CHARLESTONPLACEHOTEL
SOUTHCAROLI NA
I ti sapl e a s ur et ohos tt hea nnua lme e t i ngi n Cha r l e s t on, S out hCa r ol i naDe c e mbe r5 6 , 2 0 1 4 . T heCha r l e s t onPl a c eHot e lwa sc hos e na sour me e t i ng v e nue not onl y f or i t s e l e g a nt a c c ommoda t i onsbuta l s obe c a us ei ti swi t hi n wa l k i ngdi s t a nc et ot hemus e ums ,a nt e be l l um ma ns i ons ,a nd qua i nts hopst ha ty ourf a mi l y ma ye nj oy .Cha r l e s t ondur i ngt hehol i da y si sa uni quea ndma g i c a lc i t y .T hewe a t he ri sc ool e r a ndt heCha r l e s t oni a nsa r eme r r y !Cha r l e s t on’ s mot t oi sWhe r eHi s t or yL i v e s .Wet ooa r ema k i ng hi s t or ybyf oundi ng T he Pa i nS oc i e t yoft he Ca r ol i na sa ndwea r ede l i g ht e dt owe l c omey ou t ot heme e t i ng !
Ri c har dRauc kMD| F ounde randDi r e c t or
BOARDOFDI RECTORS
JEFFREYW FOLK, MD Pr es i dent201 4-201 6
THOMASE. BUCHHEI T, MD Pr es i dent El ec t201 4-201 6
RI CHARDLBOORTZMARX, MD Sec r et ar y201 4-201 6
EZRARI BER, MD Di r ec t or201 4-201 6
WI LLI AM SPI LLANE, MD I mmedi at ePas tPr es i dent
RI CHARDRAUCK, MD FounderandDi r ec t or
STEPHANI EVANTERPOOL, MD Di r ec t or201 4-201 6
PAULLAFAVORE, MD Tr eas ur er201 4-201 6
JAMESNORTH, MD Di r ec t or201 4-201 6
ROBERTB. WI LSONI I , MD Di r ec t or201 4-201 6
JAMESCREWS, MD
I nMemor i am Foundi ngPr es i dent
FACULTY Mi c hael Bar t os z ekMD
Wi l l i amBl auMD, PhD
Ri c har dBoor t z Mar xMD
ThomasBuc hhei tMD
Er i nCar eyMD
Er i nChaneyMD
Sc ot tCl i nganPAC
Emi l yDavi sMSN, ACNP
DanDol eysPhD
JamesEi s enac hMD
AnneMar i eFr asMD
St uar tGr antMB, CHB
I ngr i dHar mEr nandesPT, WCS, BBPMD
ThomasHopk i nsMD
Leonar do Kapur alMD, PhD
Mi c hael Lanc as t erMD
Davi dLi nds ayMD
Wi l l i amMax i nerDDS, PhD
Andr eaNac k l eyPhD
Ryan Nobl esMD
JamesNor t hMD
St evenPr ak k enPhD
Ri c har d Rauc kMD
Lanc eRoyMD
FACULTY Sc ot tRunyonMD
JoanSout her nNPC
ThomasVandeVennMD, PhD
ThomasWeberDO
Lynn Webs t erMD
Fr edWel l sBr as onRev.
Ani t aWuMD
AmandaZi mmer manPAC
Wi l l i amSpi l l ane MD
Jef f r eyFol k MD
Paul Laf avor eMD
Ez r aRi berMD
Rober tWi l s onI IMD
St ephani eVant er poolMD
Robi nHoyl eJD
Tas haChau
Mar yKi r k l ey
Jenni f erHodge
Ter r i Al l en
Li s aLi nebac k
AmandaAl l i e
Bec k yQui mby
PRELI MI NARYPROGRAM
FRI DAY, DECEMBER5, 201 4 7: 30
REGI STRATI ONOPENS
8: 00–9: 00
PLENARY1|SPECI ALGUESTLECTURER |ADDI CTI ON
9: 00–9: 45
OVERVI EW ANDUPDATEONCHRONI COPI OI DMANAGEMENT
9: 45–1 0: 1 5
L YNNWEBSTERMD WI LLI AM BLAUMD
ANEMERGI NGROLEFORMOR1 KI NOPI OI DI NDUCEDHYPERALGESI A
ANDREANACKLEYPHD
1 0: 1 5–1 0: 45
BREAK
1 0: 45–1 1 : 30
OPI OI DI NDUCEDHYPOALGESI A
1 1 : 30-1 2: 1 5
OPI OI DI NDUCEDENDOCRI NOPATHI ES
1 2: 1 5-1 : 1 5
CORPORATEMEMBERSHOWCASEWI THPLATI NUM CORPORATEMEMBERXENOPORT LUNCHPROVI DED.NO CME.
1 : 1 5–2: 1 5 2: 1 5–3: 00 3: 00–3: 45
STEVENPRAKKENMD
JAMESNORTHMD
PLENARY2 |SPECI ALGUESTLECTURER |THEPSYCHOLOGYOFPAI N
DANDOLEYSPHD
THESTELLATEGANGLI ON: ARI SI NG" STAR"REVEALI NGTHESECRETSOFPTSD MI CHAELBARTOSZEKMD
TARGETEDDRUGDELI VERY
RI CHARDBOORTZMARXMD
3: 45–4: 1 5
BREAK
4: 1 5–4: 45
I NTERVENTI ONALTECHNI QUESFORHEADACHEI NCLUDI NGBOTULI NI UMTOXI N
4: 45–5: 1 5
SCOTTRUNYONMD
VERTEBRALAUGMENTATI ON
JAMESNORTHMD
5: 1 5–5: 45
RADI OFREQUENCYDENERVATI ONOFHI PANDKNEE: ANOVELAPPROACH
5: 45–6: 00
DI SCUSSI ON
6: 00–7: 00
NETWORKI NGRECEPTI ON&POSTERCOMPETI TI ON
LEONARDO KAPURALMDPHD
FRI DAYHCPPARALLELSESSI ON MandyZi mmer manPAC, Scot tCl i nganPAC, Emi l yDavi sNPC, JoanSout her nNPC
2: 1 5–3: 00
TheLowerBac kPai nExami nat i on JohnBat s onMD
3: 00–3: 45
AMi dl evel ’ sGui det oPr oc edur al I nt er vent i ons JamesNor t hMD
3: 45–4: 1 5
BREAK
4: 1 5–4: 45
St er oi dChoi c esandRi s ks LanceRoyMD
4: 45–5: 1 5
Met hadone Er i nChaneyMD
5: 1 5–5: 45
Opt i onsf ort heManagementofOver dos e AmandaZi mmer manPAC
5: 45–6: 1 5
Per i l sandPi t f al l sofUr i neDr ugT oxi c ol ogyI nt er pr et at i on Scot tCl i nganPAC
6: 00–7: 30
NETWORKI NGRECEPTI ON
PRELI MI NARYPROGRAM
SATURDAY, DECEMBER6, 201 4 8: 00-9: 00
PLENARY2|SPECI ALGUESTLECTURER WI LLI AM MAI XNERMD
9: 00–9: 45
THESEARCHFORNOVELPREVENTI VEANALGESI CS TOM VANDEVENMD
9: 45–1 0: 30
SPECI ALGUESTLECTURER|HEADACHE ROBERTDUARTEMD
1 0: 30-1 1 : 00
BREAK
1 1 : 00–1 1 : 45
HEAL THCAREREORGANI ZATI ONANDTHEBUSI NESSOFPAI N THOMASHOPKI NSMBA
1 1 : 45–1 2: 1 5
ANNUALBUSI NESSMEETI NGOFTHEMEMBERSHI P SOCI ETYBUSI NESSUPDATE|JEFFREYFOLK, MD ADVOCACYUPDATE–ROBERTWI LSON, MDANDEZRARI BER, MD TRAI NEEPOSTERCOMPETI TI ONAWARDS–STEPHANI EVANTERPOOLMD PATI ENTSATI SFACTI ONSURVEYS–DATAANDSURVEY–TI M MULLENI X, PHARMD
1 2: 1 5–1 : 1 5
CORPORATEMEMBERSHOWCASEPLATI NUM CORPORATEMEMBERST. JUDEMEDI CAL
1 : 1 5–2: 1 5
SPECI ALGUESTLECTURER
LUNCHPROVI DED. NO CME. JAMESEI SENACHMD
2: 1 5–3: 00
JAMESC. CREWSPRESI DENTI ALLECTURER RI CHARDRAUCKMD
UL TRASOUNDWORKSHOPPARALELLSESSI ON PHYSI CI ANSONL Y|LI MI TEDTO 40ATTENDEES|SEPARATEFEEREQUI RED 3: 00–3: 30
UL TRASOUNDBASI CS STUARTGRANTMD
3: 30-3: 50
ACUTEPAI NI NDI CATI ONS STUARTGRANTMD
3: 50-4: 1 5
BREAKWI THEXHI BI TORS
4: 1 5-4: 45
CHRONI CPAI NI NDI CATI ONS THOMASBUCHHEI TMD
4: 45–6: 00
UL TRASOUNDWORKSHOPJOI NTS, PERI PHERALNERVE, OCCI PI TALNERVE, I NTERCOSTAL MODERATOR:THOMASBUCHHEI TMD
STATI ON1STUARTGRANT MD STATI ON2 RYANNOBLESMD STATI ON3 LANCEROYMD STATI ON4 SCOTTRUNYONMD
SATURDAYPARALLELSESSI ON|PEL VI CPAI N 3: 003: 30
MOLECULARCORRELATESOFVESTI BULODYNI ASUBTYPES ANDREANACKLEYPHD
3: 30–4: 00
TBD DAVI DLI NDSAYMD
4: 00–4: 30
BREAKWI THEXHI BI TORS
4: 30–5: 00
HI TTI NGBELOW THEBEL T|CHRONI CPEL VI CPAI NI NWOMEN ANNMARI EFRASMD
5: 00–5: 30 5: 30-6: 00
SACRALNEUROMODULATI ON: THENEXT“ BI GTHI NG”I NCOMPLEXGYNECOLOGI CPAI NSYNDROME
ERI NCAREYMD
THEMUSCULOSKELETALMYSTERY I NGRI DHARMERNANDESPT, WCS, BCBPMD
EVENI NGONOWN
S ATU RDAYC,H CPP ARA LL EL SE SSI ON MANDYZI MMERMANPASCOTTCLI NGANPAC, EMI L YDAVI SNPC JOANSOUTHERNNPC 3: 00-3: 30
THEROLEOFTHENP/ PAI NSPI NALCORDSTI MULATI ON EMI L YDAVI SNPC
3: 30–4: 00
THEROLEOFTHENP/ PAI NTARGETEDDRUGDELI VERY JOANSOUTHERNNPC
4: 00-4: 30
BREAKWI THEXHI BI TORS
4: 30–5: 00
OVERDOSEI NOURMI LI TARYANDVETERANS THOMASWEBERMD
5: 00–6: 00
COMMONCHALLENGESI NPAI NMANAGEMENT |CASEPRESENTATI ONSANDDI SCUSSI ON SCOTTCLI NGANPAC, AMANDAZI MMERMANPAC, EMI L YDAVI SNPC JOANSOUTHERNNPC)
EVENI NGONOWN
PRELI MI NARYPROGRAM
SUNDAY, DECEMBER7, 201 4 8: 00–8: 45
PLENARY3|PROJECTLAZARUSUPDATE MI CHAELLANCASTERMDANDREV. FREDWELLSBRASON RI SKEVALUATI ONMI TI GATI ONSTRATEGI ESFORLONGACTI NG/EXTENDED RELEASEOPI OI DS( REMSCERTI FI CATI ONANDCMEPROVI DED)
8: 459: 1 5
EVALUATI ONI SESSENTI ALFORSAFEANDEFFECTI VEPAI NMANAGEMENT USI NGER/ LAOPI OI DS
9: 1 5–9: 45
BESTPRACTI CESFORHOW TOSTARTTHERAPYWI THER/ LAOPI OI DS, HOW TOSTOP, ANDWHATTODOI NBETWEEN
9: 45–1 0: 1 5
BREAKI NEXHI BI THALL
1 0: 1 51 0: 45
EVI DENCEBASEDTOOLSFORSCREENI NGFORPATI ENTSATRI SK ANDMONI TORI NGFORADHERENCETOPRESCRI BEDER/ LAOPI OI DS
1 0: 45-1 1 : 1 5
TALKTOME: PROVENMETHODSTOCOUNSELYOUPATI ENTSONER/ LAOPI OI DS ANDACHI EVEPOSI TI VEOUTCOMES
1 1 : 1 51 1 : 45
EVERYTHI NGYOUAL WAYSWANTEDTOKNOW ABOUTER/ LAOPI OI DSASADRUGCLASS
1 1 : 45-1 2: 1 5
GETTI NGTHEMOSTCLI NI CALI NSI GHTSFROM SPECI FI CER/ LAPRODUCT I NFORMATI ONSOURCES
1 2: 1 5
CLOSI NGREMARKSANDTHANKYOU PRESI DENTJEFFREYFOLK
1 4 5KI MELPARKDRI VE WI NSTONSAL EM, NC2 7 1 0 3 PHONE: ( 4 0 1 )6 1 9 4 6 8 2 F AX: ( 7 2 7 )3 6 2 6 2 1 0 EMAI L : ROBI N ROBI NHOY L E. COM
APPLI CATI ONFORMEMBERSHI P| HEALTHCAREPROFESSI ONAL []ACTI VEMEMBER $150. 00
Ope nt oi ndi v i dual swi t hadoc t or at ede gr e ewhor e s i dei nNor t horSout hCar ol i na: i . e . MD’ s , PhD’ s , Phar mD’ s .
[]ASSOCI ATEMEMBER$150. 00 Ope nt oi ndi v i dual pai nmanage me ntpr ac t i t i one r swhor e s i deout s i det heSt at e sof Nor t hand/ or Sout hCar ol i na. []HEALTHCAREPRACTI TI ONER$100. 00 Ope nt opai nmanage me ntpr ac t i t i one r sandme mbe r s pons or e das s oc i at e swhor e s i dei nNor t h and/ orSout h Car ol i na,i . e .nur s e s ,phy s i c i an as s i s t ant s ,c ouns e l or s ,c ompl i me nt ar y me di c i ne s pe c i al i s t sandot he ral l i e dhe al t hpe r s onne l . []TRAI NEE*$20. 00
Ope nt oRe s i de nt s , Te c hnol ogi s t s i nt r ai ni ng, Nur s e s i nt r ai ni ngandot he rPar apr of e s s i onal si nt r ai ni ng.Y ou mus tat t ac hal e t t e rf r omy ourPr ogr amDi r e c t ore ndor s i ngy ourme mbe r s hi pandl i s t i ngt hes t ar tandf i ni s hdat e of y ourt r ai ni ngpr ogr am.
TOTALENCLOSED: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ NAME:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( L as t ) ( F i r s t ) ( Mi ddl e ) ( Ti t l e/De gr e e ( s ) []PROFESSI ONALADDRESS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( Pos i t i on) ( I ns t i t ut i on) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( St r e e tAddr e s s ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( Ci t y ) ( St at eorPr ov i nc e ) ( Count r y ) ( Pos t al Code ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( Te l e phone ) ( Ex t e ns i on) ( F ax ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ RED ( Emai l )REQUI []HOMEADDRESS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( St r e e tAddr e s s ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( Ci t y ) ( St at eorPr ov i nc e ) ( Count r y ) ( Pos t al Code ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( Te l e phone ) ( Ex t e ns i on) ( F ax ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ RED ( Emai l )REQUI
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1 4 5KI MELPARKDRI VE WI NSTONSAL EM, NC2 7 1 0 3 PHONE: ( 4 0 1 )6 1 9 4 6 8 2 F AX: ( 7 2 7 )3 6 2 6 2 1 0 EMAI L : ROBI N ROBI NHOY L E. COM
APPLI CATI ONFORMEMBERSHI P| HEALTHCAREPROFESSI ONAL EDUCATI ON ( YOUMAYATTACHACV) I NSTI TUTI ON/PROGRAM CI TY/ STATE
DEGREE
DATES
Pr emedi c al _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Medi c al _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Res i denc y( I FAPPLI CABLE) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Fel l ows hi p( I FAPPLI CABLE) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I nTr ai ni ng:WHENDOYOUEXPECTTOGRADUATE? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PRACTI CEWEBSI TE: ( REQUI RED) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Bys ubmi t t i nganappl i c at i onf orme mbe r s hi pt oThePai nSoc i e t yoft heCar ol i nas , I agr e et oabi deby t heBy L aws ,andc ont r i but et ot hes oc i e t ybys ubmi t t i ngpape r s ,e nt e r i ngi nt odi s c us s i ons ,and par t i c i pat i ngi nPSoCe ndor s e dandpl anne dac t i v i t i e s . SI GNATURE_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _DATE_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PRI NTNAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PLEASEMAI LCOMPLETEDAPPLI CATI ONANDPAYMENTTO: ThePai nSoc i et yoft heCar ol i nas ( TaxI dNo:271883948) At t n:Member s hi p 145Ki mel Par kDr i ve,Sui t e330 Wi ns t onSal em NC27103
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REGI STRATI ON MD/PHD/DO/PHARMD
REGI STRATI ONFEE$500 SATURDAYPM HANDSONWORKSHOP FORMD/DOFEE$1 00
MI LI TARY/VA/MD/DO/PHD/PHARM D MI LI TARYVAMDFEE$400 HANDSONWORKSHOPFEE$1 00
PA/RN/NP/PT/HCP REGI STRATI ONFEE$300
MI LI TARYVAHCP
REGI STRATI ONFEE$250
TRAI NEE
REGI STRATI ONFEE$1 00
GUESTNONMEDI CAL REGI STRATI ONFEE$1 00
rd i B y on Earl trati s i g ! e e r R e H k c i Cl