AnnuAl Meeting of the2013 July 19 - 21, 2013

The Ritz-Carlton, Palm BeachPalm Beach, Florida

Diagnostic Radiology Program: 8.5 AMA PRA Category 1 Credit(s)TM

A portion of the Diagnostic Radiology program will be submitted to the ABR for SAM qualification

Radiation Oncology Program: 4.5 AMA PRA Category 1 Credit(s)TM

Florida Radiological Society

Florida Radiology Business Management Association

Practical Solutions for Successful Radiology in the 21st Century

RLI credits will be available for some sessions.

Diagnostic Radiology Program

Radiation Oncology Program

About The ScheduleThe annual meeting of the FRS & FRBMA is an exciting, relevant and dynamic educational program. The focus of this year’s meeting is “Practical Solutions for Successful Radiology in the 21st Century.”

Each year we tee off the meeting Friday morning with our annual FRS/FRBMA Golf Tournament. The fun continues Friday evening as our exhibitors and members come together for the popular Wine and Cheese Reception in the Exhibit Hall. We are always grateful for the exhibitors’ support and we appreciate a personal visit with the exhibitors to thank them for their continued support of the FRS & FRBMA. There are additional opportunities to interact with our exhibitors on Saturday as the breakfast and coffee breaks will be held in the exhibit hall, and later, exhibitors will lunch with attendees to allow for continued discussion and interaction.

The FRBMA Session begins on Friday afternoon and joins the FRS Diagnostic General Session on Saturday morning with an outstanding lineup of speakers.

The FRS Session will be highlighted by our annual series, “The Steven G. Miles Keynote Socioeconomic Address”, featuring Dr. Paul Chang. On Saturday, there will also be breakout sessions for Radiation Oncology and the Resident and Fellow Section.

Our marquee event, the Gold Medal Reception and Cocktail Party, will be held early Saturday evening to honor the FRS Gold Medal recipient and the FRBMA Above and Beyond Award recipient. Other outstanding FRS & FRBMA members will be recognized for their contributions to the practice of radiology throughout the year. The earlier time for this event allows opportunity to go out and enjoy Palm Beach’s nightlife!

Neuroradiology is in the spotlight on Sunday. The day begins with the “Irwin L. Entel M.D., FACR Legacy Lecture and Breakfast” presented by Dr. Robert Quencer, a former FRS gold medal winner.

Target AudienceThis CME activity is structured as a practical teaching course for diagnostic imaging physicians, radiation therapy physicians, and their business managers. It should benefit radiologists, oncologists, and nuclear medicine physicians, as well as other physicians who supervise and interpret these studies.

Scientific SponsorEducational Symposia

AccreditationPhysicians: Educational Symposia is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Educational Symposia designates this live activity for a maximum of 8.5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

A portion of the Diagnostic Radiology program will be submitted to the ABR for SAM qualification.

Educational ObjectivesAttendees should, at the completion of this course, be able to: • Examinecurrentsocioeconomicissuesfacing radiologists, radiology oncologists and

radiology business managers.• Reviewtheimpactofexternalforceson radiology education, certification and maintenance of certification.• Reviewthecurrentrecommendationsfor optimizing and monitoring imaging radiation exposure.

No special educational preparation is required for this CME activity.

About The MeetingThe Radiation Oncology session will include presentations from both attending faculty and residents. Presentations will review important issues in breast, prostate and GI malignancies. Dr. Tim Williams will provide an overview of the socioeconomic issues in radiation oncology.

Target AudienceThis symposium is structured as a practical teaching course for radiation oncologists in academic and community practice.

Scientific SponsorEducational Symposia

AccreditationPhysicians: Educational Symposia is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Educational Symposia designates this live activity for a maximum of 4.5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Educational ObjectivesAttendees should, at the completion of this course, be able to:• UnderstandtheissuesofNeoadjuvant Chemoradiation followed by liver transplantation in proximal biliary tumors.• Describetechniquesofpartialbreastradiation therapy.• Understandthemolecularsubtypesof radiation for breast cancer.• DescribetheuseoffunctionalMRIinthe management of prostate cancer.

No special educational preparation is required for this CME activity.

DisclaimerThe FRS& FRBMA and Educational Symposia (ESI) as planners and presenters of this meet-ing, and Professional Travel as the official travel agency for this meeting, claim no liability for the acts of any suppliers or the safety of any attendees while in transit to, from, or during this event or any optional activities. The total amount of liability, if any, for the FRS& FRBMA and Educational Symposia is limited to a refund of the registration fee, and Professional Travel’s responsibility is limited to that of an agent.

Special Note for the DisabledThe FRS& FRBMA and Educational Symposia wish to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently from other individuals because of the absence of auxiliary aids and

services. If you need any auxiliary aids or services identified in the Americans with Disabilities Act, please contact our office at (813) 806-1070.

Contact InformationFlorida Radiological Society5620 West Sligh Avenue Tampa, FL 33634-4490

ph. (813) 806-1070 f. (813) 806-1071 Email: Lroger@flrad.org

Attn: LaDonna Nichols 1 Key Capri 712 East Treasure Island, FL 33706

ph. (727) 367-7511 Email: ladonnanichols@aol.com

Florida Radiology Business Management Association

© 2013 Educational Symposia

RLI credits will be available for some sessions.

FRS 2012 - 2013 Program Planning Committee

Diagnostic Radiology Faculty Radiation Oncology Faculty

President - Jesse A. Davila, M.D. President - Troy E. Purcell, M.S.F.

Warren R. Amos, M.D., FACRLaura W. Bancroft, M.D.Gregg A. Baran, M.D., FACRRichard M. Benator, M.D., FACR

Steven J. Buskirk, M.D., FACRJoseph G. Cernigliaro, M.D., FACRPhilip S. Cook, M.D., FACR, FSIRJesse A. Davila, M.D.

Lori A. Deitte, M.D., FACRDaryl Eber, M.D., Program Chair Al Falco, M.B.A.D. Beth Lewis, CMP

Richard L. Morin, Ph.D., FACRLawrence R. Muroff, M.D., FACRLaDonna Nichols, RCCLorraine Roger

Jonathan W. Berlin, M.D., M.B.A., FACRClinical Associate Professor of Radiology University of Chicago Pritzker School of Medicine NorthShore University HealthSystem Evanston, IL

Janice M. Blakeley*Director of Risk ManagementExecutive Director of Interventional ServicesLake Medical Imaging and Vascular InstituteLeesburg, FL

Paul J. Chang, M.D.Professor and Vice-Chairman, Radiology InformaticsMedical Director, Pathology InformaticsUniversity of Chicago School of MedicineMedical Director, Enterprise ImagingMedical Director, SOA InfrastructureUniversity of Chicago HospitalsChicago, IL

Jeffrey L. Cohen, Esquire*The Florida Healthcare Law FirmDelray Beach, FL

Jesse A. Davila, M.D.Private PracticeDiagnostic Radiologist, Musculoskeletal Imaging

Lori A. Deitte, M.D., FACR**Professor of Radiology and Associate Program DirectorUniversity of FloridaPast PresidentFlorida Radiological SocietyGainesville, FL

Alison DudleyLobbyistFlorida Radiological SocietyTallahassee, FL

Richard Duszak, M.D., FACR, FRBMAChief Executive Officer and Senior Research FellowNeiman Health Policy InstituteReston, VAPartnerMid-South Imaging and TherapeuticsMemphis, TN

Al Falco, M.B.A.*Chief Executive OfficerRadiology Imaging AssociatesDaytona Beach, FL

Harry G. Greditzer, IV, M.D.**ResidentDiagnostic RadiologyUniversity of Miami

Richard B. Gunderman, M.D., Ph.D., FACRVice Chairman, Department of Radiology and Imaging SciencesProfessor Radiology, Pediatrics, Medical Education, Philosophy, Philanthropy, Liberal Arts and in the Honors CollegePresident, Faculty of Medicine, 2011-2012

Daisha Hayden, M.D.**Radiology ResidentMount Sinai Medical CenterMiami Beach, FL

Robert P. Henry, Jr., M.D.**NeuroradiologistRadiology Specialists of FloridaAssociate Director Florida Hospital Diagnostic Radiology Residency ProgramAssistant Professor of Clinical RadiologyUniversity of Central FloridaAssistant Professor of Clinical RadiologyFlorida State UniversityMaitland, FL

Steven G. Miles, M.D., FACR*Clinical Assistant ProfessorFSU College of MedicineClinical Assistant ProfessorUniversity of Florida College of Medicine

Cynthia MoranAssistant Executive Director for Government Relations and Economic Policy DepartmentsAmerican College of RadiologyReston, VA

Lawrence R. Muroff, M.D., FACRCEO & PresidentImaging Consultants, Inc.Tampa, FLClinical Professor of RadiologyUniversity of Florida and University of South Florida Colleges of Medicine

Ryan Murtagh, M.D., MBAAssistant Professor of RadiologyUniversity of South Florida College of MedicineTampa General HospitalTampa, FL

Troy E. Purcell, M.S.F.President, FRBMA

Robert M. Quencer, M.D., FACRProfessor and Chairman The Robert Shapiro, M.D. Professor of Radiology Department of RadiologyUniversity of Miami School of Medicine

Jeff A. Younger, MHA, FACHE*Chief Executive OfficerSDI Diagnostic ImagingTampa, FL

*FRBMA Program Faculty

**FRS Resident Program Faculty

ATTENDING FACULTY

Larry C. Daugherty, M.D.Senior Associate ConsultantRadiation OncologyMayo Clinic FloridaJacksonville, FL

Alan Pollack, M.D., Ph.D.Chair and Sylvester Professor of Radiation OncologySylvester Comprehensive Cancer CenterUniversity of Miami Miller School of Medicine

Cristiane Takita, M.D.Associate Professor and Residency Program DirectorCo-Leader, Breast Site Disease GroupRadiation Oncology DepartmentUniversity of Miami Miller School of MedicineSylvester Comprehensive Cancer Center

Katherine Tzou, M.D.Senior Associate ConsultantMayo Clinic FloridaJacksonville, FL

Timothy R. Williams, M.D., FACRMedical DirectorLynn Cancer Center at Boca Raton Regional HospitalRadiation Oncology DepartmentBoca Raton, FL

RESIDENT FACULTY

Alexandra Diaz-Pardo, M.D.Resident PhysicianRadiation OncologyUniversity of MiamiJackson Memorial HospitalMiami, FL

Bevan Ly, M.D.Resident PhysicianRadiation OncologyJackson Memorial HospitalMiami, FL

Corey J. Hobbs, M.D.ResidentRadiation OncologyMayo Clinic FloridaJacksonville, FL

Nitesh N. Paryani, M.D.Resident PhysicianDepartment of Radiation Oncology Mayo Clinic FloridaJacksonville, FL

Ajay Patel, M.D.Resident PhysicianRadiation OncologyMayo Clinic FloridaJacksonville, FL

Michael Scott, M.D., MBA Resident PhysicianUniversity of Miami Sylvester Comprehensive Cancer CenterJackson Memorial HospitalMiami, FL

Faculty & topics subject to change.

gratefully acknowledges support from the following organizations in 2012 and looks forward to their support again for the 2013 annual meeting.

Advocate Radiology Billing

Aramark Healthcare Technologies

Atlas Medical Technologies

Bayer HealthCare

BilAmerica

Danna-Gracey

Data Media Associates, Inc.

DR Systems, Inc.

Florida Blue

Florida Insurance Advocates

Hitachi Medical Systems America, Inc.

IMAGINE Software

Imaging On Call

Acknowledgements

Diagnostic Radiology Program

Thursday, July 18, 2013

5:00 – 7:00 PM FRBMA Board Meeting

Friday, July 19, 2013

8:00 AM – 1:00 PM Golf Tournament

12:00 – 6:00 PM Registration

1:00 – 2:00 FRS Program & Education Committee Meeting

2:00 – 6:00 FRS Board Meeting

FRBMA Session (FRS members welcome) (not accredited for AMA PRA Category 1 Credit(s)TM)

1:00 ACO From a Radiology Side Janice M. Blakeley

1:45 Hot Topics in Radiology Steven G. Miles, M.D., FACR

2:45 – 3:00 Break

3:00 Healthcare Regulatory Matters Jeffrey L. Cohen, Esquire

4:15 Roundtable Discussions:

Hospital Practice Jeff A. Younger, MHA, FACHE, Moderator

Imaging Centers Al Falco, M.B.A., Moderator

5:00 End of FRBMA Session

6:30 – 8:30 Wine and Cheese Reception in Exhibit Hall

Saturday, July 20, 2013

7:00 – 8:00 AM Registration and Breakfast in Exhibit Hall

Diagnostic Radiology General Session: FRS/FRBMA

8:00 FRS and FRBMA Presidential Addresses Jesse A. Davila, M.D. and Troy E. Purcell, M.S.F. (not accredited for AMA PRA Category 1 Credit(s)TM)

8:15 Legislative Update Alison Dudley

Saturday, July 20, 2013 (continued)

8:30 ACR Update Cynthia Moran

9:00 The Steven G. Miles Keynote Socioeconomic Address: Re-Engineering Radiology: Value Innovation Paul J. Chang, M.D.

9:45 Question and Answer Session Faculty

10:00 – 10:45 Break in Exhibit Hall

PRACTICE MANAGEMENT – SAM SESSION*

10:45 Money, Success, and Excellence Richard B. Gunderman, M.D., Ph.D., FACR

11:30 Moving Your Radiology Practice Beyond a Commodity in the Era of Increasing Price Transparency Jonathan W. Berlin, M.D., M.B.A., FACR

12:15 PM Question and Answer Session Faculty

12:30 – 1:30 Lunch with Exhibitors

1:30 Business Intelligence and Analytics: Dashboards, Scorecards, and Beyond Paul J. Chang, M.D.

2:15 The Neiman Institute: New Initiatives to Meet New Imperatives Richard Duszak, M.D., FACR, FRBMA

3:00 Physician Burnout in Challenging Economic Times – Inevitable or Preventable? Jonathan W. Berlin, M.D., M.B.A., FACR

3:45 Future Trends That Will Impact What You Do and What You Earn Lawrence R. Muroff, M.D., FACR

4:30 Question and Answer Session Faculty

4:45 End of Session

5:15 – 7:00 Gold Medal Reception and Cocktail Party

Sunday, July 21, 2013

7:30 AM Legacy Breakfast

8:00 Resident Poster Symposium (not accredited for AMA PRA Category 1 Credit(s)TM)

8:30 Irwin L. Entel, M.D., FACR Legacy Lecture: Spine Imaging: A Look Back, a Look to the Future, and Ways to Make Image Interpretation Meaningful to the Spine Surgeon Robert M. Quencer, M.D., FACR

9:15 Resident Poster Symposium Awards (not accredited for AMA PRA Category 1 Credit(s)TM)

9:30 Clinical Keynote Lecture: Advanced Neuroimaging Made Ridiculously Easy Ryan Murtagh, M.D., M.B.A.

10:15 Question and Answer Session Faculty

10:30 FRS Business Meeting (not accredited for AMA PRA Category 1 Credit(s)TM)

10:45 END OF PROGRAM

* This SAM session will be submitted to the ABR for approval and is subject to change.

Faculty & topics subject to change.

Integrated Medical Partners

ITMD, LLC

Lancet Indemnity RRG

MAG Mutual Insurance Company

Management Services Network

Mayo Clinic - Referring Physician Office

McKesson Revenue Management Solutions

Medical Management Professionals

MedReceivables Advisor, LLC

MEGAS-Alpha II

ProAssurance

Quantum Medical

RamSoft, Inc.

Sheridan Healthcare

Siemens

South Computer Warehouse

Sun Teleradiology

Zotec Partners

Acknowledgements

Radiation Oncology Program Resident Program (not accredited for AMA PRA Category 1 Credit(s)TM)

Saturday, July 20, 2013

7:00 – 8:00 AM Registration and Breakfast in Exhibit Hall

Attending Lectures

10:00 Socioeconomic Issues in Radiation Oncology Timothy R. Williams, M.D., FACR

10:30 Functional MRI in the Management of Prostate Cancer Alan Pollack, M.D., Ph.D.

11:00 Molecular Subtype and Radiation for Breast Cancer Cristiane Takita, M.D.

11:30 Partial Breast Radiation Therapy Katherine Tzou, M.D.

12:00 PM Neoadjuvant Chemoradiation Followed by Liver Transplantation in Proximal Biliary Tumors Larry C. Daugherty, M.D.

12:30 – 1:30 Lunch with Exhibitors

Saturday, July 20, 2013 (continued)

Resident Presentations

1:30 Acute and Late Toxicities of Radiotherapy in Patients with Discoid Lupus Ajay Patel, M.D.

1:50 Re-irradiation of Gliomas Corey J. Hobbs, M.D.

2:10 The Incidence of Fat Necrosis in Balloon-Based Partial Breast Brachytherapy Nitesh N. Paryani, M.D.

2:30 Locoregional Outcomes in Clinical Stage IIB Breast Cancer after Neoadjuvant Therapy and Mastectomy With or Without Chest Wall and Supraclavicular Radiation Alexandra Diaz-Pardo, M.D.

2:50 Conventional Versus IMRT Planning for Palliation of Bone Metastases: A Dosimetric Comparison Bevan Ly, M.D.

3:10 Retrospective Review of Outcomes and Toxicities of Radiation Therapy for the Definitive Treatment of Early Stage Glottic Carcinoma Comparing Conventionally Fractionated and Hypofractionated Regimens Michael Scott, M.D., MBA

3:30 End of Radiation Oncology Breakout Session

5:15 – 7:00 Gold Medal Reception and Cocktail Party

Saturday, July 20, 2013

10:30 AM – 12:30 PM Lectures

12:30 – 1:30 Lunch with Exhibitors

1:30 – 3:45 Lectures

Topics Covered

• TrueProfessionalism Richard B. Gunderman, M.D., Ph.D., FACR

• WhatSeparatestheGreatPractices from All the Rest Lawrence R. Muroff, M.D., FACR

• TheABRCoreExam-AreYouReady? Lori A. Deitte, M.D., FACR

• PrivateVersusAcademicPractice Robert P. Henry, Jr., M.D.

• YoungPhysiciansPracticePanel: Working in the Real World

• RFSElectionsandOtherBusiness Harry G. Greditzer, IV, M.D. & Daisha Hayden, M.D.

3:45 End of Program

*Residents are invited to attend the Diagnostic Radiology sessions and social functions.

Faculty & topics subject to change. Faculty & topics subject to change.

Accommodations

The Ritz-Carlton, Palm Beach offers seven acres of lush tropical gardens and an exclusive beach for the ideal destination of a romantic weekend or a family getaway. Located just steps from the blue waters of Florida’s alluring Atlantic Coast, the award-winning luxury hotel features: playful Eau Spa, two outdoor pools, beachfront dining, the AquaNuts Ritz Kids facility and Coast Teens Lounge, a 3,000-square-foot oceanfront terrace with evening fire pit and so much more – all accompanied by renowned personalized service.

Make your reservation as soon as possible as our room block may sell out prior to the cut-off date of June 18, 2013. After this date, reservations will be accepted at the discretion of the hotel, on a space and rate available basis.

Identify yourself as a registrant of “FRS or Florida Radiological Society” to qualify for the special discounted group room rate. Rate cannot be changed at check-in or check-out for guests who fail to identify their affiliation at the time the reservation is made.

Call for reservations: (800) 241-3333 or (888) 856-4273 and provide Group Code “frs” or “florida radiological society”.

or make your reservation online at: https://reservations.ritzcarlton.com/ritz/reservation/avail-ability.mi?propertyCode=PBirZ&groupCode=frsfrsa

AccommodAtions

2013 Annual Meeting

of the FRS & FRBMA

The Ritz-Carlton, Palm Beach Palm Beach, Florida

July 18 - 21, 2013

100 South Ocean BoulevardManalapan, Florida 33462

(561) 533-6000

Per Night(Single/Double Occupancy)Non Smoking Property

room PreferenCes King bed • Two Queen beds

$189 sPeCial DisCounteD GrouP room rates:

Room rates are subject to applicable sales and resort taxes, currently 11.5%. Subject to availability, group rates may be available three days before and three days after the conference. Cribs are available at no cost upon availability. Twin sized rollaway beds are available in king bedded rooms and suites only at $35 per night. Deposit: A credit card is required to secure a room reservation. Your card will not be charged until check-in unless your reservation is cancelled within 7 days of arrival. Cancellations: All cancellations, arrival and departure date changes, must be made 7 days or more prior to scheduled arrival date/time to avoid a one night penalty. Any guest that cancels a reservation after such time will have a charge of one night room and tax applied to their account. Check in is 4 p.m.; Check out is 12:00 noon.

Call Professional Travel (official travel agency) at (800) 237-7230 (toll free U.S. and Canada) or (813) 806-1050 direct if you have any questions or problems making your hotel reservations or prefer alternate accommodations.

Meeting Registration

I wish to attend the following:

Please make checks payable to the FRBMA and mail to: FRBMA c/o L. Nichols, 1 Key Capri 712 East • Treasure Island, FL 33706

Please make checks payable to the Florida Radiological Society and mail to: 5620 West Sligh Avenue • Tampa, FL 33634-4490

FRS FRBMA

Cost Per Person X # Attending = Total Before July 9 After July 9

Member in Good Standing $295.00* $325.00* x _________ = $ ________

Retired Member / Member in Physics $50.00* $50.00* x _________ = $ ________

Resident / Fellow No Charge No Charge x _________ = $ N/A

Non-Member $500.00* $550.00* x _________ = $ ________

Resort Casual Dress Suggested for Most Functions

* FRBMA Educational

Sessions

Member in Good Standing $100.00* $125.00* x _________ = $ ________

Non-Member $325.00* $350.00* x _________ = $ ________

* FRS Scientific Sessions

Radiation Oncology Session Yes, I will be attending. No, I will not be attending.

SOCIAL/SPORTING EVENTS REGISTRATION Attendee A: ________________________________ Attendee B: _________________________________

Attendee C: ________________________________ Attendee D: _________________________________

Friday, July 19, 2013

8:00 AM Golf Tournament (Circle who will attend: A B C D ) $115.00 x _____ = $ ________ Handicap A:___ Handicap B: ___ Handicap C:___ Handicap D:___

6:30 PM Wine and Cheese Reception (Circle who will attend: A B C D ) No Charge x _____ = $ ________

Saturday, July 20, 2013

12:30 PM Lunch with Exhibitors (Circle who will attend: A B C D ) $35.00/Guest x _____ (# of Guests) = $ ________

5:15 PM Gold Medal Reception & Cocktail Party (Circle who will attend: A B C D ) $45.00/Guest x _____ (# of Guests) = $ ________

Sunday, July 21, 2013

7:30 AM Legacy Lecture Breakfast (Circle who will attend: A B C D ) $45.00/Guest x _____ (# of Guests) = $ ________ Total Amount Enclosed = $ ________

Meeting Registrant

* Tuition for each registrant includes all course materials, including a comprehensive course syllabus (Printed Syllabus or E-Syllabus), daily continental breakfast, coffee breaks, lunch with exhibitors, Wine and Cheese Reception, Gold Medal Reception & Cocktail Party, Exhibit Hall, and Legacy Lecture Breakfast.

Please provide the names of attendees (spouse and/or guests). Name tags are required for entrance to any meeting, social, and/or sporting event.

Name_________________________________________________________________________________________________________________________

Degree M.D. D.O. Ph.D. P.A. Other________________________________ Specialty____________________________________________

Facility/Organization _____________________________________________________ Dept. _______________________________________________________

Street Address _____________________________________________________________________________________________________________

City___________________________________________________________ State ________ Zip __________ Phone ________________ Fax ________________

How would you like to receive future meeting announcements? Mail Only Email Only Both Mail and Email Email__________________________________________________

First Middle Last

meeting registrant information

4 Easy Ways To REgisTERInternetRegister online using your credit card number at: http://www.flrad.org SECURE WEBSITE!!

Payment information: Check Enclosed Charge to Credit Card:

Card Number_________________________________________________________Expires _____________

Card Security Code*__________

Signature____________________________________________ (Your signature is your authorization to charge this credit card.)

if CreDit CarD name or BillinG aDDress Differs from tHe aDDress listeD aBove, Please ProviDe tHe CorreCt BillinG aDDressName on Card __________________________________________________________________________

Billing Address__________________________________________________________________________

City_________________________________________________State____________Zip_______________

Payable to: FRS or FRBMA

*in order to process your registration we will need the security code on your credit card. If you have a MasterCard, Visa or Discover the 3 digit code will be found on the back of your card in the space provided for your signature (it will be the last 3 digits shown). American Express prints their 4 digit security code on the front of the card above the last digit of your AMEX number.

A $50.00 processing charge will be made on refunds requested in writing prior to June 21, 2013. No refunds will be given on or after June 21, 2013.

MAIL

PHONE: FRS (813) 806-1070 / FRBMA (727) 367-7511FAX (813) 806-1071

Please CHoose one:

Electronic Syllabus

Printed Syllabus Both Electronic and Printed syllabus at an extra

cost of $25.00

FRS & FRBMA is pleased to offer 3 options to obtain the course syllabus.

HOMEOFFICE

FRS5620 West Sligh Avenue Tampa, Florida 33634-4490

FRBMA c/o L. Nichols 1 Key Capri 712 East Treasure Island, Florida 33706