Canadian Academy of Sport and Exerc ise Medic ine

Annual Sc ient i f ic Meet ing 2012

Exerc ise , Ev idence and Excel lence in Sport Medic ine

Canadian Academy of Sport and Exercise Medicine

Académie canadienne de médecine du sport et de l’exercice

Delta Grand Okanagan Resort and

Conference Centre , Kelowna BC

June 21-23, 2012

PRELIMINARY PROGRAM

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CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

Photos courtesy of Tourism Kelowna

HOTEL ACCOMMODATION

On the shores of majestic Okanagan Lake, our unique destination Resort and

Conference Centre provides memorable guest experiences and inspirational Food and

Beverage, in the heart of Canada's Wine Country. One of BC's finest resorts, we offer

390 guest rooms, villas and suite accommodations offering lake, city or mountain

views. Recently ranked among the Top Waterfront Hotels in Canada for 2010, the

Delta Grand Okanagan has a gorgeous property with an amazing location right on

Lake Okanagan with lots of water sports available; take a walk along Kelowna's

impressive waterfront. There a many good restaurants nearby to enjoy.

Tourists and area residents will find information on things to do and see in the

Kelowna area. For the outdoors and sports minded individuals, this includes maps to

golf courses, ski hills and lakes for fishing. There is a Kettle Valley Railroad photo

gallery and maps on how to get to the KVR trail. Explore Kelowna's past in the

'Pictorial History of Kelowna' section. Kelowna is also home to some of the best

wineries and also makes a good starting point to explore other Okanagan and

Similkameen area wineries. No matter what time of the year, there is always

something going on in Kelowna and the Okanagan.

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CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

Delta Grand Okanagan Resort & Conference Centre 1310 Water Street, Kelowna, BC V1Y 9P3, Canada Reservation Department—Phone: 250-763-4500 or

Reservation Office: 1-800-465-4651

To get the special conference room rate, identify

yourself a being with the

Canadian Academy of Sport and Exercise Medicine

Conference Group Room Rate valid until

May 28, 2012

CASEM has negotiated the room rates for the confer-

ence (all prices are plus applicable taxes)

Delta Standard Rooms $199.00 CDN

Delta Lakeview Rooms $199.00 CDN

Premier Rooms $199.00 CDN

Deluxe Rooms $244.00 CDN

Signature Club Rooms $264.00 CDN

One Bedroom Suites $299.00 CDN

One Bedroom Lakeview Suites $299.00 CDN

Two Bedroom Condominiums $399.00 CDN

Three Bedroom Condominiums $449.00 CDN

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CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

Accreditation Criteria CME ACCREDITATION

This program has been accredited by the College of Family Physicians of Canada and the British Co-

lumbia chapter of Family Physicians for up to 17 Mainpro-M1 credits.

DECLARATION OF POTENTIAL CONFLICTS OF INTEREST

Speakers will be requested to disclose to the audience any real or apparent conflict(s) of interest

that may have a direct bearing on the subject matter of this program.

Pre-and Post Conference Courses and Workshops Tuesday June 19, 2012 Sideline Emergency Course - Vaseau-Kootenay Room

MSK Ultrasound Course - Shuswap/Pennask/Skeena Room

Wednesday June 20, 2012 Sport Injury Prevention Research Day - - Vaseau-Kootenay Room

Sunday June 24, 2012 Analyzing Performance and Preventing Injuries - - Vaseau-Kootenay Room

Organizing Committee Kelowna 2012

Dr. Julia Alleyne (Chair), ON

Dr. Bruce Davidson, BC

Mr. Randy Goodman, PT, BC

Dr. Gordon Matheson, CA

Dr. Jack Oliver, BC

Dr. Ean Parsons, NL

Dr. Alan Vernec, QC

For more information on individual courses

http://www.casem-acmse.org/pg_EventList.php

Preventing and Managing Chronic Disease - An Emerging Role for Sport & Exercise Medicine Practitioners THURSDAY JUNE 21, 2012 Okanagan & North Hall

The Chronic Disease Epidemic, Moderator Dr. Gordon Matheson

8:00 - 8:10AM Embarking on a Path for Change, Dr. Doug Owram, Deputy Vice-Chanceller & Principal UBC Okanagan

8:10 - 8:30AM A Practitioner for All Seasons: Aligning Medical Education with Shifting Societal Needs and Expectations

Dr. Gavin Stuart, Dean of Medicine & Deputy Provost, University of British Columbia

8:30 - 8:50AM Why did CASEM Change It’s Name?

Dr. Gordon Matheson, Professor & Director of Sports Medicine, Stanford University School of Medicine

8:50 – 9:10AM What is “Prevention”? Where Do We Start? Tools for the Clinical Practitioner

Dr. Martin Schwellnus, Professor of Sport & Exercise Medicine University of Cape Town

9:10 – 9:30AM What is the Scientific Evidence for Prevention?

Dr. Steve Blair, Professor, Departments of Exercise, Science and Epidemiology/Biostatistics, Univ. of South Carolina

9:30- 9:45AM Questions & Discussion

9:45-10:00AM Coffee Break

Three Types of Prevention - The Role of Behavioral Change - Moderator Dr. Martin Schwellnus

10:00-10:20AM 1º Prevention - Using an Exercise “Vital Sign” in Clinical Practice

Dr. Bob Sallis, Associate Clinical Professor of FM, UCR/UCLA Biomedical Sciences Program and FM Residency Program,

Kaiser Permanente Medical Center, Fontana CA

10:20-10:40AM Exercise Training for Management of Disease and Prevention of 2º Co-Morbidities

Dr. Neil Eves, Professor Human Kinetics, University of BC, Okanagan

10:40-11:00AM 3º Prevention - The View From the Family Doctor

Dr. Martin Dawes, Head, Department of Family Practice, University of British Columbia

11:00-11:20AM How Do We Change Behavior?

Dr. Kerry Courneya, Professor, Physical Education and Recreation University of Alberta

11:20-11:45AM Questions & Discussion

11:45- 1:00PM Lunch Break

Industry sponsored Luncheon by Genzyme - Vaseau-Kootenay Room / Smith & Nephew - Columbia Room

(pre-registration necessary)

Experience with National Programs for Chronic Disease Prevention - Moderator Dr. Andrew Pipe

1:00-1:20PM The National Health Services in the UK

Dr. Richard Weiler, Honorary Consultant in SEM, University College London Hospitals NHS Foundation Trust

and Specialty Advisor in Sport & Exercise Medicine to National Health Service

1:20-1:40PM The Swedish Physician Experience,

Dr. Mats Börjesson, Professor at Cardiology, Karolinska Institute, Stockholm

Research & Innovation in the Prevention of Chronic Disease - Moderator Dr. Steve Blair

1:40-2:45PM Promoting Change Through Research & Innovation

– Preventable Chronic Disease and the Aging Process, Dr. Jennifer Jakobi, Prof, UBC Okanagan

– The International Movement Toward Prevention in Physical Therapy, Dr. Elizabeth Dean, Professor UBC

– Debunking Myths About Barriers to Behavior Change, Dr. Mary Jung, Professor UBC, Okanagan

– Once Size Doesn’t Fit All: Gender-Sensitive Health Promotion Interventions, Dr. Joan Bottorff,

Professor & Chair in Health Promotion & Cancer Research, UBC Okanagan

Real Life Examples of Chronic Disease Prevention - Moderator Dr. Bob Sallis

2:45-3:00PM Example No. 1 – Change Through Sport: Breast Cancer and Canoeing,

Dr. Don McKenzie, Professor of Human Kinetics and Sports Medicine, UBC

3:00-3:15PM Example No. 2 – Change Through Rewards: The Cape Town Experience, Dr. Wayne Derman, Prof., U of Cape Town

3:15-3:30PM Example No. 3 – Change Through Advocacy: Smoking Cessation in Canada, Dr. Andrew Pipe, Professor, U of Ottawa,

Chief Division of Prevention & Rehabilitation, University of Ottawa Heart Institute

Panel Discussion on CASEM’s Role in Chronic Disease Prevention, Moderators Drs. Don McKenzie & Lars Engebretsen

3:30-5:00PM CASEM’s Role in the Implementation of Community-Based Programs for the Prevention & Management of Chronic Disease

Panelists: Martin Schwellnus, Neil Eves, Martin Dawes, Richard Weiler, Bruce Davidson, Andrew Pipe, Steven Blair, Wayne

Derman, Mats Börjesson, Gordon Matheson, Bob Sallis, Kelly Courneya

6:30-10:30PM Wine Tasting and Supper at Summerhill Winery (pre-registration necessary)

7:00- 7:45AM WIISM (Women’s Issues In Sport Medicine) Breakfast Lecture

Concussion and Gender: Is the Female Brain Different? Dr. Connie Lebrun

8:00- 9:00AM Evidence Based Management—Not ! Dr. Bruce Davidson

9:00-10:30AM Sandy Kirkley Research Session 1, Moderator Dr. Victor Lun

9:00AM Academic Accommodation for Post-Concussion Student Athletes -

Can Physicians Do Better? Dr. James Carson

9:15 AM Baseline Concussion Symptom Report in College Athletes:

SCAT2 versus ImPACT Testing, Dr. Connie Lebrun

9:30 AM Validation of a Novel Mouth Guard for Measurement of Linear and Rotational

Accelerations During Head Impacts, Dr. Daneil Garza

9:45 AM Multimodal Physiotherapy in the Treatment of Individuals with Persistent Symptoms

Following a Sport Related Concussion: A Randomized Controlled Trial,

Kathryn Schneider

10:00AM Influence of Vagal Activity and Aerobic Fitness on Airway Responsiveness in Elite

Swimmers, Dr. Mona Luke-Zeitoun

10:15AM Using Ultrasonography to Diagnose Chronic Exertional Compartment Syndrome,

Dr. Sathish Raasekaran

10:30-11:00AM Morning Break

11:00-11:45AM Management of Critical Conditions: Pediatric Concussion, Dr. Laura Purcell

1 1:45-12:30AM Evidence-based Approach to Anti-Inflammatories, Dr. Pierre Frémont

12:30- 2:00PM Lunch / Sport-Body-Break -

Industry Sponsored Luncheon by Ferring - Columbia Room (pre- registration necessary)

2:00- 3:30PM Workshops

1. Update on Female Athlete Triad, Dr. Julia Alleyne, Dr. Doug Misener - Okanagan Room

2. MSK Ultrasound, Dr. Jon Halperin - Kootenay Room

3. Cycles: Fitting the Bike and the Athlete, Mr. Tyler Dumont PT - Vaseaux Room

4. High Yield Knee Examination, Dr. Ross Outerbridge - Shaka Room

5. Hand Examination and the Athlete, Dr. Brian Miller - Cascade/ Cassiar Room

3:30-4:00PM Afternoon Break

4:00-4:30PM Panel Discussion: Ethical Cases for Team Physicians, Confidentiality, Informed Consent,

Dealing with Media, Moderator Dr. Robert Sallis

Panel: Dr. James Kissick, Dr. Alan Vernec, Dr. Julia Alleyne

4:30PM Closure of Daily Scientific Program

5:30-7:00PM CASEM Annual General Meeting

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CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

FRIDAY JUNE 22, 2012 Okanagan & North Hall

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CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

SATURDAY JUNE 23, 2012 Okanagan & North Hall

8:00- 8:30AM CASEM 2 min/2 Slide Presentations, Moderator Dr. Kent Pottle

8:30- 9:15AM Lance Richards Memorial Lecture, Dr. Jack Oliver

9:15-10:30AM Sandy Kirkley Research Session 2, Moderator Dr. Victor Lun

9:15AM Long-Term Follow-Up of ACL Reconstruction Using Semitendinosus/Gracilis

Autograft, Dr. Jeff R.S. Leiter

9:30AM Does Ligament Preservation During Anterior Cruciate Ligament (ACL) Reconstructive

Surgery in ACL Deficient Patients Improve Patient-Reported Outcomes at One Year?

A Prospective Cohort Study, Dr. Nick Mohtadi

9:45AM Percutaneous Inside-Out-Outside-In Medial Meniscal Repair During Anterior

Cruciate Ligament Reconstruction: A Prospective Study, Dr. Nick Mohtadi

10:00AM Prescriptive Medicine: The Importance of Preparing Canadian Medical Students to

Counsel Patients toward Physical Activity (PA), Dr. Victor Ng

10:15AM The Use of Response from an Intra Articular Hip Injection as a Predictor of Outcome

Following Arthroscopic Management for Femoroacetabular Impingement.

A Prospective Cohort Trial, Dr. Olufemi Ayeni

10:30AM Comparison of a Three Viscosupplementation Products for Time Durations between

Initial and Follow-Up Injections in Osteoarthritic Knees, Dr. Preston Wiley

10:30-11:00AM Morning Break

11:00-12:30AM Evidence of a Healthy Lifestyle, Moderator, Dr. Julia Alleyne

· Fluid Management, Ms Kelly Ann Erdman MSc, R. D.

· Illness in the Traveling Athlete, Dr. Martin Schwellnus

· Exercise IS Medicine, Dr. Steve Blair

12:30PM Adjournment of the Conference

3:00- 4:00PM 5K Ferring Fun Run

7:00-1:00PM CASEM Gala Reception and Banquet with the Physician Band Rx - Okanagan Ballroom

CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

RESEARCH POSTER PRESENTATIONS 2012

Return to Pre-Activity Levels After Surgical Management of Femoroacetabular Impingement in Athletes:

Systematic Review

Hussain Alradwan, MD,1 Forough Farrokyar, MPhil, PhD,2 Raymond Chu,1 and Olufemi R. Ayeni, MD.1

1Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; and 2Department of Clinical Epidemiology and Biostatistics, McMaster, Hamilton, Ontario, Canada.

Surgical Indications for Treatment of Femoroacetabular Impingement With Surgical Hip

Dislocation: A Systematic Review

Olufemi R. Ayeni, MD,1 Sarah Crouch, BSc(c),1 Bharadwaj Pindiprolu, BHSc(c), 1 and Mohit Bhandari, MD, PhD.1,2 1Division

of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; and 2Department of Clinical Epi-

demiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Susceptibility to High-Altitude Pulmonary Edema/Immersion Pulmonary Edema Is Related to the Varia-

tions in the Extent of Pulmonary Lymphatics

E.A. Carter, MSc,1 J. Mayo, MD,2 M.J. MacInnis, BSc,1 D.C. McKenzie, PhD, MD,1,3 C. Cardoso,1 and M.S. Koehle, PhD,

MD.1,3 1School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada; 2Department of Radiology, Uni-

versity of British Columbia, Vancouver, British Columbia, Canada; and 3Division of Sports Medicine, University of British Columbia,

Vancouver, British Columbia, Canada.

A Systematic Review and Comprehensive Classification of Pectoralis Major Tears

Amr W. Elmaraghy, MD,1 and Moira W. Devereaux, MScPT.2 1St Joseph’s Health Centre, Toronto, Ontario,

Canada; and 2University of Toronto, Toronto, Ontario, Canada.

Coding Sports Injury Diagnoses In Epidemiological Studies – Does the Background of the Coder Matter?

Caroline F. Finch,PhD1 John Orchard, PhD, MD,2 Dara Twomey, PhD,3 M. Saad Saleem, PhD,3 Christina Ekegren,

MPhysio,1 David Lloyd, PhD,4 and Bruce Elliott, PhD.5 1Australian Centre for Research into Sports Injury and its Prevention

(ACRISP), Monash Injury Research Institute (MIRI), Monash University, Melbourne, Victoria, Australia; 2University of Sydney, Sydney,

New South Wales, Australia; 3University of Ballarat, Victoria, Australia; 4Griffith University, Gold Coast, Queensland, Australia; and 5University of Western Australia, Perth, Western Australia, Australia.

The Effect of Exercise on the Concentration of Platelets in a Platelet-Rich Plasma Preparation

Sara J. Forsyth, MD, Don McKenzie, MD, PhD, Jack Taunton, MD, and Michael Koehle, MD, PhD.

University of British Columbia, Vancouver, British Columbia, Canada.

Postoperative Pain and Function in Patients Having a Knee Arthroscopy With Viscosupplementation or

Placebo Injection at the Time of Surgery: A Pilot Study

Laurie A. Hiemstra, MD, PhD,1,2 Sarah Kerslake, BPT, MSc,1,3 S. Mark Heard, MD,1,2 and Gregory L. Buchko, MD.1 1Banff

Sport Medicine, Banff, Alberta, Canada; 2Department of Surgery, University of Calgary, Calgary, Alberta, Canada; 3Department of

Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.

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Cross-Border Comparison of Sport Concussion Knowledge, Clinical Practices, and Needs for Continu-

ing Medical Education: A Survey of Family Physicians Constance Marie Lebrun, MPE, MDCM1, Martin Mrazik,

PhD, R. Psych1, Abhaya S. Prasad, BSc, B. Joel Tjarks2, BS, Jason C. Dorman3, MS, Michael F. Bergeron, PhD3, Thayne A.

Munce, PhD3, Verle D. Valentine, MD3, Affiliations: 1University of Alberta, Edmonton, Alberta, Canada; 2 University of South

Dakota, School of Medicine, Vermillion, South Dakota, USA; 3 Sanford USD Medical Centre, Sioux Falls, South Dakota, USA

Diminished Cartilage Boundary Lubricating Ability of Proteoglycan 4-Deficient Human

Osteoarthritic Synovial Fluid: Restoration Through Proteoglycan 4 Supplementation

Taryn E. Ludwig, BSc,1 Jenelle R. McAllister, MSc, CAT(C),2 Victor M.Y. Lun, MSc, MD,2 J. Preston Wiley, MSc, MD,2,3

Tannin A. Schmidt, PhD1.,3 1Biomedical Engineering, 2Sport Medicine Centre, and 3Faculty of Kinesiology, University of Calgary,

Calgary, Alberta, Canada.

The Application of Consensus-Based Indications for Magnetic Resonance Imaging in Acute Knee Inju-

ries: How Often Is an MRI Really Needed?

Nick Mohtadi, MD, MSc,1 Stacy Kozak, BPE, MSc,2 Richard Walker, MD,3 Mo Donald, MSc, CAT(C),4 and Alexandra

Naylor, BKin Student.5 1University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada; 2Alberta Bone and Joint Insti-

tute, Calgary, Alberta, Canada; 3University of Calgary, Department of Radiology, Calgary, Alberta, Canada; 4The Soft Tissue Injury

Working Group of the Alberta Bone and Joint Clinical Network, Calgary, Alberta, Canada; and 5The Acute Knee Injury Clinic, Cal-

gary, Alberta, Canada.

Identifying the Agreement Between the Non-Physician Expert's (NPE) Diagnoses, Based Solely on

Online Diagnostic Questionnaire Information, Compared to a Confirmed Sport Medicine Physician's

Diagnosis in Patients Presenting With Acute Knee Injuries

Nick Mohtadi, MD, MSc,1 Niko Lagumen, MSc, CAT(C),1 Meryl Wheeler, BKin, CAT(C),1 Kelly Brett, MD,1 Denise

Chan, MBT, MSc,1 and Breda Lau, MSc, CAT(C).2 1University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada; and 2Mount Royal University, Calgary, Alberta, Canada.

Athlete Perspectives on the Increasing Media Attention Toward Concussion: Do We Need More Education?

Dhiren J. Naidu, MD, Martin Mrazik, PhD, and Jesse Karpman. Faculties of Medicine, Dentistry, and Education, University of

Alberta, Edmonton, Alberta, Canada.

Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Thigh Mus-

cle Strength and Function

Jason Peeler, PhD1,3,4 Matt Christian, MSc,1 Jeff Leiter, PhD,1,2,4, and Peter MacDonald, MD.2,4 1Department of Human

Anatomy & Cell Science, 2Department of Surgery, and 3Undergraduate Medical Education Program, Faculty of Medicine, Univer-

sity of Manitoba, Winnipeg, Manitoba, Canada; and 4Pan Am Clinic, Winnipeg, Manitoba, Canada.

Mood and Trait/State Anxiety Profiles in Circus Artists: Similarities and Differences Compared to Athletes

I. Shrier, MD, PhD1 J.S. Raglin, PhD2 and Janette Powell, PT, OCS, STC.3 1Centre for Clinical Epidemiology and Community

Studies, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada; 2Department of

Kinesiology, Indiana University, Bloomington, Indiana; and 3Cirque du Soleil, Las Vegas, Nevada.

Developing a Baseline Functional Test for Athletes Post a Lower Extremity Injury

Rebecca Shultz, PhD,1 Melissa Hodgins, MSPT, SCS, ATC,2 Karyn Haitz,3 Jessica Popish,3 and Gordon O. Matheson, MD,

PhD.1,3 1Sports Medicine Center, Department of Orthopaedic Surgery, Stanford University, Stanford, California; 2Sports Medicine

Center, Department of Athletics, Physical Education, and Recreation, Stanford University

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CASEM SPORT MEDICINE CONFERENCE KELOWNA 2012

SOCIAL PROGRAM

Wednesday June 20, 2012 5 to 8pm CASEM Welcome Reception - Welcome Reception in the Exhibit Hall with four different Wineries from Kelowna presenting Wine Tasting

2 Tickets will be included in the full registration package - Cash bar available.

Thursday June 21, 2012 - 11:34-1pm -Industry Sponsored Luncheon Smith & Nephew (limited to 120 seats)

Genzyme (limited to 80 seats) Sign up at CASEM reception desk for your ticket.

Wine Tasting Tour and Supper - Thursday June 21, 2012 6:30 - 10:30pm

CASEM has organized a wine tour and tasting at Summerhill Pyramid Winery (www.summerhill.bc.ca), famous for its

sparkling wines and one of the most unique and prestigious wineries in the Okanagan where its wines are regularly

honoured in international competitions – their sparkling wine won the gold medal in Champagne, France – against

French Champagne!!

CASEM members will be taken up by bus from the hotel, given a tour and wine tasting and then will enjoy sparkling

wine on the balcony overlooking the Okanagan valley – finally we will sit down to a gourmet 3-course meal including

wine pairing watching the sunset – all for $90. Now if that doesn’t get you to Kelowna, nothing will! $90.00

Ferring 5k Fun Run - Saturday June 23, 2012 - 3pm Back by popular demand the 5K run/walk- this year sponsored by Ferring -

sign up at the reception desk for your running kit - all proceeds will go to a Charity $20.00 CASEM Gala Dinner, Entertainment and Dance - Saturday June 23, 2012 7pm - 1am CASEM Gala Dinner and Entertainment with the Band RX from Kelowna

Tickets available until Friday lunch at CASEM reception desk. In advance $50.00 in advance or $80.00 on site

Friday June 22, 2012 12:30-1:45pm - Industry Sponsored Luncheon by Ferring Luncheon: Speaker: Dr. Bob Mackie - Anterior Knee Pain “Is it Patello-femoral Syndrome

and does it matter” (limited to 60 seats) Sign up at CASEM reception desk for your ticket.

Rex is a collection of medical professionals, and music is the shared prescription they all enjoy. They are known locally as 'the Doc Band' and play Classic Rock favourites to get and keep the dance floor jumping all night long...

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CONFERENCE RATES AND REGISTRATION

Registrations @ www.casem-acmse.org click on Event

Conference Rate Registration On Site

Until June 16, 2012 after June 6, 2012

CASEM Member $645.00 $695.00

Non Member $700.00 $750.00

Allied Health $650.00 $700.00

CASEM Resident/ Fellows $350.00 $400.00

Non Member Resident $400.00 $450.00

CASEM Medical Student $250.00 $300.00

Non Member Student $300.00 $350.00

Daily Rate $325.00 $375.00

INCLUDED Full Registration Fee : 3-day Scientific Program, Welcome Reception, Daily Continental

Breakfast, Refreshment Breaks. NOT Included In Your Registration and has to be purchased separately:

Saturday Evening Gala Dinner $50.00 purchased with your registration

$80.00 with onsite registration or sold separately on site

Social Outing: $90.00 Summerhill Winery Wine Tasting and 3course Supper

Name____________________________________________ Lastname________________________________

Address____________________________________________________________________________________

Address____________________________________________________________________________________

City/PC____________________________________________________________________________________

Email address_______________________________________________________________________________

Telephone Number__________________________________________________________________________

Credit Card Information VISA ___ M/C ___

Credit Card Number ________________________________________________________________________

Expiry Date ____________________________________________ Total Amount paid $_________________

CANCELLATION POLICY

$100.00 cancellation fee will apply to all reimbursements issued PRIOR to March 31, 2012 -

After this date NO refunds will be issued.

Canadian Academy of Sport and Exercise Medicine (CASEM)

180 Elgin Street, Suite 1400

Ottawa ON K2P 2K3

Tel. 613 748-5851 - Fax: 613 231-3739

www.casem-acmse.org