    Saturday, February 23
San Diego, California                                 Mid-Day Break: 10:30am-4:00pm
                                                                                                           7:00am Office Management of Acute &
Barry J. Reiner, MD                                     4:00pm Pediatric Acne Management:                         Overuse Knee Injuries
Private Practice, Pediatric Endocrinology                      Optimizing Outcomes (Rx = 35 minutes)              Steven Anderson, MD
Clinical Instructor                                            Lawrence Eichenfield, MD
Division of Pediatric Endocrinology                                                                        7:45   Psychopharmacology in the
Johns Hopkins Hospital                                  4:45       Disorders of Sexual Differentiation:           Pediatric Practice (Rx = 45 minutes)
                                                                   A Newborn Emergency                            Alison Schonwald, MD
Baltimore, Maryland
                                                                   Barry Reiner, MD
                                                                                                           8:30   What’s Hot in Pediatric
Alison Schonwald, MD                                                                                              Gastroenterology (Rx = 15 minutes)
                                                        5:30       Attention Deficit Hyperactivity
Assistant Professor of Pediatrics                                  Disorder: Update (Rx = 25 minutes)             William Balistreri, MD
Harvard Medical School                                             Alison Schonwald, MD
Assistant in Medicine                                                                                      9:15   Questions & Answers
Developmental Medicine Center                           6:15       Questions & Answers                            Group Discussion
Children’s Hospital, Boston                                        Group Discussion                               Faculty Panel & Audience
Boston, Massachusetts                                              Faculty Panel & Audience
                                                                                                          10:15   Conference Adjourns
                                                        7:15       Adjourn Afternoon Session
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                Thursday, February 21                                        Rx = Pharmacology Credit for
creating a conflict related to the material                                                                        Prescriptive Authority will be
they will be presenting, as well as                                                                                 granted for these sessions
limitations on clinical studies presented, and
                                                        7:00am Taking the “Idiopathic” Out of
any “off-label” use suggestions for medical                    Idiopathic Short Stature
products. Additionally, Symposia Medicus                           (Rx = 10 minutes)
Board, Planning Committee, and Staff                               Barry Reiner, MD
members have disclosed that they have no
significant financial relationships that could
pose a conflict of interest to the planning of          7:45       Common Pitfalls in the Diagnosis
this conference. This information is i                             of Pediatric Sports Injuries
ntended to assist you in forming your                              Steven Anderson, MD
own judgments about content presented.
Disclosure information will be included in
your syllabus and/or verbally disclosed at              8:30       Case Studies in Pediatric
the conference.                                                    Dermatology: Audience Response –
                                                                   Test Your Knowledge
                                                                   Lawrence Eichenfield, MD

Page 3      Conference Brochure #1248, 13 th Annual Winter Conference on Pediatrics                                               Symposia Medicus       35
                                                                                                                                         Since 1978
CONFERENCE REGISTRATION INFORMATION                                                                                                             TERMS & CONDITIONS
• Enrollment for this conference is limited in order to provide the best possible learning environment. Early registration is advised.           Hotel Policies
• TUITION:                                          EARLY                                            REGULAR                                    • Above Group Rates do not include the following (subject to
                                     If postmarked by December 11, 2012                If postmarked after December 11, 2012                      change):
 Physicians                                          $610                                               $710                                      - 7% state accommodation tax
 Residents, Nurses, PAs & All Others                 $510                                               $610                                      - 7% resort service fee
• Tuition includes continuing education certification, extensive conference syllabus, break refreshments, and group reception. The group          - 3% resort tax
  reception is for faculty, registrants and their guests.                                                                                         - Meals (unless otherwise stated)
                                                                                                                                                  - Nor gratuities
• Tuition may be paid by check, money order, Visa, MasterCard, Discover, or American Express.
                                                                                                                                                • Maximum occupancy in rooms cannot be exceeded
• Register on-line at www.symposiamedicus.org or by using the form in this brochure.
                                                                                                                                                • Children 10 and under stay free in room with adult with existing
• Telephone registrations can be made Monday-Friday, 8:30am-5:00pm (Pacific Time), by calling (925) 969-1789 or                                   bedding (includes complimentary buffet breakfast)
  (800) 327-3161. Registrations can also be faxed to (925) 969-1795.
                                                                                                                                                • See above for additional person charges, over 10 years old (listed
• If paying by check, make payable and send with registration form to Symposia Medicus, 399 Taylor Blvd., Suite 201,                              under room rates)
  Pleasant Hill, CA 94523-2287.
                                                                                                                                                • Cribs and rollaways are available at $10 per night (subject to
• Conference registration will be confirmed via email and more information on travel, hotel, and activities will be sent.                         availability)
• This conference meets the requirements for CE tax deductibility; however, we suggest you consult your financial authority for more            • The Big Sky Resort is a smoke-free environment
  information.
                                                                                                                                                • Check-in time for all units is 5pm. Check-out time is 10am for
• For additional conference or lodging information, call Symposia Medicus at (800) 327-3161 or (925) 969-1789, or visit our                       the Shoshone, Summit & Village buildings, and Noon for the
  website at www.symposiamedicus.org                                                                                                              Huntley Lodge.
• For information on air reservations and ticketing assistance, you may either call your travel agent or the airlines direct.                    Cancellation Policies
  Please see the Airline Travel Information portion of this brochure for further information.
                                                                                                                                                • Conference cancellations must be confirmed in writing and a
                                                                                                                                                  10% of paid tuition processing fee will be assessed.
CONFERENCE LODGING INFORMATION                                                                                                                    No refunds will be made if cancellation is postmarked after
                                                                                                                                                  January 15, 2013; however, tuition, less 10% processing fee
GROUP RATES INCLUDE DAILY BUFFET BREAKFAST                                                                                                        may be applied to a future Symposia Medicus conference.
Group Rates have been arranged at the Big Sky Resort. These rates will also be available three days before and three days after the             • Per our hotel contract, hotel reservation cancellations must be
conference, based on availability, if you wish to extend your stay.                                                                               made in writing to Symposia Medicus and you will receive a full
Two nights’ deposit (room rate only) must accompany your reservation. The balance of your lodging, hotel fees as stated below, and all            refund if postmarked by December 18, 2012. Between
incidental charges are due to the hotel. The hotel accepts most major credit cards.                                                               December 19, 2012 and January 15, 2013, one night’s deposit
                                                                                                                                                  is forfeited. After January 15, 2013, no hotel refunds can be
You can receive these rates by reserving the following ways:                                                                                      made.
• On-line at our website, www.symposiamedicus.org; OR                                                                                           • All cancellations must be made in writing and postmarked by the
• Call Monday-Friday, 8:30am-5:00pm (Pacific Time), (925) 969-1789 or (800) 327-3161; OR                                                          dates stated above.
• Fax form with Visa, MasterCard, Discover, or American Express to (925) 969-1795; OR                                                           • In the unlikely event of conference cancellation by Symposia
                                                                                                                                                  Medicus, full tuition and, if reservation was made with Symposia
• By mail, make check payable to Symposia Medicus and send with registration form to 399 Taylor Blvd., Suite 201,                                 Medicus, hotel deposit refunds will be made. Symposia Medicus
  Pleasant Hill, CA 94523-2287.                                                                                                                   will not be responsible for refunding travel or any other expenses.
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
                                                                                                                                                AIR TRAVEL INFORMATION
Big Sky Resort is a full-service resort with several restaurants, heated indoor/outdoor pools, several hot tubs, steam room, sauna, and         You will be flying into Bozeman, Montana, which is approximately
spa.                                                                                                                                            one hour from the resort.
                                           RATES                MAX.        SQUARE                                                              Symposia Medicus has arranged for discount fares with Alaska
         TYPE OF ROOM                 (Single/Double        OCCUPANCY FOOTAGE                                DESCRIPTION                        and Delta airlines for this conference. Reservations can be made
                                       (Occupancy)                                                                                              either through your travel agency or through the airlines Convention
                                                                                                                                                Desk at the website or numbers listed below.
  Huntley First Class (Room)            $262/night                4          Approx.           Rooms have two queen size beds, mini
   (Main Lodge – contains            (additional people                        375             refrigerator, TV, one bathroom, wet bar,         In order to receive the discounted rate, you or your travel
 conference center & spa).             over two, add                                              coffeemaker, iron & ironing board,            agent must refer to the Symposia Medicus Group ID number
                                   $25/person per night)                                                     and blow dryer.                    listed below.
                                Shoshone Building: Attached to the Huntley Lodge & Conference Center                                                                          For discounts on Alaska Airlines
                                          Most rooms face Lone Mountain or Andesite Mountain                                                                                  flights, please book online at
                                                                                                                                                  Alaska Airlines             www.alaskaair.com and insert
 Shoshone 1-Bedroom Suite               $413/night                4          Approx.        Has a private bedroom with one queen bed,             Convention Desk:            ECMU47 into the e-certificate code
                                     (additional people                        790            1-3/4 bathrooms, Murphy bed and double                                          box. For questions, please call the
                                       over two, add                                     sleeper sofa in living room, fully equipped kitchen,                                 Alaska Airlines Convention Desk at
                                   $25/person per night)                                          gas fireplace and a small balcony.                                          (800) 445-4435.
      Shoshone Loft Suite               $574/night                6          Approx.           Downstairs of Loft Suite is the same as                                        For discounts on Delta Airlines flights,
                                     (additional people                       1140         1-Bedroom suite (no Murphy bed). Open spiral                                       please book online at
                                       over two, add                                        staircase goes up to loft. Has a queen or two         Delta Airlines              www.delta.com and click the box
                                   $25/person per night)                                           beds in the loft with a bathroom.              Convention Desk:            “from Airport” and another page will
                                        Euro-western luxury hotel adjacent to the Mountain Village                                                                            appear. At the bottom of that page,
                                                A two-minute walk to the Conference Center                                                                                    click the link “Meeting Event Code”
         *Summit Studio                 $308/night                2          Approx.          Has a queen size pull-down Murphy bed,                                          and insert NME7E. For questions,
                                                                              450               kitchen, dining room and private bath.                                        please call the Delta Airlines
                                                                                                                                                                              Convention Desk at (800) 328-1111.
          *Summit Hotel                 $361/night                4          Approx.                Has 2 queen size beds, wet bar
                                     (additional people                        400                         and private bath.
                                       over two, add                                                                                            CAR RENTAL DISCOUNT
                                   $25/person per night)
                                                                                                                                                Symposia Medicus has arranged conference discounts with AVIS
  *Summit 1-Bedroom Suite               $570/night                4          Approx.       Has one or two queen beds, one sleeper sofa,         and Budget Car Rentals. Reservations can be made by phone;
                                     (additional people                        880          full kitchen, dining area and two bathrooms.        please refer to the conference code and the conference/airport
                                       over two, add                                                                                            location when making your reservations. Please see below:
                                   $25/person per night)
  *Summit 2-Bedroom Suite               $719/night                6          Approx.             Has one queen bed in one bedroom,
                                     (additional people                       1300              one king or two queen beds in second                                   AVIS 800-331-1600
                                       over two, add                                       bedroom, and queen size sleeper sofa in living                                 AWD # B766625
                                   $25/person per night)                                 room; three bathrooms, full kitchen and fireplace.
                                                                                                 More bedding options are available.
                                  Big Sky Resort’s newest section in the heart of the Mountain Village                                                                Budget 800-772-3773
                                           Located between the Summit and Shoshone buildings
                                                                                                                                                                          BCD # U076767
     *Village Center Studio             $294/night                2          Approx.           Has queen size pull-down Murphy bed,
                                                                              432            microwave, coffeemaker, small refrigerator
                                                                                                   & dishwasher, and one bathroom.
   *Village 1-Bedroom Suite             $544/night                4          Approx.        Has queen bed in private bedroom, one sofa
                                     (additional people                       1050              sleeper in living room, two bathrooms,
                                       over two, add                                                       and a full kitchen.
                                   $25/person per night)
*Summit and Village units are VERY limited. Please reserve early. Condos and larger suites may be available. Please contact Symposia
Medicus at (925) 969-1789.

Page 4       Conference Brochure #1248, 13 th Annual Winter Conference on Pediatrics                                                                                        Symposia Medicus                 35
                                                                                                                                                                                        Since 1978
                                                                      CONFERENCE LOCATION

         This exciting conference will be held in the picturesque Northwestern Rockies at the beautiful Big Sky Resort, just an hour’s drive from
         Bozeman, Montana. This lovely hotel and suite/condominium resort, with ski-in and out access, is located within Big Sky Resort-Moonlight
         Basin, providing you access to 5,512 skiable acres, more skiing than anywhere else in the United States. Annual snowfall of more than 400
         inches results in spectacular beginning, intermediate and expert slopes, with plenty of wide, groomed cruising runs, as well as narrow chutes
         and trees for the advanced skier. You will also experience the incomparable Big Sky powder snow!

         If it’s Nordic skiing you enjoy, just six miles from the Big Sky Resort lies the Lone Mountain Ranch cross country skiing area, rated one of the
         best in the United States. And, for a change of pace, you are sure to enjoy a horse-drawn sleigh ride through the beautiful Big Sky Mountains, or
         a snow coach tour of nearby Yellowstone National Park. Big Sky Resort is a self-contained village with many restaurants to choose from, as
         well as live evening entertainment and dancing. The resort has a giant heated indoor/outdoor swimming pool, full spa and whirlpools to
         help soothe those aching muscles at the end of a busy day. A full range of shops are available around Big Sky Resort.

         You are sure to find many thrilling winter activities in this spectacular setting while attending our 13 th Annual Winter Conference on
         Pediatrics.




                                                                     2012 CALENDAR OF FUTURE CONFERENCES
                                                    (For our complete calendar of conferences, please visit www.symposiamedicus.org)

    1230     Current Issues in Women’s Health Care                                           Mediterranean Cruise (Celebrity Cruises - Silhouette)              Sep 29-Oct 11
    1235     28th Annual Fall Conference on Pediatric Emergencies                            Maui, Hawaii                                                       Oct 24-27
    1238     23rd Annual Conference on Hot Topics in Primary Care Medicine                   Aruba, Dutch Caribbean                                             Nov 7-10
    1236     Challenges in Obstetrics & Gynecology                                           Eastern Caribbean Cruise (Celebrity Cruises - Eclipse)             Nov 9-17
    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
    1253     24th Annual Spring Conference on Pediatrics                                     St. Maarten                                                        Apr 10-13
    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
    1261     15th Annual Summer Conference on Pediatrics                                     Napa, California                                                   Jul 10-13
    1265     Current Issues in Women’s Health Care                                           Alaska Cruise (Celebrity Cruises - Solstice)                       Jul 26-Aug 2
    1266     18th Annual Summer Conference on Primary Care                                   Atlantis, Bahamas                                                  Jul 31-Aug 3
    1271     Challenges in Obstetrics & Gynecology                                           Mediterranean Cruise (Celebrity Cruises - Reflection)              Sep 20-30

                                   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 #1248, 13 th Annual Winter Conference on Pediatrics                                                                    Symposia Medicus         35
                                                                                                                                                             Since 1978
    CONFERENCE & LODGING REGISTRATION FORM                                                                                                                         SYMPOSIA               MEDICUS
                                                                                                                                                                       13 th Annual
     Register on-line at www.symposiamedicus.org                                                                                                                  Winter Conference on
    OR COMPLETE THIS FORM & MAIL OR FAX WITH APPROPRIATE PAYMENT TO:
                                                                                                                                                                PEDIATRICS
                                         Symposia Medicus
                                                                                                                                                                  Big Sky Resort
                  35                     399 Taylor Blvd., Suite 201
                                         Pleasant Hill, CA 94523-2287                                                                                           BIG SKY, MONTANA
                                         Phone (925) 969-1789 or (800) 327-3161 • Fax (925) 969-1795                                                            February 19-23, 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, tour 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 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.
                                                                                                                                                                                                                 #1248


    LODGING RESERVATIONS                                                               Please reserve accommodations at the Big Sky 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:
                                                           RATE                                   CHARGE FOR ADDITIONAL                                    *Summit and Village units are VERY limited. Please
                           TYPE OF UNIT                   (based        MAXIMUM              OCCUPANTS OVER 10 YEARS OF AGE                                reserve early. A few larger units maybe available.
                                                                                                                                                           Please contact Symposia Medicus at (925) 969-1789.
                                                         on Double     OCCUPANCY             (NOT EXCEEDING MAX. OCCUPANCY)
                                                        occupancy)                         (charges will be added to final hotel bill)                     • Group Rates do not include the following
                                                                                                                                                             (subject to change):
                 Huntley First Class (Room)             $262/night             4                       $25/person per night                                  - 7% state accommodation tax
                                                                                                                                                             - 7% resort service fee
               Shoshone One Bedroom Suite               $413/night             4                       $25/person per night                                  - 3% resort tax
                                                                                                                                                             - Meals (unless otherwise stated)
                      Shoshone Loft Suite               $574/night             6                       $25/person per night                                  - Nor gratuities
                                                                                                                                                           • Maximum occupancy in rooms cannot be
                         *Summit Studio                 $308/night             2                                    N/A                                      exceeded

                          *Summit Hotel                 $361/night             4                       $25/person per night                                • Children 10 and under stay free in room with adult
                                                                                                                                                             with existing bedding (includes complimentary
                                                                                                                                                             buffet breakfast)
                *Summit One Bedroom Suite               $570/night             4                       $25/person per night
                                                                                                                                                           • See box to the left for additional person charges,
                *Summit Two Bedroom Suite               $719/night             6                       $25/person per night                                  over 10 years old

                    *Village Center Studio              $294/night             2                                    N/A                                    • Cribs and rollaways are available at $10 per night
                                                                                                                                                             (subject to availability)
                *Village One Bedroom Suite              $544/night             4                       $25/person per night

    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.org


Page 6       Conference Brochure #1248, 13 th Annual Winter Conference on Pediatrics                                                                                              Symposia Medicus                          35
                                                                                                                                                                                              Since 1978

								
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