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					                                                                                Texas Podiatric Medical Association
                                      Important Registration Material Inside!
                                                      Registration Brochure
                                                            21.5 CME Credits
                                                        2012 Fall Conference
    Permit #272
    US Postage

     Austin, TX
     First Class


                                                                                2012 Southwest Foot &
                                                                                    Ankle Conference
Texas Podiatric Medical Association
918 Congress Avenue, Suite 200

                                                                                Assistants General Course & Radiology
Austin, TX 78701

                                                                                Exhibit Hall with New Products and Promotions
                                                                                Diverse National Faculty
                                                                                Contributing Organizations:
                                                                                Texas Scottish Rite Medical Center
                                                                                University of Texas Southwestern Medical Center at Dallas, TX
                                                                                Leslie Campbell, DPM, FACFAS, FACFAOM, FAPWCA - Program Chair
                                                                                Scott W. McKinney, DPM – Chair of Continuing Education
                                                                     FACULTY LIST
Marque A. Allen, DPM, FACFAS, FAAPSM                                                                   Mikhail Samchukov, MD
Sports Medicine Associates of San Antonio, San Antonio, TX                                             Co-director, Center for Excellence in Limb Lengthening and Reconstruction, Texas Scottish
                                                                                                       Rite Hospital for Children, Associate Professor, Department of Orthopaedics, UT Southwestern
Donald Blum, DPM, JD                                                                                   Medical Center, Associate Professor, Department of Biomedical Sciences, Texas A&M University,
Southwest Podiatry Associates, Dallas, TX                                                              Health Science Center, Dallas, TX

Steven Brancheau, DPM, FACFAS, FACFAOM                                                                 Harold D. Schoenhaus, DPM, FACFAS, FACFAOM
Residency Director, Hunt Regional Medical Center, Foot and Ankle Surgery, Greenville, TX               Professor, Temple University School of Podiatric Medicine, Podiatric Medical Director, Penn
                                                                                                       Wound Care Center, Surgical Editor PRESENT e-Learning Systems, Philadelphia, PA
Michael L. Brody, DPM
Private Practice, Commack, NY                                                                          James W. Stavosky, DPM, FACFAS, FACFAOM, CWS-P, FAAWCP
                                                                                                       Adjunct Professor CCCPM at Samuel Merritt College, Oakland, CA, Attending San Francisco
Joel W. Brook, DPM, MS, FACFAS                                                                         Center for Advanced Wound Care, Daly City, CA
Dallas Podiatry Works, Dallas, TX
                                                                                                       Jeffrey P. Taylor, DPM, AACFAS
Maureen L. Caldwell, DPM, MBA, FACFAS                                                                  North Texas Podiatry Associates, Euless, TX
Podiatry Associates, Victoria, TX
                                                                                                       Robert P. Taylor, DPM, FACFAS
Leslie Campbell, DPM, FACFAS, FACFAOM, FAPWCA                                                          Stonebriar Foot and Ankle, Frisco, TX
Private Practice, Plano, Texas
                                                                                                       Robert Wimberly, MD
Dennis M. Chaney, DPM, FACFAS                                                                          Assistant Professor, Department of Orthopaedic Surgery, UT Southwestern Medical Center
Alamo Family Footcare, San Antonio, TX                                                                 Staff Orthopaedist, Texas Scottish Rite Hospital, Dallas, TX

Damien M. Dauphinée, DPM, FACFAS, FAENS, CWS-P, FACCWS
Medical Director, Center for Wound Healing & Hyperbaric Medicine, President, Complete Foot
and Ankle Care of North Texas, PA, Denton, TX

Brian E. De Yoe, DPM, FACFAS
Alamo Family Footcare, San Antonio, TX
                                                                                                               ONLINE CONFERENCE
Robert J. Dimeff, MD                                                                                            REGISTRATION AT
Professor, Orthopedic Surgery, Family Community Medicine, Pediatrics, UT Southwestern
Medical Center, Dallas, TX
Jason G. DeVries, DPM
Fellowship Trained Foot and Ankle Surgeon, Center for Bone and Joint Health, Agnesian
Healthcare, Ripon, WI                                                                                  CME CREDITS
Henry B. Ellis, MD                                                                                     TPMA is approved by the Council on Podiatric Medical Education
Staff Orthopaedist, Texas Scottish Rite Hospital for Children, Staff Orthopaedist, Children’s          as a sponsor of continuing education in podiatric medicine. The
Medical Center, Dallas, TX
                                                                                                       2012 TPMA Southwest Foot & Ankle Conference is intended for
Ovidio J. Falcone, DPM, FACFAS                                                                         licensed podiatric physicians and their assistants. Program, sched-
Private Practice, Astoria, NY                                                                          ule, and CE contact hours are subject to change without notice.
John V. Guiliana, DPM, FACFAS                                                                          Speakers are required to disclose significant financial relationships
Foot Care Associates, Hacketstown, NJ                                                                  with any and all commercial products discussed during the pre-
                                                                                                       sentation per CPME 720 guidelines. Speakers and sponsors are
Dan Halloran, DPM, FACFAS
North Texas Podiatry Associates, Euless, TX                                                            required to provide disclosure and written agreements to TPMA
                                                                                                       per the CPME 720 guidelines.
Salahuddin Kazi, MD
Chief Health Informatics Officer, VA North Texas Health Care System, Associate Professor Internal
Medicine, UT Southwestern Medical Center, Dallas, TX                                                   CORPORATE SPONSORS
Misti Knight, ATC, PhD                                                                                 PICA
Children’s Medical Center, Plano, TX

Gregg Lessly, MD
                                                                                                       Richie’s Specialty Pharmacy
Pinnacle Anesthesia Consultants, PA, Dallas, TX

Rodney Lindsay, MD                                                                                     PROGRAM SPONSORS
Family Practice, Medical Director, Comprehensive Wound Center Baylor Carrollton, TX
Matthew McCoy, MPT, OCS, CSMT                                                                          Bako Podiatric Pathology Services
Ortho Spine and Pain, Dallas, TX
Robert W. Mendicino, DPM, FACFAS
Pinnacle Orthopedic Associates, Salisburg, NC                                                          Stryker
Karl Rathjen, MD                                                                                       Synthes
Associate Professor, Department of Orhthopaedic Surgery, UT Southwestern Medical Center
Director, Division of Pediatric Orthopaedics, Children’s Medical Center, Dallas, Staff Orthopaedist,   Wright Medical
Texas Scottish Rite Hospital for Children, Dallas, TX
Embassy Suites & Convention Center, www.embassysuitesfrisco. SEPTEMBER 14, 2012
com, 7600 John Q. Hammons Drive, Frisco, Texas 75034. Call
972-712-7200 or 800-EMBASSY (362-2779) and ask for the 8.5 HOURS
TPMA rate of $135/night for a single/double based on availability.
To make an online reservation go to http://embassysuites.hilton.
index.jhtml?WT.mc_id=POG The hotel will release all unused                7:00am-7:30pm               Registration Open
rooms on the CUTOFF date of August 13, 2012. Rates include
full breakfast buffet each morning and 2-hour reception each eve-         8:00am-12:00pm              Workshops
ning provided in the atrium. Surface parking lot at the hotel is free.
Garage parking $8 per day, valet $14 per day.                             Workshop 1                  OsteoMed (30 participant maximum)
                                                                                 1st MTP Solutions: Finding the Right Tool for the
                                   We invite you to check out all that           Disorder
                                   Frisco has to offer! Home to one              Ovidio J. Falcone, DPM, FACFAS
                                   of the largest concentrated retail     OBJECTIVES: This lecture will contain both lecture and hands-
                                   areas in the state, the opportuni-     on practical experience with a focus on different techniques for
                                   ties are endless for trying out new    treating disorders of the 1st MTP. All participants will have
                                   restaurants or strolling through
                                                                          the opportunity to gain hands-on experience with a phalangeal
                                   boutiques in downtown Frisco. Arts
                                   and culture are also an important
                                                                          replacement, a metatarsal head resurfacing implant, and a total
                                   dynamic of the city. Visitors can      joint device. The workshop will utilize cadavers for the hands-on
                                   admire more than 100 works of art      practice portion.
                                   on display at Hall Office Park—or
                                   see western sculptures depicting       Workshop 2                 Stryker (40 participant maximum)
                                   Frisco’s pioneer past at Central              New Solutions in Foot Reconstruction: The Lapidus
                                   Park and Centre at Preston Ridge.             Procedure and Jones Fracture Management
                                   The Frisco Discovery Center offers            Speaker: Robert W. Mendicino, DPM, FACFAS
                                   the Frisco Art Gallery, the Black
                                                                          OBJECTIVES: This workshop will include both lecture and
                                   Box Theatre, a Special Event
                                   Center and the Sci-Tech Discovery
                                                                          hands-on lab on advanced principles and reconstruction tech-
                                   Center. Sports enthusiasts will find   niques. Evidence-based methods of managing Jones Fractures as
                                   Frisco has something to offer all      well as approaches to the Lapidus procedure will be discussed,
                                   year long. Catch a baseball game       reviewed and applied in the sawbones lab. Attendees will have
                                   with the Frisco RoughRiders or         the opportunity to use various implant fixation technologies
                                   watch some of the best soccer play-    and will be able to engage in case discussion with experienced
                                   ers in the world with FC Dallas.       faculty.
                                   Take in a Texas Tornado Junior
                                   League Hockey game or watch
                                                                          Workshop 3                 Arthrex (35 participant maximum)
                                   the professionals at a Dallas Stars
                                   practice. Finally, the hospitality
                                                                                 Advancement in Forefoot Surgery: Plantar Plate Repair
                                   and generosity of Frisco is second            and Hallux Valgus Correction
                                   to none. Come discover why Frisco             Jeffrey P. Taylor, DPM, AACFAS and Jason G. DeVries,
                                   is known, far and wide, as the                DPM
                                   home of the friendliest people you     OBJECTIVES:This workshop will include both lecture and
                                   will ever meet!                        hands-on practical experience focused on forefoot, midfoot, and
                                                                          rearfoot applications as well as soft tissue repair. All participants

THURSDAY,                                                                 will have the opportunity to gain hands-on experience with these
                                                                          techniques and implants in cadaveric specimens.

SEPTEMBER 13, 2012                                                        Workshop 4                  Synthes (35 participant maximum)
                                                                                 Midfoot and Hindfoot Arhtrodesis: My Way, His Way
6:00pm-9:00pm              Non CME Workshop Sponsored by                         Brian E. De Yoe, DPM, FACFAS and Dennis M. Chaney,
                           Wright Medical                                        DPM, FACFAS
        Hammertoe and F&Q Cadaveric Workshop                              OBJECTIVES: Advanced internal osteosynthesis will be pre-
        (30 participant maximum so register early!)                       sented in both lecture and a hands-on sawbones lab. Proper
OBJECTIVES: This workshop will include both lecture and                   techniques and the avoidance of pitfalls for mid and hindfoot
hands-on practical experience in PRO-TOE Vo hammertoe                     fusions will be lectured at length. Attendees will receive abundant
fixation system, DARCO modular forefoot system, CLAW II                   opportunity to perform discussed procedures in the lab. Attendees
polyaxial compression plating system and ORTHOLOC polyaxial               are also welcome to bring their own cases for discussion.
forefoot fracture system.
                                                                    EVERYTHING YOU THOUGHT YOU
FRIDAY, CONT.                                                       KNEW ABOUT BUNIONS
11:30am                   Exhibit Hall Opens                        OBJECTIVES:
                                                                    1. Identify the pathomechanics and review the staging of
12:00pm-1:15pm            Lunch Break                                  Hallux Limitus and Hallux Rigidus.
                                                                    2. Discuss evidenced based methods of anatomic restoration of
                                                                       the 1st MPJ and functional outcomes.
PEDIATRIC LOWER EXTREMITY                                           3. Discuss the indications for surgical correction of the 1st
DEFORMITIES:                                                           MPJ for Hallux Limitus and Hallux Rigidus and review the
When to Worry, When Not to Worry                                       algorithm of treatment based upon staging of the deformity.
                                                                    4. Present ancillary intraoperative approaches for realignment
OBJECTIVES:                                                            of the 1st MPJ in Hallux Valgus correction.
1. Understand the etiology, clinical manifestations and             5. Review of complications of Hallux Valgus correction –
   treatment of torsional and angular deformities in the child         clinical pearls.
   and adolescent; a simple physiologic variation during normal
   stages of development or true pathology?                         4:30pm-4:45pm
2. Discuss the pathomechanics, diagnostic evaluation and                Hallux Limitus: Metatarsal Head Resurfacing or Implant
   algorithm of treatment of pes planus from flexible to                Arthroplasty?
   pathological.                                                        Harold D. Schoenhaus, DPM, FACFAS, FACFAOM
3. Discuss the etiology of toewalking from idiosyncratic habit
   to profound muscular disease. Understand the algorithm of        4:45pm-5:15pm
   treatment based upon pathophysiology.                                Hallux Rigidus: Decompress, Endoprosthesis or Arthro-
4. Discuss the pathophysiology, clinical and diagnostic                 edesis?
   assessment of pedal deformities including clubfoot,                  Harold D. Schoenhaus, DPM, FACFAS, FACFAOM
   cavovarus and MTA and associated treatments.
5. Discuss the rational investigation and treatment strategies of   5:15pm-5:45pm
   foot pain in the pediatric patient.                                  Hallux Valgus Repair: Intraoperative Tweaking
6. Review the latest advancements in treatment of complex foot          Joel W. Brook, DPM, MS, FACFAS
   and ankle disorders in the pediatric patient.
1:15pm-1:45pm                                                           Complications of 1st Ray Surgery; Get me out of this fix!
    Torsional & Angular Deformities of Childhood                        Robert P. Taylor, DPM, FACFAS
    Karl Rathjen, MD
1:45pm-2:10pm                                                           Q&A Session and Panel Discussion
    Other Foot Deformities: Cavovarus, TEV, MTA
    Robert Wimberly, MD                                             6:30pm-7:30pm
                                                                        Welcome Reception Sponsored by
2:10pm-2:40pm                                                           Bako Podiatric Pathology Services
    Flatfeet and Toe Walking
    Karl Rathjen, MD

    Overview: “Doctor, his feet hurt”
    Robert Wimberly, MD
                                                                    SEPTEMBER 15, 2012
    Correction of Complex Foot and Ankle Pathology in the
                                                                    8.5 HOURS
    Pediatric Patient
    Mikhail Samchukov, MD                                           8:00am-5:15pm             Registration and Exhibit Hall Open
                                                                                              Breakfast in Exhibit Hall
    Q&A Session and Panel Discussion

3:45pm-4:30pm             Break
SATURDAY, CONT.                                                                      Young Members
KIDS ARE NOT YOUNG ADULTS                                            11:25am-11:45pm
                                                                         Managing Growth Plate Injuries of the Foot and Ankle
OBJECTIVES:                                                              Henry Ellis, MD
1. Understand guidelines for preoperatiave anesthetic
   evaluation of the pediatric patient.                              11:45pm-12:05pm
2. Review the etiology and types of juvenile arthridities,               Rehabilitation of Pediatric Foot & Ankle Injuries
   clinical manifestations and treatment of the juvenile arthritic       Matthew McCoy, MPT, OCS, CSMT
3. Discuss the classification, radiologic evaluation and             12:05pm-12:25pm
   management of bone tumors in the pediatric and adolescent             Preventing Lower Extremity Injuries in the Pediatric
   patient.                                                              Athlete
                                                                         Misti Knight, ATC, PhD
    Perioperative Assessment in the Pediatric Patient                12:25pm-12:45pm
    Gregg Lessly, MD                                                     Q&A Session and Panel Discussion

8:50am-9:15am                                                        12:45pm-2:00pm           Lunch Break
    Juvenile Arthridities
    Salahuddin Kazi, MD

    Overview of Pediatric Bone Tumors
    Leslie Campbell, DPM, FACFAS, FACFAOM, FAPWCA
                                                                     YOUNG MEMBERS TRACK
                                                                     SATURDAY, SEPTEMBER 15, 2012
    Q&A Session and Panel Discussion                                 10:45am-12:45pm
                                                                         Narcotics and the New Podiatric Physician
10:00am-10:45am             Break                                        DEA Department of Diversion Enforcement Officer and
                                                                         Maureen L. Caldwell, DPM, FACFAS, MBA
                                                                     A CASE STUDY PRESENTATION
1. Understand the incidence of sports related injuries in the        TO DEMONSTRATE THE RISKS
   pediatric population, the mechanism and type of injury.           AND RESPONSIBILITIES OF THE
2. Review osteochondridities in the lower extremities and
   indications for treatment.
                                                                     PODIATRIC PHYSICIAN WHEN
3. Discuss the classification of growth plate injuries and the       PRESCRIBING NARCOTICS.
   algorithm of treatment.
4. Understand the principles of preventing lower extremity           OBJECTIVES:
   injuries in the pediatric patient.                                1. To identify the patient at risk for narcotic abuse and/or
5. Introduce principles of rehabilitation of sports related             narcotic diversion.
   injuries in the pediatric patient including the important of      2. To understand the common drug seeking patient behaviors.
   core stability.                                                   3. To understand the podiatric physician’s ethical and legal
                                                                        responsibility in identifying and reporting abuse.
10:45am-11:05am                                                      4. To identify some techniques for dealing with the addicted
    Overview of Pediatric Injuries; Hypertrophic                        patient.
    Robert J. Dimeff, MD

    Managing Lower Extremity Osteochondritidies
    Henry Ellis, MD
SATURDAY, CONT.                                                      SUNDAY,
                                                                     SEPTEMBER 16, 2012
OBJECTIVES:                                                          WOUND CARE
1. Understand the pathomechanics of the pes cavus foot and the
   mechanism of conservative and surgical treatment.                 OBJECTIVES:
2. Understand the pathomechanics of the pes planus foot and          1. Discuss stem cell therapy as an enhancement of diabetic
   evidence based algorithm of treatment.                               wound healing.
3. Discuss the implications for implementation of STJ                2. Discuss current and emerging treatment of chronic diabetic
   arthroeresis in treatment of the pediatric and adult flatfoot.       wounds including advanced therapeutic modalities
4. Correlate the use of tendon balancing procedures in treating      3. Review of evidenced based treatment in supporting the
   foot and ankle pathology.                                            use of hyperbaric oxygen therapy for crush injuries and
5. Review the etiology of the unstable ankle and algorithm of           refractory wound healing in the foot.
   treatment in the pediatric and adult population.                  4. Discuss pertinent insights on biologic matrices for soft tissue
                                                                        repair, examining the clinical evidence.
2:00pm- 2:30pm                                                       5. Review current therapeutic approaches to the assessment
    The Problematic High Arched Foot                                    and management of peripheral arterial disease (PAD) and its
    Jeffrey P. Taylor, DPM, AACFAS                                      relationship to wounds and healing.

2:30pm- 3:00pm                                                       8:00am-8:30am
    Managing the Symptomatic Flatfoot                                    Stem Cell Therapy in Wound Management: Is There
    Dan Halloran, DPM, FACFAS                                            Sufficient Evidence?
                                                                         Damien M. Dauphinée, DPM, FACFAS, FAENS, CWS-P,
3:00pm-3:30pm                                                            FACCWS
    STJ Arthroereises
    Steven Brancheau, DPM, FACFAS, FACFAOM                           8:30am-9:00am
                                                                         The Infected Diabetic Foot
3:30pm-3:50pm                                                            James W. Stavosky, DPM, FACFAS, FACFAOM, CWS-P,
    Tendon Balancing Proc.: Pulling the Foot into the Right              FAAWCP
    Marque A. Allen, DPM, FACFAS, FAAPSM                             9:00am-9:30am
                                                                         Hyperbaric O2 Therapy for Crush Injuries of the Foot
3:50pm-4:10pm                                                            Rodney Lindsay, MD
    The Unstable Ankle
    Marque A. Allen, DPM, FACFAS, FAAPSM                             9:30am-10:00am
                                                                         Debridement and Offloading of Chronic Ulcers/ Negative
4:10pm-4:30pm                                                            Wound Pressure
    Q&A Session and Panel Discussion                                     James W. Stavosky, DPM, FACFAS, FACFAOM, CWS-P,
4:30pm-5:15pm              Break
                           Exhibit Hall Closes at 5:15               10:00am-10:30am
                                                                         Understanding Your Obligations with the HIPAA Security
5:15pm-7:15pm                                                            Rule
     PICA Risk Management: Optimizing EHR to Improve                     Michael L. Brody, DPM
     Patient Care and Mitigate Risk
     Michael L. Brody, DPM and John V. Guiliana, DPM,                10:30am-10:45am              Break
OBJECTIVES: This lecture will focus on how to optimize               10:45am-11:15am
technology to improve patient care and minimize risks. It will           New Standard of Care in Treating Diabetic Foot Ulcers
include a discussion of potential risks associated with the use of       James W. Stavosky, DPM, FACFAS, FACFAOM, CWS-P,
electronic health records and how to use electronic health records       FAAWCP
to optimize patient communication and education. It will also
include a discussion of electronic health record documentation       11:15am-12:15pm
techniques, use of functional clinical alerts and HIPAA security         Medical Ethics for Podiatric Practices
issues.                                                                  Donald Blum, DPM, JD
                      ASSISTANT’S PROGRAM
FRIDAY,                                                    SATURDAY,
SEPTEMBER 14, 2012                                         SEPTEMBER 15, 2012
GENERAL COURSE                                             GENERAL COURSE
7:30am-8:00am     Welcome                                  8:00am-9:30am              Event Marketing

8:00am-10:30am    Anatomy, Physiology and Terminolo-       9:30am-10:30am             ICD 10 Update/Coding Update and
                  gy for the Podiatric Medical Assistant                              Q&A

10:30am-11:00am   Break                                    10:30am-11:00am            Break

11:00am-12:00pm   Ankle/Foot Strapping Technique           11:00am-12:00pm            The Exceptional Receptionist
                                                           12:00pm-1:00pm             Lunch
12:00pm-1:00pm    Lunch
                                                           1:00pm-2:30pm              The Podiatric Assistant…Agent of the
1:00pm-2:30pm     Bako Pathology Workshop                                             Doctor Medical-Legal Concerns

2:30pm-3:00pm     Break                                    2:30pm-3:00pm              Break

3:00pm-4:00pm     Platelet Rich Plasma Injections          3:30pm-4:30pm              Collections…What is an Account
4:00pm-5:00pm     Wound Healing: Post-Operative Re-
                  dressing, Suture/Fixation Removal        4:30pm-5:00pm              Roundtable discussion

    TPMA Upcoming Meetings
        TPMA/ Dallas County
          Winter Conference                                RADIOLOGY CERTIFICATION
          January 26-27, 2013
     Marriott at Legacy Town Center                        Saturday, September 15, 2012
                                                           8:00am - 7:00pm
                Plano, TX                                  Podiatric Medical Assistant Radiology Training Program
                                                           Joe Martin, DPM, FACFAS
            Annual Meeting                                 OBJECTIVE: The Podiatric Medical Assistant’s radiography
            June 28-30, 2013                               certification course is a 10-hour course with 10 hours of pre-study
          Marriott Horseshoe Bay                           required prior to the first day of conference. It has been approved
                                                           by the Texas State Board of Podiatric Medical Examiners. Basic
           Horseshoe Bay, TX                               Radiology Principles will be reviewed with a special emphasis on
                                                           practical application. At the end of the course, upon proven com-
                                                           petency, the student will be certified to take podiatric radiographs
       Southwest Foot and Ankle                            under the supervision of a licensed podiatrist.
         September 13-15, 2013                             *Must register by August 24, 2012.

          Embassy Suites and
           Conference Center
              Frisco, TX
                          Southwest Foot & Ankle Conference
                                September 14-16, 2012
                                                  21.5 CE Contact Hours
                                     Register on-line at
    DPM Registration                                               by August 24, 2012                       after August 24, 2012
    TPMA/APMA Member                                                            $375                                        $475
    Non-Member                                                                  $775                                        $875
    Life Member                                                                  $95                                        $195
    Student/Resident                                                            Free                                        Free
    Special Seminar Rate for TPMA Young Members. Call 800-839-3668.
    Assistant Registration                                             DPM Member                              DPM Non-Member
    Friday & Saturday                                                           $225                                       $425
    Friday Only                                                                 $150                                       $350
    Saturday Only                                                               $150                                       $350
    Radiology                                                                   $295                                       $895
    **10 hours pre-study required. Must register by August 24, 2012

    Mark each workshop that you will be attending
      Wright Medical – Thursday, 6:00PM – 9:00PM (30 participant maximum)
       Osteomed – Friday, 8:00AM – 12:00PM (30 participant maximum)
       Synthes– Friday, 8:00AM – 12:00PM (35 participant maximum)
       Stryker – Friday, 8:00AM – 12:00PM (40 participant maximum)
       Arthrex – Friday, 8:00AM – 12:00PM (35 participant maximum)
      Young Members Track – Saturday, 10:45AM – 12:45PM
       PICA – Saturday, 5:15PM – 7:15PM
       I have special dietary needs: __________________________________________________
   DPM Name: ___________________________________Assistant Name: ________________________________
   Address: _____________________________________City, State, Zip: _________________________________
   Phone: ___________________________Fax: _______________________Email: _______________________

   Payment Information: circle method of payment Check enclosed               MasterCard        VISA         AMEX
   Card Number: __________________________________________________ Expiration: __________________
   Billing Address:___________________________________________________________________________
   Signature: ____________________________________________________ Total: $_____________________
Return form with payment to TPMA at 918 Congress Ave., Ste. 200, Austin, TX 78701. 800-TEX-FOOT, 512-494-1123, 512-494-1129 (fax) or register online at Confirmations will be sent via email. *One form per registrant*
Cancellation policy:
For DPM’s and Assistants, full refund minus 10% service charge for cancellation prior to September 5, 2012. No refund or credit for cancellations between
September 6th through September 14th and for no shows. For Radiology Certification, full refund prior to September 5th, 2012 if study guide is returned to
TPMA headquarters, otherwise refund minus $30 prior to September 5th. No refund starting on September 6th. Pre-registration for the Southwest Foot & Ankle
Conference ends on September 7, 2012.
                                      Texas Podiatric Medical Association

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