Post on 12-Mar-2016
description
JUNE 25 - 29, 2012
H O U S E o f D E L E G A T E S & A N N U A L
S C I E N T I F I C M E E T I N G
Ri t z -Car l ton Mar ina del ReyLos Angeles , CA
You are cordiallY invited to join
Your fellow diplomates, members, and
other health-care professionals
for discussions and up-to-date information on
women’s health issues
mondaY, the twentY-fifth of june through fridaY, the twentY-ninth of june, two thousand twelve
ritz-carlton marina del reY
los angeles, california
• Providephysicianspecialistswithup-to-dateinformationaboutWomen’sHealthissues.
• Provideaforuminwhichtodiscussdevelopingandemergingissuesinyourspecialtyorsub-specialty.
• PlanandconductbusinessthatwillfurtherstrengthenthemissionoftheAAPS,itsaffiliatedAcademiesofMedicine,anditsBoardsofCertification.
• EncouragecollegialrelationsthatenableindividualmemberstopursuetheirprofessionalgoalsofparticipationintheAssociation’sactivities.
AnesthesiologyDermatologyDiagnosticRadiologyDisasterMedicineEmergencyMedicineFamilyMedicineObstetricsFamilyPracticeGeriatricMedicine
HospitalMedicineInternalMedicineObstetrics&GynecologyOphthalmologyOrthopedicSurgeryPlastic&ReconstructiveSurgeryPsychiatry
RadiologyandRadiationOncologySurgeryUrgentCare
intended audienceABPS Diplomates and AAPS Members in:
overall meeting objectives
emergency medicine examination development Workshop, June 24 – By Invitation Only. TheAAPSdesignatesthistest-itemwritingactivityforamaximumof4 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.
examination development Workshop i, June 25–TheAAPSdesignatesthistest-itemwritingactivityforamaximumof 9 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.
examination development Workshop ii, June 26–TheAAPSdesignatesthistest-itemwritingactivityforamaximumof5 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.
2012 annual scientific meeting, June 27 and 28:TheAAPSdesignatesthisliveactivityforamaximumof16 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.
cme credit statements
accreditation statementTheAmericanAssociationofPhysician
Specialists,Inc.(AAPS),isaccreditedbytheAccreditationCouncilforContinuingMedical
Educationtoprovidecontinuingmedicaleducationforphysicians.
•Upto16.0CMEcreditsforScientificPresentationsessions
•Upto7.5CMEcreditsforMedicalEthicscourse
•Upto14.0CMEcreditsforExaminationDevelopmentWorkshops(Non-EM)
•Upto18.0CMEcreditsforExaminationDevelopmentWorkshops(EM)
KennethM.Flowe,M.D.,FAAEP,MBA,Co-ChairStephenA.Montes,D.O.,FAASOS,Co-Chair
MuhammadA.Ahmed,M.DLingappaS.Amernath,M.D.
JackV.Greiner,D.O.,PhD,FAASSGustavoG.Leon,M.D.
JerryR.Majers,D.O.,FAAIM,FAAGMHerbertPardell,D.O.,FAAIM
LuisM.Velasco,M.D.
cme committee
earn cme credits by participating in . . .
separate registration required $450.00
one-day course: Friday, june 29, from 8:00 am to 5:00 pm
course objectivesupon completion of this program participants should be able to:
1.Understandthetheoreticalandhistoricalfoundationsofmedicalethics;
2.Engageinallocationofresourcesdecisions;
3.Applyethicaldecision-makingtoolstoactualcircumstances;
4.Understandtheappropriaterolesofmedicalethics/bioethicscommitteesandbeabletoconstructivelycontributetothesecommittees;
5.Recognizethestakeholdersinmedicalethicsdecisionsandweighstakeholderethicalperspectives;and
6.Guidepublicdiscussionofmedicalethicsissuesandexplaintheperspectivesofmedicalprofessionalsonsuchissues.
medical etHics course: practical issues and approaches – 7.5 cme credits
This course provides a solid conceptual grounding in medical ethics, while focusing on practical issues and tested approaches for resolving such issues. This course satisfies a professional development requirement for fulfilling, in part, Board recertification of the American Board of Physician Specialties of the American Association of Physician Specialists.
accreditation statement
TheAmericanAssociationofPhysicianSpecialists,Inc.(AAPS),isaccreditedbytheAccreditationCouncilforContinuingMedicalEducationtoprovidecontinuingmedicaleducationforphysicians.
TheAmericanAssociationofPhysicianSpecialists,Inc.,designatesthisliveactivityforamaximumof7.5 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecredit
commensuratewiththeextentoftheirparticipationintheactivity.
ThiscoursefulfillsABPSrecertificationrequirementsforMedicalEthics.CMEcreditearnedforattendingthiscoursemayalsobeappliedtotheCMErecertificationrequirements.
AccordingtoAMApolicy,physiciansmaynotclaimcreditforattendingthesameactivitymorethanonce,unlesstherehasbeenasubstantialchangeinthematerialsthathadbeenpreviouslypresented.
cme credit statement
recertiFication credit
great Hotel in great location• TheRitz-CarltonHotelMarinadelRey,LosAngeles–EASYACCESSTOLAXandshopping,dining,Fisher-man’sVillage,VeniceBeach,Hollywood,andmore.
• Indulgeinwateractivities,boatandkayakrentals,harborcruises,outdooradventures,naturewalks,sportsfishing,andmore.
Flexible options• Customizeyourschedule–choosethesessionsthatworkforyou–eithertheBusinessPackage,CMEPackage,orDiscountPackage.
great pricing• Registrationpackagesallowyoutopayonlyfortheportionofthemeetingyouplantoattend.
• WelcomeReceptionincludedinallpackages.
generous deadlines• TakeadvantageofbestpricesduringEarlyRegistration– THIS IS YOUR BEST BUY!!!
• EarlyRegistrationuptoMarch23,2012
• Still-Time-To-RegisteruptoJune1,2012
medical ethics course• One-daycourseonFriday,June29,2012
advance your career! netWorK! learn! relaX & enjoy!
attend tHe 2012 annual meeting
•BoardofDirectorsMeeting–EveryoneisencouragedtoattendallorpartoftheBODmeetingonMonday,June25.
•OrientationSessionfornewlyelected/appointedAcademyandBoardmembers.Requiredforallnewlyelected/appointedmembersofAcademiesandBoards.ThissessiononTuesday,June26,willoutlineyourdutiesandresponsibilitiesaswellasassociationprocedures.
•FirstTimeAttendeesLunchonWednesday,June27,willintroduceyoutoBODMembersandyourfellowDiplomates.
•Flashdrivesprovidedforyourconvenienceinsteadofbulkyscientificpresentationmaterials.
NO HARD COPIES WILL BE PROVIDED BY AAPS.
HigHligHts For 2012!
aaps auXiliary• Opentoallfamilymembers
• Auxiliaryduesare$60peryear
• AnnualMeetingandBrunchMonday,June25,at9am
• WelcomeReceptionMonday,June25at5:30-7pmTicketscourtesyofAAPSAuxiliary
• ChecktheAuxiliaryscheduleattheRegistrationDesk
sunday, june 24: business & discount pacKages only
12noon–5pm............. RegistrationDesk1pm–5pm.................. EmergencyMedicineExaminationDevelopmentWorkshopBY INVITATION ONLY
monday, june 25: business & discount pacKages only
7:30am–11:30am...... AAPSBoardofDirectorsMeeting8am–5pm.................. Credentialing–AllSpecialties– Open to BOC Members/Credentialing Committee Only8am–5pm.................. ExaminationDevelopmentWorkshopI–AllSpecialties–Open to Diplomates Only9am–11am................ AuxiliaryBrunchandMeeting11:45am–1pm.......... PastPresidentsLunchMeetingLUNCH............................ Onyourown1pm–3pm.................. HouseofDelegates3pm–4:15pm............. CouncilofAcademyPresidentsMeeting3pm–5pm.................. AmericanBoardofPhysicianSpecialties(ABPS)Meeting5:30pm–7pm............. WelcomeReception
tuesday, june 26: business & discount pacKages only
8am–9:15am............. AcademiesofMedicineMeetings(Anesthesiology,EmergencyMedicine,FamilyPractice, InternalMedicine,Radiology,OrthopedicSurgery,andSurgery)8am–9:15am............. BoardsofCertificationMeetings(FamilyMedicineObstetricsandUrgentCareMedicine)9:30am–11am............ CorrespondingBoardsofCertificationMeetings(Anesthesiology,EmergencyMedicine, FamilyPractice,InternalMedicine,Radiology,OrthopedicSurgery,andSurgery)9:30am–11am............ AcademiesofMedicineMeetings(DisasterMedicineandDermatology)
scHedule oF eventsScheduleissubjecttochangebeyondthecontrolofAAPS.
monday-Friday:7am–5pm.................. RegistrationDesk7am–8am.................. Breakfast
11am–12:30pm......... AAPSFoundation AJCMEditorialBoard11:15am–12:45........... BoardsofCertificationMeetings(DisasterMedicine,HospitalMedicine,andDermatology)12noon–5pm............. ExaminationDevelopmentWorkshopII– Open to Diplomates OnlyLUNCH............................ Onyourown12:30pm–2:30pm..... PublicMemberMeeting2pm–3:15pm............. CMECommittee2:30pm–4pm............. Academy&BoardOrientation3pm–4pm.................. GovernmentalAffairsCommittee(GAC)Meeting3:15pm–4:30pm........ MembershipCommitteeMeeting4pm–5:45pm............. StrategicPlanningCommitteeMeeting6:15pm–7pm............. President’sReception7pm–10pm................ President’sAwardsDinner
Wednesday, june 27: cme & discount pacKages only
7am–8am.................. CMEBreakfastforregistrants8am–5:30pm............. CMEScientificSessionsforregistrants12noon–1:30pm........ CMELunchforregistrants12noon–1:30pm........ First-TimeAttendeesLunch
tHursday, june 28: cme & discount pacKages only
7am–8am.................. CMEBreakfastforregistrants8am–5pm.................. CMEScientificSessions12noon–1pm............. CMEPackageLunchforregistrants
Friday, june 29: medical etHics only
7am–8am.................. MedicalEthicsBreakfast8am–5pm.................. MedicalEthicsCourse12:30pm–1:30pm...... MedicalEthicsLunch
AndresAbreu,D.O.----------------- ScreeningMammographyandAssociatedMedicareCostsinElderlyWomen
JosephM.Damiani,M.D.,FAAPRS------ BreastAugmentation–TheGood,theBadandtheUgly
FranklinO.DeLaCruz,M.D.----------- HypertensioninPregnancy
MarkDeSantis,D.O.----------------- AdvancingTrendsinWomen’sImaging
KennethM.Flowe,M.D.,FAAEP,MBA --- HIVandtheOppressionofWomeninEastAfrica
SurinderK.Kad,M.D.,FAAIM,MPH,MBA- Amenorrhea:DiagnosticEvaluationandTreatmentOptions
DavidM.Lemonick,M.D.,FAAEP------- OrthopedicIssuesinWomen:WhatEveryPhysicianShouldKnow
RecognizingandTreatingPostpartumEmergencies:WhatEveryPhysicianShouldKnow
DouglasL.Marciniak,D.O.,FAAIM------ HeartDiseaseinPregnancy
DavidR.Meece,M.D.,FAAEP--------- FemaleAthleticTriad–RamificationsforHealth
LeslieMukau,M.D.,FAAEP,FACEP------ JohnsHopkinsandtheFeministLegacy:HowaGroupofBaltimoreWomenShapedAmericanGraduateMedicalEducation
MarkPastin,Ph.D. ------------------ IsGenderanEthicalIssueinMedicine?
ThomasG.Pelz,D.O.,FAAIM---------- EvaluationoftheWomanwithCAD
JayanthG.Rao,M.D.,FAAR,MRCP----- BreastCancerin2012fromaRadiationOncologistPerspective
speaKers
JRMacMillanRodney,M.D.----------- ElectronicFetalMonitoringUpdate2012:FamilyMedicineObstetrics
UsingiPhoneandiPadTechnologytoImproveObstetricalUltrasoundSkillsinRuralFamily&EmergencyMedicine
Wm.MacMillanRodney,M.D.--------- IntrauterineDevicesforFamilyPlanning,Diagnosis,&ManagementofComplications
BetsyB.Schenck,D.O.,FAAEP--------- TheHighRiskWoman–Age18-24
EduardoScholcoff,M.D. ------------- AdvancedLifeSupportinObstetrics:EssentialEmergencySkillsinOB
GaryL.Shultz,D.O.,FAAR------------- LocallyRegionalAdvancedBreastCarcinomaTreatmentwithIMRTCorrespondingReductioninOrganatRisk
Presenter Disclosure:TheAmericanAssociationofPhysicianSpecialists,Inc.,believesinfulldisclosure.Eachpresenterorsponsorisrequiredtodiscloserealorapparentconflictsofinterestrelatingtotopicsofthiseducationalactivity.Presenterdisclosurewillbemadetoallparticipantsintheeduca-tionalactivitymaterialsandatthebeginningofeachpresentation.
4375AdmiraltyWayMarinadelRey,CA90292HotelReservations800-474-6501•HotelDirect310-823-1700•HotelFax310-574-4300
www.ritzcarlton.comgroup code aapaapg
AAPShasalimitednumberofroomsavailableattheAAPSguaranteedroomrateonafirstcome,firstservedbasis.HotelreservationsmustbemadeNO LATER THAN MAY 30, 2012.WestronglyencourageyoutomakeyourreservationsASAP!
Any problems making hotel reservations, call the AAPS Meetings Department.
accommodationstHe ritz-carlton marina del rey
Hotel reservations
•Singleordoubleoccupancy$195+tax
perroompernight(currently13.1%)
•Childreninsameroomasparents:Free
•Guaranteedroomrateappliesthreedaysbeforeandthreedaysaftermeeting,
basedonavailabilityatthetimeoftherequest.
•Check-inafter3:00pm•Check-out12:00noon
•Hotelcancellationsmustbemademorethan24hourspriortodayofarrivaltoavoidcancellationfee.
tHe Fitness centerSetonthewaterfront,overlookingthepool,theFit-
nessCenterisfurnishedwithstate-of-the-artmachineswithprivateentertainmentsystems.Alsofeatured-freeweights
andcablemachines,exerciseballsandstretchingarea.Separateladies’andgentlemen’slockerareas,
featuringeucalyptussteamroom.
sWimming pool and WHirlpoolThe3,200squarefootheatedoutdoorpoolandwhirlpoolareenvironmentally-
friendly,withasalinepurificationsystemusingonlypure,naturalsaltfromtheocean. Thepooldeckoffersoutdoorteakloungefurnishingsandprivatecabanas.
recreation courtGuestsenjoycomplimentaryuseofthehotel’sbasketballcourt,foosball,andpingpongtable.
tennis courtsThehotelofferstwotenniscourts.Atennisprofessionalisavailableforprivateorgrouplessonsbyappointmentonly.
bicyclesTheConciergeoffersanassortmentofbikesavailableforrent.
yacHt and boat cHartersAprivatedockprovidesaccommodationsforpersonalyachts,partyexcursions,andfishingandsailingcharters.
Hotel amenities
The Ritz-Carlton Marina del Rey offers guests luxury hotel facilities and services as well as convenient freeway access to some of the city’s main visitor attractions.
nearby attractions• WatersideandFisherman’sVillageinMarinadelRey(1mile)
• VeniceBeach(1mile)
• MainStreetandThirdStreetPromenadefeaturinganoutdoorshoppingmallandanumberofhigh-endstoresinSantaMonica(5miles)
• BeverlyHills/RodeoDrive(11miles)
• J.PaulGettyVillaMuseumandGettyCenter(13miles)
• LosAngelesCountyMuseumofArt(LACMA)(13miles)
• StaplesCenter,homeoftheLosAngelesLakers(18miles)
• DodgerStadium(20miles)
• UniversalStudios,Hollywood(24miles)
• HollywoodBowl(26miles)
• Disneyland,WaltDisney’soriginalthemepark(39miles)
HelpFul WebsitesVisitMarinaDelRey.comdiscoverLosAngeles.com
climate and clotHingThesummermonthstypicallyvaryfromahighof73°toalowof56°,anditcanbeovercast-“Junegloom.”Checklocallistingstodetermineweatherconditions.
CasualclothingisrecommendedwiththeexceptionofSaturdayeveningwhenajacketandtieformen(blacktieisoptional)andcorrespondingattireforwomenisrequested.Youmaywanttobring“layers”ofclothingtoaccommodateallmeetingroomtemperatures.Asyouknow,meetingroomscansometimesgetchilly!
nearby attractions & sHopping
travel inFormation
airport LosAngelesAirport(LAX)islocatedapproximatelyfivemilesfromthehotel.
airport transportation Transportationtothehotelisavailableintheairportshuttlearea.
Taxisareapproximately$24.
Hotel parKingHotelparkingvaletonly-
$13fordayand$35forovernight.
special aaps – Hertz rental rateYoucanmakeyourreservationsonlineatHertz.comorcallHertzdirectlyat1-800-654-2240.UseAAPSCodeCV#04SW0001.Meetingrateisguaranteedfromoneweekpriorthroughoneweekafterthemeetingdatesandissubjecttoavailability.
Attendance Policy: You must register for the 2012House of Delegates and Annual Scientific Meetingin order to attend any sessions including businessmeetings,continuingmedicaleducationactivities,and/or examination development workshops. All personsattendingmust pay theappropriate registration fee inadvance regardless of the purpose or the number ofmeetingsyouplantoattend.
To complete registration for the 2012 Annual Meeting,all fees must be paid in full in advance.SeeRegistrationFormforspecificinformation.
Confirmation of Registration: Aconfirmationpacketwillbemailedwithintwo(2)weeksofreceiptofyourregistrationform and PAID IN FULL registration fees. Please retaincopies of your registration information. If you do notreceiveaconfirmationpacketwithintwoweeks,pleasecontacttheAAPSMeetingsDepartmentimmediately.
Schedule changes beyond AAPS control may occur. AAPS is not responsible for notifying registrants of program changes prior to the meeting.
Cancellation Policy: Written cancellations must bereceived by the AAPS Meetings Department prior toApril 15, 2012, in order to receive a refund of MeetingRegistrationFees,lessa$150processingfee.Cancellationsreceivedafterthisdatewillnotbeaccepted.
1.Tobeofficiallyregisteredandtoreceivespecialrates,all fees must be paid in full prior to the appropriatedeadlines: Early Registration byMarch 23, 2012, or Still-Time-To-RegisterbyJune 1, 2012
2.All registrations receivedafterJune1,2012, includingon-site,mustbepaidinfullpriortoadmissiontoanyAAPSactivities.On-SiteRegistrationwillbeacceptedbyCREDIT CARD ONLY.
3.Therearenoexceptionstothefeesanddeadlines.
4.Noonewillbeadmittedtoanybusinesssessions,CMEsessions,breakfastorlunchwithoutavalidbadge.
5.NoonewillbeadmittedtotheWelcomeReceptionorPresident’sAwardsDinnerwithoutaticket.
important registration inFormation
THERE ARE FOUR MEMBER CATEGORIESDiplomate/Emeritus/Member
PresenterAAPS Retired
Non-Member CME Only
THERE ARE THREE REGISTRATION PACKAGESBusiness Only
CME OnlyDiscount Package
Business: Includes all meetings – Board of Directors, Academies of Medicine, Boards of Certification, House of Delegates, Committees, and any other scheduled business meetings; conference materials; and breakfast on Monday, June 25, and Tuesday, June 26. Two days – see pricing on registration form.
CME: Includes up to 16 CME credits for scientific presentations, conference materials, breakfast, and lunch on Wednesday, June 27, and Thursday, June 28. Two days – see pricing on registration form.
Discount: Combines Business and CME Packages. Monday, June 25, through Thursday, June 28. Four days – see pricing on registration form.
THERE ARE THREE REGISTRATION DEADLINES
Early Registration – By March 23, 2012Still-Time-To-Register – By June 1, 2012
Late/On-Site Registration – After June 1, 2012
ADDITIONAL OPTIONSMedical Ethics: Includes one-day course on Friday, June 29, course materials, 7.5 CME credits, breakfast, and lunch. One-day-course – $450.
Welcome Reception on June 25: All tickets are free – sponsored by the AAPS Auxiliary - however, you must register in order to reserve a ticket.
President’s Awards Dinner on June 26: Per ticket $125
IMPORTANT REGISTRATION INFORMATION
REGISTRATION FORM: AAPS 2012 HOUSE OF DELEGATES AND ANNUAL SCIENTIFIC MEETINGTO REGISTER BY FAX: 813-830-6599 (CREDIT CARD ONLY) • MAIL: AAPS, 5550 W. EXECUTIVE DRIVE, SUITE 400, TAMPA, FL 33609-1035
Name________________________________________________________________Email_Address:______________________________________________________
Address_ ____________________________________________________ City_____________________________ State_ _____________Zip_____________________
Home_phone________________________________ _Work_phone____________________________________ _Cell_phone_ ___________________________________
_ Package_Total_$_____________
MEDICAL ETHICS COURSE - FRIDAY, JUNE 29_.........$_450_per_person_x_________(#_attending)_=_ _Medical_Ethics_Registration_Total_$_ ___________
NO ONE WILL BE ADMITTED TO ANY SESSIONS INCLUDING MEALS WITHOUT A VALID BADGE
WELCOME RECEPTION - MONDAY, JUNE 25_....................................$_0_per_person_x_______(#_tickets)_=_ Welcome_Reception_Total_$_____________(Complimentary, but you must register)
PRESIDENT’S AWARDS DINNER - TUESDAY, JUNE 26_................. $_125_per_person_x______(#_tickets)_=_ _President’s_Dinner_Total_$_ ___________
MEETING REGISTRATION PAYMENT _Check_enclosed_ _American_Express_ _MasterCard__ _Visa_ _Grand_Total_to_be_charged:__$
Cardholder’s_Name_________________________________________________Card_Number________________________________ Expiration_Date________________
Cardholder’s_Mailing_Address_ ____________________________________________________ Cardholder’s_Signature_ ______________________________________
ALL PARTICIPANTS MUST COMPLETE DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS BELOW
I DO HAVE A RELEVANT FINANCIAL RELATIONSHIP WITH A COMMERCIAL INTEREST. (You MUST list relevant financial relationships below)
Signature __________________________________________________________________________ Date _________________________
1. Commercial Interest (Example: Company ‘X’)
Nature of Relevant Financial Relationship (Include all those that apply)
2. What was received (Example: Honorarium) 3. For what role? (Example: Speaker)
Example Terminology
What was received:_Salary,_royalty,_intellectual_property_rights,_consulting_fee,_honoraria,_ownership_ interest_ (e.g.,_ stocks,_ stock_ options_ or_ other_ ownership_ interest,_ excluding_diversified_mutual_funds),_or_other_financial_benefit.
Role(s): Employment,_ management_ position,_ independent_ contractor_ (including_ contracted_ research),_consulting,_ speaking_ and_ teaching,_ membership_ on_ advisory_ committees_ or_ review_ panels,_ board_membership,_and_other_activities_(please_specify).
Glossary of Terms
Commercial Interest: The_ACCME_defines_a_“commercial_interest”_as_any_proprietary_entity_producing_health_care_goods_or_services,_used_on,_or_consumed_by,_patients,_with_the_exemption_of_non-profit_or_government_organizations_and_non-health_care_related_companies.Financial relationships:_Financial_relationships_are_those_relationships_in_which_the_individual_benefits_by_receiving_a_salary,_royalty,_intellectual_property_rights,_consulting_fee,_honoraria,_ownership_interest_(e.g.,_stocks,_stock_options_or_other_ownership_interest,_excluding_diversified_mutual_funds),_or_other_financial_benefit.__Financial_benefits_are_usually_associated_ with_ roles_ such_ as_ employment,_ management_ position,_ independent_ contractor_ (including_ contracted_research),_consulting,_speaking_and_teaching,_membership_on_advisory_committees_or_review_panels,_board_membership,_and_other_activities_from_which_remuneration_is_received,_or_expected.__ACCME_considers_relationships_of_the_person_involved_in_the_CME_activity_to_include_financial_relationships_of_a_spouse_or_partner.
Relevant financial relationships: ACCME_ focuses_ on_ financial_ relationships_ with_commercial_ interests_in_the_12-month_period_preceding_the_time_that_the_individual_is_being_asked_to_assume_a_role_controlling_content_of_the_CME_activity._ACCME_has_not_set_a_minimal_dollar_amount_for_relationships_to_be_significant.__Inherent_in_any_amount_is_the_incentive_to_maintain_ or_ increase_ the_ value_ of_ the_ relationship._The_ACCME_ defines_“’relevant’_ financial_relationships”_as_financial_relationships_in_any_amount_occurring_within_the_past_12_months_that_create_a_conflict_of_interest.Conflict of Interest:_Circumstances_create_a_conflict_of_interest_when_an_individual_has_an_opportunity_to_affect_CME_content_about_products_or_services_of_a_commercial_ interest_with_which_he/she_has_a_financial_relationship.
I DO NOT HAVE A RELEVANT FINANCIAL RELATIONSHIP WITH A COMMERCIAL INTEREST. (You MUST list relevant financial relationships below)
Signature __________________________________________________________________________ Date _________________________
TO COMPLETE THE REGISTRATION FORM DO THE FOLLOWING:
1. Review_Important_Registration_Information._
2._ Select_one_of_three_registration_packages_(Business,_CME,_Discount_Package).__
3._ Select_from_Additional_Options_(Medical_Ethics_Course,_Welcome_Reception,_President’s_Dinner).__
4._ Review_registration_table_on_right_and_circle_your_registration_choice.__Enter_fee_amount_in_subtotal._
Early Registration By Mar 23, 2012
Still-Time-To Reg By June 1, 2012
Late/On-Site After June 1, 2012
AAPS_Diplomate/__Emeritus/Member
Business_Package $295 $495 $695
CME_Package $525 $725 $925_______________________
Discount_Package $725 $1125 $1525
Presenter_REGISTRATION_REQUIRED_BY__JANUARY_31,_2012
Business_Package $295 NA NA
CME_Package $325 NA NA
Discount_Package $525 NA NA
AAPS_Retired Business_Package $295 $495 $695
CME_Package $325 $525 $725
Discount_Package $525 $925 $1395
Non-Member CME_Package $650 $850 $1050
First,_list_the_names_of_proprietary_entities_producing_health_care_goods_or_services,_consumed_by,_or_used_on,_patients,_with_the_exemption_of_non-profit_or_government_organizations_and_non-health_care_related_companies_with_which_you_or_your_spouse/partner_have,_or_have_had,_a_relevant_financial_relationship_within_the_past_12_months._ For_ this_purpose_we_consider_ the_ relevant_financial_ relationships_of_ your_ spouse_or_partner_that_you_are_aware_of_to_be_yours.
Second, describe_what_you_or_your_spouse/partner_received_(ex:_salary,_honorarium_etc)._The_American_Association_of_Physician_Specialists,_Inc._does_NOT_want_to_know_how_much_you_received._
Third,_Describe_your_role.
$0.00
5550 West Executive Drive • Suite 400Tampa, Florida 33609-1035
ADDRESS SERVICE REQUESTED
PRESORTEDFIRST-CLASS MAIL
U. S. POSTAGE PAIDPERMIT #100
TAMPA, FL