HEMATOLOGY ONCOLOGY George Washington University Medical Center

Document Sample
HEMATOLOGY ONCOLOGY George Washington University Medical Center Powered By Docstoc

    October 4-11, 2006 · Hyatt Regency Crystal City · Arlington, Virginia

Hematology            October 4-8, 2006
                                                           Register Online
Medical Oncology      October 7-11, 2006

                                                              SPONSORED BY

                                 COURSE DIRECTOR:
                               ROBERT S. SIEGEL, MD

                                                         DEPARTMENT OF MEDICINE
       Endorsed by the GW Cancer Institute               DIVISION OF HEMATOLOGY
                                                              AND ONCOLOGY
                                                                                        October 4-11, 2006
Target Audience
This five- or eight-day course is designed for the fellow in training, the physician planning to take the hema-
tology or medical oncology certifying examination, or the practitioner of hematology and medical oncology
who wishes to review both established standards of care and recent basic and clinical advances in hematol-
ogy and medical oncology.

Educational Outcomes
At the conclusion of the Hematology- Medical Oncology Board Review, the successful learner will be able

 Understand red cell disorders;

 Understand both established information and recent clinical advances in coagulopathies, anticoagulant

  and thrombolytic therapies;
 Understand blood and marrow morphology and hematopathology;

 Understand both established information and recent clinical advances in immunohematology, bone mar-

  row transplantation, and hematopoietic growth factors;

Hematology and Oncology
 Be familiar with the diagnosis, evaluation, and management of hematologic malignancies;

 Understand the most recent advances in the pharmacology and toxicology of anti-neoplastic drugs; and

 Identify strategies for taking the board examinations.

 Understand the epidemiology of malignant diseases and management of the medical complications of

 Recognize the latest advances in cancers of the lung, the breast, and the gastrointestinal tract;

 Understand the principles of management of gynecologic and other genito-urinary malignancies;

 Contend with complexity of HIV related malignancies;

 Recognize principles of new developments in biologic therapy of cancer.


The content of this course is developed independently by GW’s Hematology/Oncology
Board Review course director, who has no special knowledge of or access to American
Board of Internal Medicine examinations. The ABIM is not affiliated with, nor does it
endorse, any continuing medical education program.

Audio or video recording of this program is strictly prohibited.
PROGRAM CHAIR:                                Nancy E. Davidson, MD                        Philip Kantoff, MD
Robert S. Siegel, MD                          Professor of Oncology, Director, Breast      Professor of Medicine, Harvard Medical
Professor of Medicine and Director,           Cancer Program, Johns Hopkins                School, Chief, Division of Solid Tumor
Division of Hematology and Oncology,          University School of Medicine,               Oncology, Dana Farber Cancer Institute,
The George Washington University              Baltimore, MD                                Boston, MA
Medical Center, Washington, DC
                                              Howard Fine, MD                              Donald Karcher, MD
FACULTY:                                      Oncologist, Bethesda, MD                     Professor and Acting Chair of
David J. Adelstein, MD                                                                     Pathology, The George Washington
Department of Solid Tumor Oncology,           James N. George, MD                          University Medical Center
Cleveland Clinic Taussig Cancer Center        George Lynn Cross Professor                  Washington, DC
Cleveland, OH                                 University of Oklahoma
                                              Oklahoma City, OK                            Craig M. Kessler, MD
Dean Bajorin, MD                                                                           Professor of Medicine and Pathology
Attending Physician and Member,               Morie A. Gertz, MD                           Chief, Division of Hematology and
Genitourinary Oncology Services               Professor of Medicine, Division of           Oncology, Lombardi Comprehensive
Memorial Sloan-Kettering Cancer Center        Hematology, Mayo Clinic,                     Cancer Center, Washington, DC
Professor of Medicine, Weil Medical           Rochester, MN
College of Cornell University, New York, NY                                                Nigel Key, MD
                                           Victor Gordeuk, MD                              Harold R. Roberts Professor, Director,
Kenneth A. Bauer, MD                       Professor of Medicine, Center for               UNC Comprehensive Hemophilia
Program Director, Division of Hematology Sickle Cell Disease, Howard University            Treatment Center, Department of
and Oncology, Memorial Sloan-Kettering Hospital, Washington, DC                            Medicine, Division of Hematology/
Cancer Center, New York, NY                                                                Oncology, University of North Carolina
                                           Stephen M. Hahn, MD                             at Chapel Hill Chapel Hill, NC
Ann Berger,MSN, MD                         Professor and Chairman, Department
Pain and Palliative Care, Bethesda, MD     of Radiation Oncology, University               Thomas Kickler, MD
                                           of Pennsylvania School of Medicine,             Professor of Medicine, Oncology,
Nancy Berliner, MD                         Philadelphia, PA                                Pathology, Director of Hematology and
Professor of Medicine and Genetics,                                                        Coagulation Laboratory
Yale University School of Medicine,        Daniel Haller, MD                               Johns Hopkins University School of
New Haven, CT                              Professor of Medicine, Abramson                 Medicine, Baltimore, MD
                                           Cancer Center of the University
Michael Bishop, MD                         of Pennsylvania Medical Center,                 Hedy Lee Kindler, MD
Clinical Head and Investigator,            Philadelphia, PA                                Associate Professor of Medicine,
Experimental Transplantation and                                                           Director, Gastrointestinal Oncology,
Immunology Branch, National Cancer         Daniel F. Hayes, MD                             Director, Mesothelioma Program,
Institute, Bethesda, MD                    Professor of Internal Medicine                  University of Chicago, Chicago, IL
                                           University of Michigan Comprehensive
Edward Chu, MD                             Cancer Center, Ann Arbor, MI                    Richard Little, MD
Professor and Chief, Section of Medical                                                    Clinical Director, HIV and AIDS
Oncology, Associate Director, Yale Cancer Catherine P.M. Hayward, MD                       Malignancy Branch, Center for Cancer
Center, Yale University School of Medicine Professor of Pathology and Molecular            Research, National Cancer Institute,
New Haven, CT                              Medicine                                        Bethesda, MD
                                           Head, Coagulation, Hamilton Regional
Daniel Clarke-Pearson, MD                  Laboratory Medicine, McMaster                   Thomas Lynch MD
James M. Ingram Professor of Gynecologic University, Hamilton, Ontario, Canada             Director, Massachusetts General
Oncology, Duke University Medical Center,                                                  Hospital Thoracic Oncology Center,
Durham, NC                                 Bruce Johnson, MD                               Boston, MA
                                           Program Director, Lowe Center for
Joshua L. Cohen, MD                        Thoracic Oncology, Lowe Center                  John Macdonald, MD
Associate Professor of Medicine, Division for Thoracic Oncology, Dana Farber               Chief Medical Officer, Aptium Oncology,
of Endocrinology and Metabolism,           Cancer Institute,Boston, MA                     Inc. Professor of Medicine, GI Oncology
The George Washington University                                                           Services, St. Vincent's Comprehensive
Medical Center, Washington, DC             Hagop Kantarjian, MD                            Cancer Center, New York, NY
                                           Professor of Medicine, Department
                                           of Leukemia,MD Anderson Cancer
                                           Center/Tumor InstituteHouston, TX
www.hemoncboardreview.com                                                          BOARD REVIEW IN HEMATOLOGY & MEDICAL ONCOLOGY    3
B. Gail Macik, MD                              Margaret Rick, MD                         Ayalew Tefferi, MD
Associate Professor of Medicine and            Assistant Chief, Hematology Services,     Professor of Medicine, Division of
Pathology, Health Science Center               Clinical Center, National Institutes of   Hematology, Mayo Clinic, Rochester, MN
University of Virginia Health Science          Health, Bethesda, MD
Center, Charlottesville, VA                                                              J. Tate Thigpen, MD
                                               Frederick Rickles, MD                     Professor of Medicine and Director,
Robert Maki, MD                                Professor of Medicine                     Division of Medical Oncology,
Co-Director, Adult Sarcoma Program             Pediatric and Pharmacology and            University of Mississippi Medical Center,
and Assistant Member, Department of            Physiology, The George Washington         Jackson, MS
Medicine, Memorial Slogan-Kettering            University Medical Center
Cancer Center, New York, NY                    Washington, DC                            Susan Urba, MD
                                                                                         Associate Professor Internal Medicine
John Marshall, MD                              Afsoon Roberts, MD                        Division of Hematology/Oncology
Chief, Hematology and Oncology,                Associate Professor of Medicine           University of Michigan Comprehensive
Lombardi Comprehensive Cancer Center           Department of Medicine-Division           Cancer Center, Ann Arbor, MI
Washington, DC                                 of Infectious Diseases, The George
                                               Washington University Medical             Julie Vose, MD
Jeffrey Medeiros, MD                           Center, Washington, DC                    Neumann M. and Mildred E. Harris
Director of Clinical Hematology                                                          Professor
Hematologic Malignancies and Bone              Lynn Schuchter, MD                        Chief, Section of Hematology and
Marrow Transplantation Unit                    Associate Professor of Medicine           Oncology, Professor of Medicine
Beth Israel Deaconess Medical Center           Abramson Cancer Center of the             Nebraska Medical School
Boston, MA                                     University of Pennsylvania                Omaha, NE
                                               Philadelphia, PA
Kenneth Miller, MD                                                                       Theodore E. Warkentin, MD
Director of Clinical Hematology                Jerry L. Spivak, MD                       Professor, Department of Pathology
Hematologic Malignancies and Bone              Professor of Medicine and Oncology        and Molecular Medicine, and
Marrow Transplantation Unit                    Johns Hopkins University School of        Department of Medicine McMaster
Beth Israel Deaconess Medical Center           Medicine, Baltimore, MD                   University, Hamilton, Ontario Canada
Boston, MA
                                               Martin H. Steinberg, MD                   Daniel G. Wright, MD
Susan O’ Brien, MD                             Professor of Medicine, Pediatrics,        Professor of Medicine and Chief,
Professor of Medicine, UT MD Anderson          Pathology and Laboratory Medicine         Division of Hematology-Oncology
Cancer Center, Houston, TX                     Boston University School of Medicine      Boston University School of Medicine
                                               Boston, MA                                Boston, MA
S. Vincent Rajkumar, MD
Associate Professor of Medicine, Division      Imad Tabbara, MD                          Neal S. Young, MD
of Hematology, Mayo Clinic, Rochester, MN      Professor of Medicine, Division of        Chief, Hematology Branch, National
                                               Hematology and Oncology                   Heart, Lung, and Blood Institute
                                               The George Washington University          National Institutes of Health,
                                               Medical Center, Washington, DC            Bethesda, MD

    Optional Feature:

    Registered participants may join a few of our experts on Thursday and Tuesday evenings for an informal question
    review session! Detailed information will be provided to registrants.

The George Washington University Medical Center is accredited by the Accreditation Council for Continuing Medical
Education to sponsor continuing medical education for physicians.

CME Credit:
The George Washington University Medical Center designates the 8-day Hematology/Oncology Board Review for up to
60.25 credit hours in Category 1 of the Physicians’ Recognition Award of the American Medical Association. The 5-day
Hematology session awards up to 38 hours, and the 5-day Oncology session awards up to 37.5 hours. Each physician
should claim only those hours of credit that he/she actually spent in the educational activity.

4    BOARD REVIEW IN HEMATOLOGY & MEDICAL ONCOLOGY                                               www.hemoncboardreview.com
                                                     H E M AT O L O G Y
    Wednesday, October 4, 2006                    Thursday, October 5, 2006                Friday, October 6, 2006
7:00 am      Continental Breakfast        7:00 am      Continental Breakfast          7:00 am     Continental Breakfast and
             and Registration                          and Registration                           Registration

8:00 am      Biology of Hematopoiesis     8:00 am      The Coagulation Cascade        8:00 am     Molecular Diagnostic
             Jerry Spivak, MD                          Nigel Key, MD                              Methods of Common
                                                                                                  Hematologic Disorders
9:00 am      Megaloblastic and            8:45 am      The Hemophilias                            Nancy Berliner, MD
             Sideroblastic Anemias                     Nigel Key, MD
             Victor Gordeuk, MD                                                       9:00 am     Transfusion Medicine
                                          9:30 am      Von Willebrand's Disease                   Thomas Kickler, MD
10:00 am     Refreshment Break                         Margaret Rick, MD
                                                                                      9:45 am     Refreshment Break
10:15 am     Iron Deficiencies and        10:15 am     Refreshment Break
             Overload States                                                          10:00 am    Platelet Alloimmunization
             Victor Gordeuk, MD           10:30 am     Acquired Disorders of                      Thomas Kickler, MD
11:15 am     Hemoglobinopathies and                    Margaret Rick, MD              10:45 am    Disorders of Granulopoiesis
             Thalassemias                                                                         Daniel Wright, MD
             Martin Steinberg, MD         11:15 am     Aplastic Anemia
                                                       Neal Young, MD                 11:45 am    Consumptive
12:15 pm     Lunch Break
             (provided)                   12:05 pm     Lunch Break
                                                                                                  Theodore Warkentin, MD
1:15 pm      Sickling Disorders
             Martin Steinberg, MD         1:00 pm      Hypercoagulable States
                                                                                      12:15 pm    Lunch Break (provided)
                                                       Kenneth Bauer, MD
2:00 pm      Hemolytic Anemias
                                                                                      1:15 pm     Prothrombotic Complications
             Imad Tabbara, MD             2:00 pm      Qualitative Platelet Defects
                                                       Catherine P.M. Hayward, MD                 of Anticoagulation
2:45 pm      Refreshment Break                                                                    Theodore Warkentin, MD
                                          2:45 pm      Refreshment Break
3:00 pm      Porphyrias                                                               2:15 pm     Problems in Hemostaisis
             Victor Gordeuk, MD           3:00 pm      ITP and Drug Induced                       and Thrombosis
                                                       Theombocytopenia                           Theodore Warkentin, MD,
3:30 pm      Anemia of Chronic Disease                 James George, MD                           Robert Siegel, MD, and
             Victor Gordeuk, MD                                                                   Craig Kessler, MD
                                          4:00 pm      Parenteral Antithrombotics
4:15 pm      RBC Enzymes, Membranes,                   and Thrombolytic Therapy       2:45 pm     Refreshment Break
             and Metabolism                            B. Gail Macik, MD
             Imad Tabbara, MD                                                         3:00 pm     Hematologic Complications
                                          4:45 pm      Oral Anticoagulants and                    of Pregnancy
5:00 pm      Adjourn                                   Antithrombotic Therapy                     Robert Siegel, MD
                                                       B. Gail Macik, MD
                                                                                      3:30 pm     Myeloproliferative Diseases
                                          5:15 pm      Adjourn                                    Ayalew Tefferi, MD

                                                                                      4:45 pm     Eosinophilic Disorders and
                                                                                                  Mast Cell Disease
                                                                                                  Ayalew Tefferi, MD

                                                                                      5:15 pm     Adjourn
                                            Evening reviews using MKSAP and
                                            other tools, with participation by
                                            our panel of experts.

5 BOARD REVIEW IN HEMATOLOGY & MEDICAL ONCOLOGY                                                 www.hemoncboardreview.com
                                                    H E M AT O L O G Y
                                                       O N CO LO G Y
                            Saturday, October 7, 2006               Sunday, October 8, 2006

                      7:00 am      Continental Breakfast and   6:30 am    Continental Breakfast and
                                   Registration                           Registration

                      8:00 am      Pathology of Lymphomas      7:30 am    Clinical Problems in
                                   and Hodgkin’s Disease                  Coagulation
                                   Jeff Medeiros, MD                      Craig Kessler, MD

                      9:00 am      Hodgkin's Disease           8:15 am    Thrombosis and Cancer
                                   Julie Vose, MD                         Frederick Rickles, MD

                      9:45 am      Refreshment Break           9:15 am    Acute Myeloid Leukemia
                                                                          Imad Tabbara, MD
                      10:00 am     Non-Hodgkin’s Lymphoma
                                   Julie Vose, MD              10:15 am   Refreshment Break

                      11:00 am     Chronic Lymphocytic         10:30 am   Pharmacology I
                                   Leukemia                               Edward Chu, MD
                                   Susan O'Brien, MD
                                                               11:30 am   Pharmacology II
                      11:45 am     Acute Lymphocytic                      Edward Chu, MD
                                   Hagop Kantarjian, MD        12:30 pm   Lunch Break
                      12:15 pm     Lunch Break
                                   (provided)                  1:30 pm    Chemoprotection
                                                                          Edward Chu, MD
                      1:15 pm      Chronic Myeloid Leukemia
                                   Hagop Kantarjian, MD        2:00 pm    Bone Marrow
                      2:00 pm      Multiple Myeloma                       Michael Bishop, MD
                                   S. Vincent Rajkumar, MD
                                                               3:00 pm    Refreshment Break
                      2:45 pm      Amyloidosis
                                   Morie Gertz, MD             3:15 pm    HIV Malignancies
                                                                          Richard Little, MD
                      3:15 pm      Refreshment Break
                                                               4:00 pm    Infectious Disease
                      3:30 pm      Myelodysplasia                         Afsoon Roberts, MD
                                   Kenneth Miller, MD
                                                               4:45 pm    Adjourn
                      4.15 pm      Morphology Review
                                   Kenneth Miller, MD

                      5.00 pm      Adjourn

6   BOARD REVIEW IN HEMATOLOGY & MEDICAL ONCOLOGY                                           www.hemoncboardreview.com
                                                   O N CO LO G Y
    Monday, October 9, 2006                 Tuesday, October 10, 2006                 Wednesday, October 11, 2006
7:00 am    Continental Breakfast and   7:00 am     Continental Breakfast and       7:00 am    Continental Breakfast and
           Registration                            Registration                               Registration

8:00 am    Head and Neck Cancer        8:00 am     Testicular Cancer               8:00 am    Gastric Cancer
           David Adelstein, MD                     Philip Kantoff, MD                         John Macdonald, MD

9:00 am    Non-Smal-Cell Lung Cancer 8:30 am       Renal Cell Cancer               8:45 am    Hepatobiliary Cancer
           Thomas Lynch, MD                        Dean Bajorin, MD                           Daniel Haller, MD

9:50 am    Refreshment Break           9:15 am     Prostate Cancer                 9:15 am    Carcinoid and Islet Cell
                                                   Philip Kantoff, MD                         Tumors
10:05 am   Small-Cell Lung Cancer                                                             Daniel Haller, MD
           Bruce Johnson, MD           10:15 am    Refreshment Break
                                                                                   9:45 am    Refreshment Break
10:45 am   Neuro-Oncology              10:30 am    Bladder Cancer
           Howard Fine, MD                         Dean Bajorin, MD                10:00 am   Rectal Cancer
                                                                                              Daniel Haller, MD
11:30 am   Metastatic Disease to Brain, 11:00 am   Ovarian Cancer
           Spine, Carcinomatous                    J. Tate Thigpen, MD             10:30 am   Esophageal Cancer
           Meningitis                                                                         Susan Urba, MD
           Howard Fine, MD              12:00 pm   Trophoblastic Tumors
                                                   Daniel Clarke-Pearson, MD 11:15 am         Colon Cancer: Biology and
12:00 pm   Lunch Break                                                                        Adjuvant Therapy
           (provided)                  12:30 pm    Lunch Break                                John Marshall, MD
1:00 pm    Epidemiology and                                                        12:00 pm   Lunch Break
           Prevention of Breast Cancer 1:30 pm     Endometrial Tumors                         (provided)
           Robert Siegel, MD                       J. Tate Thigpen, MD
                                                                                   1:00 pm    Treatment of Metastatic
1:30 pm    Adjuvant Therapy for        2:00 pm     Cancer of the Cervix, Vagina,              Disease
           Breast Cancer                           Vulva                                      John Marshall, MD
           Nancy Davidson, MD                      Daniel Clarke-Pearson, MD
                                                                                   1:30 pm    Anal Cancer
2:30 pm    Refreshment Break           3:00 pm     Refreshment Break                          John Macdonald, MD

2:45 pm    Treatment of Metastatic     3:15 pm     Sarcomas                        2:00 pm    Pancreatic Cancer
           Breast Cancer                           Robert Maki, MD                            Hedy Lee Kindler, MD
           Daniel Hayes, MD
                                       4:00 pm     Melanoma                        2:45 pm    Refreshment Break
3:30 pm    Problems in Breast                      Lynn Schuchter, MD
           Cancer Treatment                                                        3:00 pm    Supportive Care/Pain
           Panel: Drs. Siegel,         4:45 pm     Endocrine Malignancies                     Control
           Davidson, Hayes and                     Joshua Cohen, MD                           Ann Berger, MD
                                       5:30 pm     Adjourn                         4:15 pm    Adjourn
4:00 pm    Principles of Radiation
           Stephen Hahn, MD

5:00 pm    Adjourn
                                        Evening reviews using MKSAP and
                                        other tools, with participation by
                                        our panel of experts.

                                                                          *Program schedule subject to change without notice.
www.hemoncboardreview.com                                                BOARD REVIEW IN HEMATOLOGY & MEDICAL ONCOLOGY     7

Enrollment Fee:                                                In addition to the fine services and facilities that are
Tuition for the combined 8-day Hematology and Oncology         standard at Hyatt Hotels, at the Hyatt Regency Crystal City
course is $1,670 for practicing physicians and $1,445          overnight guests have use of the following facilities:
for residents and fellows. Tuition for either the 5-day           Free weights
Hematology or the 5-day Oncology course individually              Weight machines
is $1095 for practicing physicians and $995 for residents
                                                                  Cardiovascular bikes, treadmills, and stair-steppers
and fellows. (Residents and fellows are required to
submit a letter from their training program director with         Heated outdoor swimming pool and jacuzzi

the registration form and payment to verify status as             Near by golf course
a resident or fellow). Full payment is required with the          Jogging paths
completed registration form to reserve a place in the
course. If you register on or after August 30, 2006 please     The Hyatt Regency Crystal City offers complimentary
add $100 to the registration fee. The registration fee for     shuttle service for hotel guests to/from National Airport
all attendees includes a comprehensive course syllabus,        and the Crystal City Metro Station from 5:30am until 12
faculty presentations, continental breakfast each day, lunch   midnight. Overnight parking is available to guests at a rate
everyday, and refreshment breaks. All registration forms,      of $16 per night, and to daily commuters at a rate of $10
with payment, must be received by the Office of CEHP           per day (Parking rates are subject to change).
before September 20, 2006; however, enrollment space
will be limited and may be filled at an earlier date. Early    Taxi fares from Washington Dulles International Airport
registration is strongly encouraged. Written confirmation      are approximately $45.00. From Baltimore-Washington
of registration is mailed within one week of receipt of your   International Airports taxi fares are approximately $70.00.
completed form and full payment.                               The hotel's address is:

Cancellation Policy:                                                          Hyatt Regency Crystal City
Cancellation of course registration will be accepted in                      2799 Jefferson Davis Highway
writing only through August 30, 2006. Please include your                      Arlington, Virginia 22202
home address and social security number to expedite the                              703-418-1234
processing of your cancellation. Your refund, less a 10%
administrative fee, will be sent within four weeks following
the conclusion of the course. No refunds will be made for
cancellation notification received after August 30, 2006.

Course Location - Hyatt Regency Crystal City:
The entire Board Review course will be hosted at the Hyatt
Regency Crystal City with is located adjacent to Ronald
Reagan Washington National Airport a few blocks from the
Metro subway system. Room rates for the Board Review at
the Hyatt Regency Crystal City are only $159 per night plus
tax (currently 10% and $1.00 occupancy tax) at single or
double occupancy. Room reservations can be made at this
reduced rate until September 3, 2006, or until our block of
rooms is filled - whichever comes first!

Reservations can be made at the group rate by calling 703-
418-1234. The guest rooms at the Hyatt Regency Crystal
City are furnished with:
   Two-line phones with voicemail

   Wireless high speed internet

   Coffee maker
   Iron and ironing board                                     Please call GW's Office of CEHP at 800-314-1423
   Hair dryer                                                 (or 202-994-4285 outside of the US) or visit
   Oversized work area

8   BOARD REVIEW IN HEMATOLOGY & MEDICAL ONCOLOGY                                           www.hemoncboardreview.com
       R E G I S T R AT I O N                                                            2006
                                                                                           IN REVIEW
Registration Form
Hematology and Medical Oncology Board Review
October 4-11, 2006                                                                             HEMATOLOGY &
                                   Physicians                  Residents/Fellows*                 MEDICAL
Hematology and Oncology              $1670**                          $1,445**
(October 4-11)                                                                                   ONCOLOGY
Hematology Only                       $1095**                          $993**
(October 4-8)                                                                                     Reg. # __________
                                                                                                  (for office use only)
Oncology Only                        $1095**                           $995**
(October 7-11)

*letter of verification from your training program director must accompany this form.
**add $100.00 if registering on or after August 30, 2006

First Name                                              Last Name                                                            DO



City                                                          State                                Zip

Daytime Telephone                                                      Fax

E-mail Address

Method of Payment:

   Check enclosed          Visa/MasterCard           American Express

If paying by credit card, please print your name legibly as it appears on the card, and include account number of card and expi-
ration date. Registration forms paid by credit card (Visa, MasterCard, American Express Only) may be faxed to (202) 994-1791.
Charges will appear on your statement as “GWUMC CME.” All registration confirmation cards are sent via mail.

Card Number                                                                     Expiration Date

Cardholder Name                                                   Cardholder Signature

If paying by credit card, you may fax your completed registration form to 202-994-1791. Otherwise, please make checks pay-
able to “GWUMC” and mail along with this form to:

                                Office of Continuing Education in the Health Professions (CEHP)
                                       The George Washington University Medical Center
                                           2300 Eye Street, NW, Ross Hall, Suite 313-D
                                                    Washington, DC 20037
                                           Phone: 202-994-4285 Fax: 202-994-1791

              Please check this box if you require assistance with hearing, vision, or mobility to make this program accessible to
              you. Please return this form by August 30, 2006, if you require assistance.

Shared By: