CSGNA 2016 program.indd

Transcription

GENERAL INFORMATION
Full Conference or Daily Conference Registration Fees
Include:
Nutrition as noted in program; admission to the Exhibit Hall;
the Opening Reception on Thursday evening; a delegate bag;
and printed materials.
NOTE: a FULL CONFERENCE registration can NOT be shared
between two or more delegates – all persons wishing to attend
must register individually.
Special Notes:
CONFERENCE OBJECTIVES
a) Delegate name and provided address will be shared with
exhibitors.
b) Business casual dress is requested.
c) Our conference is fragrance free.
•
To encourage camaraderie and networking on a
national basis.
•
To provide current information in the speciality of
gastroenterology.
Cancellation / Substitution Policy:
•
To encourage the exchange of clinical and research
information.
•
To provide nurses with the opportunity to
experience what is new and upcoming in both
medical devices and pharmacology.
•
•
To promote membership in the CSGNA.
•
•
•
Cancellations will be refunded less 20% administration fee with
notice of cancellation being received at [email protected]
no later than FRIDAY, AUGUST 19, 2016. No refunds will be
issued after this date.
Substitutions may be made but notice must be received at
[email protected] no later than FRIDAY, SEPTEMBER 2, 2016.
CSGNA 2016 reserves the right to make appropriate program
changes as deemed necessary and/or cancel events due to
circumstances beyond CSGNA’s control.
To participate in the planning and future direction
of the CSGNA.
CONTINUOUS LEARNING ACTIVITY FOR CANADIAN NURSES
ASSOCIATION (CNA) CERTIFICATION:
PLANNING COMMITTEE
While this educational activity is not officially endorsed by the Canadian
Nurses Association (CNA), nurses may claim it as a continuous learning
(CL) activity toward renewal of the CNA certification credential if it is
related to their nursing specialty. Pre-authorization from the CNA
Certification Program is not required. Participants are encouraged to
retain a confirmation of attendance.
Carol Reidy RN, CGN(C) – Chair
Bien que cette activité de formation ne soit pas officiellement appuyée par
l’Association des infirmières et infirmiers du Canada (AIIC), les infirmières
et infirmiers peuvent la compter comme activité d’apprentissage continu
(AC) en vue de renouveler leur titre de certification de l’AIIC si elle se rapporte
à leur spécialité infirmière. Aucune préautorisation du Programme de
certification de l’AIIC n’est exigée; on incite néanmoins les participants à
conserver une attestation de présence.
Donna Provost RN, CGN(C)
PRIVACY STATEMENT: Registration information is collected to
process registrations and payments for educational events, correspond
with registered delegates, and to publish delegate lists for event
participants. If you do not wish to have your registration information
used for these purposes please indicate this on the registration form.
CONSENT TO USE OF PHOTOGRAPHIC IMAGES: Your registration
and attendance in CSGNA 2016 conference constitutes an agreement
by the registrant to the Canadian Society of Gastroenterology Nurses &
Associates (CSGNA) to use the registrant’s image in photographs.
2 | csgna 2016
Ginelle Centina RN, BN
Keith Harris M.D.R. Technician
Carina Kirk RNBN, CGN(C)
Jacquie Radtke RN, CPN(C)
Krizel Rodriguez RN, BN
Lori Sitter RN, BA
DISTINGUISHED SPEAKERS INCLUDE . . .
Valerie Cade CSP MA, Conflict
Resolution and Reconciliation (Hon)
Encouragement for
the Encouragers!
Putting the Hope
Back into Healthcare
Stephanie Staples
Patricia Raymond
MD FACP FACG
Get Lost – Finding
Resiliency Without
and Within
Belly Buttons: Not
Just Innies, Outies
or Piercings
Saturday | 1500-1600
Thursday | 0900-0950
Polypolooza: You
Don’t Know Polyps!
Bully Free at Work
Thursday | 1330-1450
Wouldn’t it be great to know how to handle
others “who don’t get it” and be able to
influence them to a win–win understanding?
This inspirational session will help healthcare
professionals want to work through anything
with anyone! This session helps to remove
defensiveness with understanding through
humour, relevant examples and creates the
ability for participants at all levels to be able to
approach others easily.
Here’s What You Will Learn and Experience:
• You will be able to narrow the interpersonal gaps between co-workers and
figure out why do they do what they do
in order to create a respectful workplace
for all;
• You will be inspired through humor and
specific insights, which will give people
an open mind to hear you;
• You will be able to identify your “most
difficult situation” at work and be able to
have a “here’s what I can do about it” plan;
• You will find that while it is often natural to
take things personally, it is not productive.
But how do you take things professionally?
This will show you how!
You will truly be given the gift of a “lift” after
all you’ve given – now it’s your turn to be
encouraged!
Stephanie works with busy professionals who
want to be happier and healthier so that
they can bring their “A” game to work and
life! She is a highly-acclaimed, international
inspirational speaker, author and Corus
Entertainment broadcast radio host.
As the founder of Your Life, Unlimited,
Stephanie shares her expertise as regular
magazine and newspaper columnist and has
been quoted and featured in publications
globally, she is regularly called upon for TV
interviews to share her unique take on success.
Her books and audio programs are used worldwide and her programs have been proven to
increase feelings of hope, happiness and
empowerment for participants. With a 20+
year background in nursing, Stephanie is hardwired for helping others.
As a Certified Speaking Professional, she has
created exceptional experiences for her
audiences time and time again and has moved,
challenged and motivated them into positive,
pro-active action.
Within her roles as a wife and mom of 3,
Stephanie has founded three businesses (two
successful – one a nightmare, you can’t win
them all!) and is the 2014 Manitoba Women
Entrepreneur of the Year award winner for
Contribution to Community.
www.BullyFreeAtWork.com
twitter.com/@BullyFreeAtWork
facebook.com/BullyFreeAtWork
www.yourlifeunlimited.ca
twitter.com/@stephaniestaples
facebook.com/stephaniestaples
When Mr. Creosote Meets the Waferthin Mint: Gastroparesis
Dr. Patricia Raymond is a practicing gastroenterologist, Associate Professor at Eastern
Virginia Medical School, media spokesperson,
and speaks nationally to nurses and docs
on rediscovering their joy in the practice of
medicine.
Raymond, as her alter ego the divine Ms
Butt Meddler, is known for her medical
music parodies on the joy of screening
colonoscopy, various GI conditions, and
weight management. She is honoured to
have been nominated multiple times for the
WEGO Hilarious Health Activist Award.
Please subscribe to her music parody YouTube
channel at ButtMeddler.com to catch all her
latest digestive ditties!
www.RxForSanity.com
www.ButtMeddler.com
twitter.com/@PatriciaRaymond
facebook.com/patricia.raymond
facebook.com/rxforsanity
www.csgna.com | 3
WEDNESDAY September 28
1930 – 2030 EVENING REGISTRATION
THURSDAY September 29
0700 – 0815 Registration and Breakfast
2D
0830 – 0900 OPENING CEREMONIES
• Hands-on instructor-led lab work
• Identify defining characteristics of foreign body events
• Identify specialized tools and techniques unique to specific
needs
0900 – 0950 OPENING KEYNOTE
Encouragement for the Encouragers!
Putting the Hope Back Into Healthcare
Valerie Cade CSP MA - Calgary, Alberta
0950 – 1010 Stretch Break
1010 – 1100 PLENARY ADDRESS
An Endoscopy Nurse’s Guide to Diagnosis of
GI Diseases
Dana Moffat MD FRCPC - Winnipeg, Manitoba
Presented by:
1330 – 1415 CONCURRENT SESSIONS 3A – 3D
3A
• Learn the clinical presentation of common Gi diseases
• Learn the endoscopic presentation of common Gi diseases
• Learn about rare GI “Zebras” commonly missed at endo
1110 – 1200 CONCURRENT SESSIONS 1A – 1B
1A
3B
TBD
????? RN BScN LLB - Ottawa, Ontario
Blood Thinners and Impact on Procedures
Peter Thomson BSc(Pharm) PharmD - Winnipeg, Manitoba
3C
Twists and Turns – Best Practices for Care and
Handling of Endoscopes
Jane Smallwood - London, Ontario
• Review care and handling based on best practices and OEM
• Learn ways to minimize repairs due to twists and turns
• Discuss reprocessing best practices
Presented by:
3D
Presented by:
1430 - 1515 CONCURRENT SESSIONS 4A – 4D
Ensuring Patient Safety with Endoscopic Marking
Speaker TBD
• Identify the risks and benefits of the marking of lesions in
the GI tract
• Describe the indications of endoscopic marking in 5 areas
of the GI tract.
• Discuss the impact of endoscopic marking on wrong site
surgery reduction
Presented by:
2C
• Review the common complications of ALD (e.g. ascites, varices)
• Discuss the management of common complications of ALD
• Understand the unique challenges of caring for patients with
ALD
4 | csgna 2016
Current and Evolving Role of Endoscopy in the
Diagnosis and Treatment of Colorectal Cancers
Jason Park MEd MD FRCSC FACS - Winnipeg, Manitoba
• Describe how pre-operative endoscopy facilitates tumour
identification and treatment in colorectal cancers
• Describe how intra-operative endoscopy facilitates tumour
identification and resection margins
• Highlight evolving endoscopic and combined endoscopiclaparoscopic techniques to treat colorectal cancers
4B
Care of Patients with Advanced Liver Disease (ALD)
Susan Cuvelier BSc(Hons) MSc MD FRCPC - Winnipeg, Manitoba
Foreign Bodies Animal Lab
Chris Davin - Winnipeg, Manitoba
needs
4A
2B
Radiation Safety and Protection in the
Endoscopy Room
Chester Neduzak RTR - Winnipeg, Manitoba
• Fundamentals of radiation and safety
• Protection of staff
• Protection of the patient
1240 – 1320 CONCURRENT SESSIONS 2A – 2D
2A
Bully Free at Work Especially for Nurses!
Valerie Cade CSP MA - Calgary, Alberta
• Gain the full awareness, hope and implementation to help
cope with and stop workplace bullying
• Stop disruptive behaviours both personally and organizationally
• Restore hope and feel inspired once again!
• A brief review of oral and parenteral anticoagulants in Canada
• Discuss periprocedural outcomes from recent clinical trials
• Offer thoughts on handing anticoagulants around GI
procedures
1200 – 1240 Lunch
Nurses Role in Capsule Endoscopy
Carina Kirk RN BN CGN(C) - Winnipeg, Manitoba
• Indications for Capsule Endoscopy
• Capsule Endoscopy implications for the future
• Learn how procedure is performed
• To review xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
• To review xxxxxxxxxxxxxxxxxx
• To review xxxxxxxxxxxx
1B
LVADs for the GI Nurse: How Do They Impact Care
Allan Schaffer MD FRCPC - Winnipeg, Manitoba
• Introduce the components and function of LVADs
• Why to LVAD patients develop frequent GI bleeds
• Provide safe and effective care to these complex patients
4C
Latest Developments in IBD
Norine Miller RN BN - Winnipeg, Manitoba
1525 - 1610 PLENARY ADDRESS
Size Does Matter – The Procedures and Outcomes
in Bariatric Surgery
Ashley Vergis MMEd MD FRCSC FACS - Winnipeg, Manitoba
4D
needs
• Define the rationale for bariatric surgery
• Understand pre, intra, and post operative care in bariatric surgery
• Outline patient outcomes in bariatric surgical programs
1615 - 1700 PLENARY ADDRESS
Overall Review of Celiac Disease: Gluten Free Diet –
Is It an Entity?
Donald Duerksen MD FRCPC - Winnipeg, Manitoba
Presented by:
1700 – 1900 OPENING RECEPTION in Exhibit Hall
FRIDAY September 30
0700 – 0800 Breakfast and Exhibits
6C
• Understand the tests offered in the GI motility laboratory
• Understand the investigative pathway for GERD
• Understand the investigative pathway for achalasia
Getting Down to The Bowels of Body Mechanics
and Ergonomics – Taking Care of Your Darn Self!
George Matos CAT(C) CSEP-CPT RCRT BA Kin - Winnipeg, Manitoba
• Self awareness body mechanics to reduce Injury
• Better understanding of how injuries occur
• Practical/applicable ROM exercises for the workplace
6D
• Describe xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
• Learn xxxxxxxxxxxxxxxxxx
• Review xxxxxxxxxxxx
7A
5A EBUS / FNA / Bronchs
???? CREDENTIALS - Winnipeg, Manitoba
Hurt Your Patients
Michelle Alfa PhD FCCM - Winnipeg, Manitoba
7B
1515 – 1545
1200 – 1315 Lunch in Exhibit Hall
8A
Honorarium
provided by:
6B
Hepatitis C – “C” stands for Curable!
Stephen Wong BSc BSc(MEd) MD MHSc FRCPC FAASLD
Winnipeg, Manitoba
• Understand the importance of hepatitis C (HCV) screening
• Review the knowledge learned from the past HCV therapies
• Learn of the highly-effective present and future HCV therapies
Inner Space! Direct Endoscopy and Therapeutics
of the Pancreatic and Bile Ducts
Dana Moffat MD FRCPC - Winnipeg, Manitoba
• Learn the indications for pancreatoscopy and cholangioscopy
• Learn the therapies available at pancreatoscopy/cholangioscopy
• Understand the impact of these technologies on traditional ERCP
Nutrition Break in Exhibit Hall
6A
Fecal Microbiota Transplant
Christian Schneider MD FRCPC - Winnipeg, Manitoba
• List 3 factors contributing to biofilm buildup in endoscopes
• Role of monitoring in quality system for endoscope reprocessing
• What to do to prevent biofilm buildup in endoscopes
Honorarium
provided by:
Dissecting Endoscope Outbreaks – What are
the Issues?
Michelle Alfa PhD FCCM - Winnipeg, Manitoba
• Discuss extent of infectious outbreaks due to flexible endoscope
• List key factors in three recent outbreaks
• Understand recent FDA recommendations for reprocessing
scopes
5B Endoscope Biofilm: What You Can’t See Can
News in Crohn’s Disease and Ulcerative Colitis
Laura Targownik MD FRCPC - Winnipeg, Manitoba
0930 – 1030 CSGNA ANNUAL GENERAL MEETING
1030 – 1115 Nutrition Break in Exhibit Hall
Welcome to the GI Motility Laboratory
Alexandra Ilnyckyj MD FRCPC - Winnipeg, Manitoba
8B
Management of GI Bleeding with Endotherapy
Sonny Dhalla MD FRCSC FACS- Winnipeg, Manitoba
• Overview of GI bleeding
• Stratifying upper GI bleeding
• Different techniques employed in control of hemostasis
Endoscopic Management of Barrett’s Esophagus:
A focus on Radiofrequency Ablation
Michael Cantor MD FRCSC - Winnipeg, Manitoba
• Indications for endoscopic treatment of BE
• Limitations and complications of RFA
• Post RFA care and follow up
1800 – 2230 EVENING SOCIAL
Folklorama Flair – Fun, Food and Cultural Festivities!
Delegate
Non-Delegate
| $75 per person
| $85 per person
Honorarium
provided by:
www.csgna.com | 5
SATURDAY October 1
0700 – 0830 Breakfast
11C
0830 – 0915 CONCURRENT SESSIONS 9A – 9C
9A
9B
• Identify patients who are candidates for HIPEC surgery
• Understand the basic concept of the surgery
• Know the expected longterm outcomes of HIPEC surgery
Belly Buttons: Not Just Innies, Outies or Piercings
Patricia Raymond MD FACP FACG - Virginia Beach, Virginia
• Describe the anatomic origins of the umbilicus and give
examples
• Establish the utility of the umbilical cord in banked stem cells
• Exercise techniques to protect the pieced umbilicus during
electrical cautery
The Shocking Truth - Understanding
Electrosurgery and Polyp Management
Colin L. DeSouza B.Sc. - Ottawa, Ontario
1200 – 1300 Lunch in Exhibits
12A Sharing Best Practices in Endoscope
Reprocessing
Mary Ann Drosnock MS CIC CFER RM(NRCM)
Fraser, Michigan
• Understand endoscope reprocessing procedures and
challenges
• Identify best practices in reprocessing of flexible endoscopes
• Understand how to determine if an endoscope is patient
ready
• Classification of the different types of Polyps
• Guidance with technique and understanding generator
settings
• Identifying and avoiding potential complications
9C
CNA Certification (English & French combined)
• Why certify
• How to prepare for the certification exam
Curing the Incurable: Surgery for
Carcinomatosis
Pamela Hebbard MD FRCSC - Winnipeg, Manitoba
Presented by:
Presented by:
12B TEM and other Transluminal Surgery
David Hochman BSc MD FRCS(C) - Winnipeg, Manitoba
0915 – 1000 Nutrition Break in Exhibit Hall
10A
The Evils That Lurk – Foreign Bodies in Lower
GI Tract
Cliff Yaffe MD FRCSC - Winnipeg, Manitoba
• Understand the risks of foreign bodies in the lower GI tract
• Describe the strategies for management
• Describe the different approaches for foreign body removal
10B
Endoscopy in the Bariatric Surgery Patient:
A Long and Windy Road
Christopher Andrew MD BSc FRCSC - Winnipeg, Manitoba
• Understand the anatomy of the common bariatric procedures
• Describe the most common complications after bariatric
surgery
• Realize the challenges of performing endoscopy in the
bariatric surgery patient
11A
Polypolooza: You Don’t Know Polyps!
• Review and describe the basic kinds of polyps and compare
removal methods
• Categorize classic FAP versus attenuated FAP and compare
management and family screen guidelines
• Review the “strange” polyposis syndromes and their
associated clinical finds to better diagnose these conditions
11B
Infection Prevention and Control:
The Excitement Never Ends!
John Embil MD - Winnipeg, Manitoba
6 | csgna 2016
12C Everything You Ever Wanted To Know About
Anal Cancer in 45 minutes!
Benson Yip MD FRCSC - Winnipeg, Manitoba
• What is anal cancer?
• The signs and symptoms of anal cancer
• The management of anal cancer
1355 – 1450 PLENARY
When Mr. Creosote Meets the Wafer-thin Mint:
Gastroparesis
• Describe the epidemiology and causes of gastroparesis
• Review diagnosis and differential diagnosis of gastroparesis
• Examine current treatment options for gastroparesis
1450 – 1500 CLOSING CEREMONIES | CSGNA 2017
Get Lost – Finding Resiliency Without & Within
Stephanie Staples - Winnipeg, Manitoba
CONFERENCE 2016
The CSGNA 2016 Planning Committee
is currently accepting submissions for
POSTER PRESENTATIONS
CSGNA 2016 submissions should be
appropriate for the novice through to the
advanced practice professional.
Topics of interest may include: clinical research,
innovative projects and solutions, ethics,
case presentations and clinical reviews.
For submission details visit
www.csgna.com
Poster Specifications and Preparation Tips
Submission deadline is:
FRIDAY, SEPTEMBER 2, 2016
Send submissions to:
Sharon Lapointe at [email protected]
MEMBERSHIP HAS
ITS REWARDS!
CSGNA is committed to investing
in the professional development
of its members.
• Check the CSGNA website for
national funds available (for both
nurses and allied health professionals)
• Contact your chapter for local
scholarship opportunities
• Your professional association (eg.
RNAO in Ontario) may have education
funds available
• Your hospital/department may also
have an educational fund that you
may be able to tap into
• Your local chapter executive may be
able to assist you with the process
GOOD LUCK!
We hope to see
you in Winnipeg, Manitoba . . .
Photo credit: Ruehle Design | www.tourismwinnipeg.com
www.csgna.com | 7
FRIDAY EVENING ENTERTAINMENT
FOLKLORAMA FLAIR – Fun, Food and Cultural Festivities!
Delegate
| $75 per person
Non-Delegate
| $85 per person
Join your nursing colleagues and exhibitor representatives for a fabulous evening experiencing the spirit of FOLKLORAMA.
FOLKLORAMA (which happens annually in August) is the largest and longest-running multicultural festival of its kind in the
world! Join us for a delicious sit-down dinner and then be captivated with the FOLKLORAMA stage show! Our show will take
you to the four corners of the world – as Winnipeg residents share the diversity of their cultures, their music and their talents
with us. We promise this will be a night of pageantry, excitement and powerful performances!
Register early as spots are limited and tickets will not be available onsite at the conference!
8 | csgna 2016
www.csgna.com | 9
CONFERENCE INFORMATION
2016 CONFERENCE
RATES
Early Bird | on or before August 15
Members and
Affiliates
Non-members
TRAVEL INFORMATION
By using the CSGNA 2016 booking codes, you have the opportunity to save
on regular ticket fares (does not include discount promotional fares or seat
sales). Fare Discount Code MUST be provided at the time of booking.
$450.
$610.
Regular | after August 15
Members and
Affiliates
Non-members
$550.
$710.
Use the CSGNA 2016 Promotion Code CYWGOZ
and Coupon Code Z106ZAC
No discount will apply to any current travel seat sales. Restrictions may
apply, refer to Terms and Conditions on the WestJet website.
www.westjet.ca
RESERVATIONS LINE: 1-888-493-7853
BOOK ONLINE:
Single Day | fee per day
Members, Affiliates
and Non-members
Use the CSGNA 2016 Promotion Code U4HZVX41
$250.
Student Rate | 3-day conference
Students must be actively
enrolled full-time in an
undergraduate Nursing
program or Practical
$255.
Nurse program
No discount will apply to Tango and Executive Class lowest bookings for
travel. To receive the discount fare TRAVEL MUST BE BOOKED ONLINE with
this code. Restrictions may apply, refer to Terms and Conditions on the Air
Canada website.
BOOK ONLINE:
WINNIPEG ACCOMMODATIONS
Register
ON-LINE
ACCESS SECURE
ON-LINE REGISTRATION
including credit card payment
(VISA or MASTERCARD)
by visiting
www.csgna.com
Early Bird
DRAW
2 CHANCES TO WIN
www.aircanada.com
Use the CSGNA 2016 Booking Code CS3
Delta Winnipeg Hotel
350 St Mary Ave., Winnipeg, Manitoba R3C 3J2
Rates
Mode Room: $199.00 CDN + taxes
Mode Deluxe: $239.00 CDN + taxes
Reservations
Please call the Delta reservations department at
1-888-311-4990 or Global Reservations Office at
1-888-330-5422, and identify the group as CS3
A block of rooms has been reserved until SEPTEMBER 6, 2016 unless the
block has been completely filled prior to this cut-off date.
CONFERENCE VENUE
one FREE night accommodation
at the DELTA WINNIPEG
Registration must be faxed,
postmarked or received
on-line by midnight
AUGUST 15, 2016
375 York Ave., Winnipeg, Manitoba R3C 3J3 www.wcc.mb.ca
The Delta Winnipeg hotel is attached to the conference centre
and easily accessible by a heated skywalk.
Don’t be disappointed, book now to reserve your travel and accommodations!
Should you have any difficulty in making your reservation, please inform Susan Mason 519-652-0364 or [email protected]
CSGNA 2016 requests your support of the conference by staying at the Delta Winnipeg for the
duration of the conference. Your support will assist CSGNA in meeting its contract obligations.
We sincerely appreciate your cooperation.
10 | csgna 2016
Please print and complete this form and send it to
CSGNA 2016 using one of the following options:
Email:
[email protected]
Fax:
519-652-5015
Mail:
CSGNA 2016 | Innovative Conferences & Communications
PO Box 319, 59 Millmanor Place
Delaware, ON, Canada N0L 1E0
REGISTER & PAY ONLINE AT: www.csgna.com
NAME - as it will appear on name badge
CSGNA MEMBER
POSITION/TITLE- as it will appear on name badge
HOME ADDRESS
eMAIL ADDRESS (REQUIRED)
CITY
NAME OF ORGANIZATION
HOME PHONE
DEPARTMENT / CITY
WORK PHONE
PROVINCE /STATE / COUNTRY
EXT.
POSTAL CODE
FAX
Please note any special dietary / accessibility restrictions:
Please CIRCLE ALL applicable credentials: RN
Is this your first CSGNA conference?  YES NO
BN CGRN CGN(C) LPN MN NP Other:
 YES NO
 I do not consent to the use of photographic images
All presentations will be given in English, unless otherwise noted. Will you require translated hard copy handouts of the presentation slides?
 I do not consent to the use of my registration information as outlined in the privacy statement
SUMMARY OF PAYMENT OWING | Fees shown on previous page
CONFERENCE FEES:
FULL Conference
Registration Fee $
DAILY Conference
Registration Fee $
$
$
SOCIAL EVENT:
Friday Evening
$
________
(includes Thursday, Friday
and Saturday Program)
________
________
________

Thursday, September 29

Friday, September 30

Saturday, October 1
________
# of Delegate tickets
_____ X $75 per person
# of Non-Delegate tickets
_____ X $85 per person
NOTE: All tickets to the FRIDAY SOCIAL are ordered separately and must be pre-paid
ONSITE GUIDE: ** NEW this year!


YES
$ ________ # of GUIDES _____ X $15 each


NO
I choose to ‘go green’ and download my own copy
SESSION CHOICES
It is anticipated that interest in some sessions may FIRST SECOND
exceed available seating. Please indicate you FIRST Choice Choice
1A
1C
and SECOND choices with # and LETTER.
Thursday, September 29
1A
2A
3A
4A
– 1B
– 2D
– 3D
– 4D
1st choice
1st choice
1st choice
1st choice
______
______
______
______
2nd choice
2nd choice
2nd choice
2nd choice
______
______
______
______
2nd choice
2nd choice
2nd choice
2nd choice
______
______
______
______
2nd choice
2nd choice
2nd choice
2nd choice
______
______
______
______
Friday, September 30
5A
6A
7A
8A
– 5B
– 6D
– 7B
– 8B
1st choice
1st choice
1st choice
1st choice
______
______
______
______
Saturday, October 1
TOTAL PAYMENT
OWING:
$ ________
NOTE: REGISTRATION will NOT be processed until both REGISTRATION FORM
and FULL PAYMENT are received at INNOVATIVE CONFERENCES’ office.
9A – 9C
10A –10B
11A –11C
12A –12C
1st choice
1st choice
1st choice
1st choice
______
______
______
______
PAYMENT OPTIONS

Cheque - made payable to (CSGNA) | NO POST DATED CHEQUES - $30.00 administration fee will be charged on all NSF cheques

FOR OFFICE USE ONLY


CSGNA 16 - ___________
Card #
3 digit CCV number
on back of card
AMT PAID ____________
PAID BY _____________
PROCESS DATE ____________
Credit Card Holder Name
Signature
Expiry Date
CONFIRMATION OF RECEIPT OF REGISTRATION: Registrants will receive confirmation by email (or mail) within 10 days of registering for CSGNA 2016.
If you have not received confirmation within 10 days from when registration form was mailed or faxed, call INNOVATIVE CONFERENCES at 519-652-0364.
CSGNA CONFERENCE 2016 | care of
Innovative Conferences & Communications
PO Box 319, 59 Millmanor Place
Delaware, ON, Canada N0L 1E0

CSGNA 2016 program.indd

Transcription

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