Registration How to Register

Transcription

Registration How to Register
Registration
To register for the 18th Annual Winterlude
Anesthesia Symposium this registration form with
payment must be received. Please remember if
paying by cheque it must be received before
December 15th, 2011.
On Site registration will be available
Registration Information:
Family Name:
Given Name:
Mailing Address:
How to Register
There are four easy ways to register for Winterlude
Symposium 2012. Payment must accompany form.
Cheques should be payable to “Anesthesia CME
Fund.”
1. Register Online
http://www.anesthesia.org/winterlude
18th Annual Anesthesia
Winterlude Symposium
Registration Form
2. Register by Fax
Simply complete this form and fax to 613- 761-5032.
Fax registrations must include payment by credit card.
3. Register by Mail
Complete this form and mail the completed form and
your payment to the address below.
4. Onsite Registration
City:
Province/ State
Winterlude Symposium
c/o Lynne McHardy
Postal / Zip Code
Telephone:
Department of Anesthesiology,
The Ottawa Hospital& University of Ottawa
1053 Carling Avenue, B309, Ottawa, Ontario, K1Y 4E9
Fax:
Email:
If mailing, please ensure your cheque and registration
are received before December 15th, 2011 to ensure
proper processing.
Hospital Affiliation:
Cancellation policy:
Professional Status:
A refund will be made (less $50 processing fee) if a cancellation
request is received in writing no later than December 15st, 2011.
No Refunds will be given after December 15st, 2011. The Planning
Committee reserves the right to cancel or move the conference
should this become necessary. In this circumstance, each registrant
will be notified by telephone or email and a full refund will be given.
Winterlude Anesthesia 2012 is not responsible for any other costs
incurred, such as airline or hotel penalties.
The Science and PracƟce of
PerioperaƟve Medicine
February 4th and 5th, 2012
The WesƟn Hotel
11 Colonel By Drive
OƩawa, Ontario
hƩp://www. anesthesia.org/winterlude
uOSSC- University of Ottawa Skills and Simulation Centre,
724 Parkdale Avenue, Ottawa, Ontario
Westin Hotel, Ottawa, Ontario
Sunday 5th February 2012
Location:
Saturday 4th February 2012
Location:
Workshops & PBL’s
Program
0700-0800 Registration and Delegate Breakfast
0800-0810 Welcome and Opening Remarks
Plenary Session-Ambulatory Surgery
Dr. Naveen Eipe
Moderator: Dr. Gregory Bryson
0810-0840
Dr. Alan Tallmeister
1800 laparoscopic gastric band procedures at an independent Ontario Surgicentre
0840-0910
Difficult Airway Management in an Ambulatory Setting
Dr. Edward Crosby
0910-0940
Regional Anesthesia and Ambulatory Surgery
Dr. Jennifer Szerb
OHI- Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario
Problem Based Learning- 2 hours (max 20 each)
OHI
8:00am-10:00am and 10:00am-12:00pm
Staff
Registration Fees
A-Full Meeting & Two PBLs:
Before Dec.15/11
$350
After Dec. 15/11
$500
Medical student/
$75
$150
Resident/Fellow/RT/RN
Please indicate preference for PBLs (Circle two):
Acute Pain/
Bariatric/
Safety/
Transfusion/
After Dec. 15/11
$650
Staff
1. Multimodal Analgesia and Enhanced Recovery Programs
Dr. Francesco Carli
Dr. Lorri Lee
Acute Pain/
Bariatric/
Safety/
Transfusion/
Thrombosis
*Please indicate preference for 2hr Workshop (Circle One):
Airway/
Neonatal/
Regional/
TEE
Dr. Jeannie Callum
5. Perioperative Anticoagulation and Regional Anesthesia
Dr. William Geerts
Workshops - 2 hours
uOSSC
8:00am-10:00am and 10:00am-12:00pm
1. Airway Surgical/Bronchoscopy
(Max 12 Participants)
Dr. Ted Crosby
C-Full Meeting-Two 2hr Workshops or One 4hr Workshop:
Before Dec.15/11
$550
Staff
Medical student/
$275
Resident/Fellow/RT/RN
After Dec. 15/11
$800
$450
Please indicate preference for 2hr Workshop (Circle two):
Airway/ Neonatal/ Regional/
TEE
OR
Please indicate preference for 4hr workshop (Circle One):
Adult Crises/
2. Neonatal Resuscitation Practitioner
(Max 10 Participants)
Pediatric Crises/
ACLS
Dr. Patti Murphy
Method of Payment
3. Regional Cadaveric Ultrasound
(Max 12 Participants)
Cheque: Payable to CME Fund
Card Type
Card Number
Dr. Jennifer Szerb
4. Trans Esophageal Echocardiography Basic
(Max 6 Participants)
Dr. Chris Hudson
Workshops - 4 hours (max 10 each)
uOSSC
8:00am - 12:00pm
1. Adult Crises Management
(Max 10 Participants)
Thrombosis
B-Full Meeting-One PBL & One 2hr Workshop:
Before Dec.15/11
$450
Medical student/
$175
$350
Resident/Fellow/RT/RN
*Please indicate preference for PBLs (Circle One):
2. Morbidly Obese Patients for Bariatric and Non Bariatric Surgery
Dr. Alan Tallmeister
3. Patient Safety and Preventable Patient Injuries
0940-1000 Panel Discussion/Question Time
4. Perioperative Transfusion Medicine
1000-1030 Coffee & Exhibits
Plenary Session-Patient Safety & Outcomes
Moderator: Dr. Donald Miller
1030-1110
Dr. Lorri Lee
Visual Loss after Major Spine Surgery: Can we Identify Risk Factors?
1110-1150
Dr. Francesco Carli
Fast Track Surgery: What is the role of the Anesthesiologist?
1150-1200 Panel Discussion/Question Time
1200-1300 Lunch & Exhibits
J. Earl Wynands Lecture
(Sponsored by the Royal College of Physicians and Surgeons of Canada)
Introduction: Dr. Homer Yang
1300-1345
Dr. Tait Shanafelt
Finding Meaning, balance and Personal Satisfaction in the Practice of Medicine
1345-1355 Open to the Floor
Plenary Session- Thrombosis & Transfusion Moderator: Dr. Christopher Hudson
1400-1500
New Oral Anticoagulants: Promise, Peril and Practice
Dr. William Geerts
Optimizing and Treating Coagulopathies
Dr. Jeannie Callum
1500-1510 Open to the Floor
1510-1530 Coffee & Exhibits
1530-1630 Debate
Moderator: Dr. Kimmo Murto
Out of OR Sedation Anesthesiologists or Non Anesthesiologists?
Dr. Lawrence Roy
Dr.Robin Cox
1630-1640 Open to the Floor
1630-1830 A Taste of Winterlude-Wine & Cheese Reception
Dr. Simone Crooks
Expiry
Date:
Signature:
Total Cost:
2. Pediatric Crises Management
(Max 10 Participants)
I authorize Winterlude 2011 to
Charge my account for:

Winterlude Symposium
Dr. Dylan Bould
3. ACLS Recertification
(Max 10 Participants)
$____________
Dr. Viren Naik