E d u c a t i o n a l P ro g r a m s f o r 2014
20th Annual
Paul C. Peters
Urology Symposium
31 1
2
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28
January
FEBRUARY 2014
Urology
Symposium
20th Annual Paul C. Peters
Time Sensitive Material
Not printed or mailed at State expense
Office of Continuing Medical Education
5323 Harry Hines Blvd.
Dallas, Texas 75390-9059
NONPROFIT
US POSTAGE
PAID
TWMS
Friday-Sunday
January 31- February 2, 2014
20th Annual
Paul C. Peters
Westin Galleria
13340 Dallas Parkway
Dallas, Texas
Urology
Symposium
Friday-Sunday
January 31- February 2, 2014
Westin Galleria
Dallas, Texas
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
Sponsored by
UT Southwestern Department of Urology
and the Office of Continuing Medical Education
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
20th Annual
Paul C. Peters Urology Symposium
Target Audience
The symposium is designed for urologists and urologic healthcare professionals who
wish to enhance their knowledge of the current diagnostic and therapeutic modalities in urology.
Purpose and Content
This symposium will review current recommendations, issues, and controversies in the
management of urologic conditions, with an emphasis on topics relevant to the general
urologist. Breakout sessions will focus on the management and therapeutic modalities of
selected disease processes. Additionally, management of practical cases in urology will be
reviewed, with audience participation.
Educational Objectives
Upon completion of this symposium, the participants should be able to link the
educational objectives to Core Competencies (Medical Knowledge and Patient Care)
and be able to:
• Discuss management of advanced prostate cancer
• Discuss management of early stage kidney cancer
• Review applications of MRI to management of urologic cancers
• Discuss management of balanitis xerotica obliterans and penile
curvature disorders
• Describe medical and surgical approaches to management of vaginal
mesh and sling complications
• Review the concepts involved in cancer survivorship
• Identify the latest development in care of patients with benign
prostatic disease
• Review the latest developments and treatment strategies for the
overactive bladder
• Identify the need for more hospital transparency in data reporting
to allow better consumer choice regarding their health needs
Accreditation
The University of Texas Southwestern Medical Center is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to provide
continuing medical education for physicians.
Location and
Accommodations
Westin Galleria
13340 Dallas Parkway
Dallas, Texas 75240
(972) 934-9494
(972) 851-2869
The Westin Galleria Dallas puts you in
the middle of everything Dallas has to offer. Enjoy access to the best shopping, dining, and entertainment in prestigious North Dallas. Our hotel is located within the
impressive Galleria shopping center with over 200 shops, restaurants, and attractions
all just an elevator ride away.
A special rate of $189 plus applicable state and local taxes has been secured for this
meeting, for reservations booked before Thursday, January 3, 2014. Reservations made
after Thursday, January 3, 2014 are subject to prevailing rates and availability. All guests
shall make reservations directly with the Hotel or through The Central Reservation Office,
at 1-888-627-8536 on an individual basis, identifying themselves as members of “UTSW
MEDICAL CENTER AT DALLAS: 20th Annual Paul C. Peters Urology Symposium.”
Westin Galleria
Rate: $189.00 (Single/Double)
The Hall of State
3939 Grand Avenue
Dallas, TX 75210
Credit Designation
The University of Texas Southwestern Medical Center designates this live activity for a
maximum of 17.50 AMA PRA Category 1 Credit(s)™ and 1 hour of medical ethics.
Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Texas Southwestern Medical Center designates
the presentation titled "How Patients Choose Us: Medicine's New Era of Transparency
and Quality" for 1 hour in medical ethics and/or professional responsibility.
UT Southwestern University Hospitals is an approved provider of continuing nursing
education by the Texas Nurses Association, an accredited approver by the American
Nurses Credentialing Center’s Commission on Accreditation.
This activity provides 17.50 contact hours.
Its original name was the State of Texas Building. Eventually designed by Donald
Barthelme, the building is a premier example of Cret's Modernism. That is a reference to noted designer Paul Cret, who was the design consultant for the project. The design blends classicism and Art Deco – with a few Texas motifs (cacti,
oil wells) tossed in for good measure. Crafted from Texas limestone, The Hall of
State was, at a cost of $1.2 million, the most expensive building per square foot
built in Texas at the time. The signature element of the building's exterior is the
11-foot-tall statue of a Tejas Indian poised above the main entrance. Artist Allie
Tennant made the statue of bronze and covered it with gold leaf. Meanwhile, the
bronze doors feature designs that represent Texas industries and activities – a
cowboy's lariat, cotton bolls and wheat sheaves, among others. 59 Texans are
honored in the frieze around the top of the building.
Agenda
Friday Morning, January 31, 2014
8:00 am
Discussion of Off-Label Use
This course is meant to educate physicians with what is currently in use and what may
be available in the future. There may be “off-label” use discussed in the activity.
Speakers have been requested to inform the audience when off-label use is discussed.
Registration
The registration fee entitles the participant admission to the conference, all course
materials, continental breakfast, lunch and refreshment breaks during the meeting.
Enrollment is confirmed upon receipt of registration fee. Registration cannot be
processed without payment. Please register early. Course materials are not guaranteed
for registrations received after January 17, 2014.
Refund Policy
A $50 handling fee will be deducted from cancellation refunds. Refund requests
must be received by email or fax prior to January 17, 2014. No refunds will be
made thereafter.
8:30 am
FEMALE UROLOGY
Urodynamic Guidelines - Gary Lemack
Update on Robotics in Female Pelvic Medicine and Reconstructive Surgery
- Maude Carmel
Mesh Controversy - Philippe Zimmern
Cancellation Policy
The Office of Continuing Medical Education reserves the right to limit registration
and cancel courses, no less than one week prior to the course, should circumstances deem necessary.
II.
Challenging Cases in Urothelial Cancer
– Yair Lotan/Vitaly Margulis/Arthur Sagalowsky
III. Contemporary Management of Overactive Bladder
– Gary Lemack/Maude Carmel/Philippe Zimmern
3:00 pm
Break
10:00 am
Buried Penis: Reconstruction Armamentarium - Allen Morey/Ronald Hoxworth
3:30 pm
Advanced Prostatic Imaging – Integration into Clinical Practice
- Claus Roehrborn/Ivan Pedrosa/ Inderbir Gill
10:30 am
Break
10:45 am
Fellows Forum--Reconstructive Urology Case Discussions
- Andrew Peterson
4:30 pm
Metastatic Castration Resistant Prostate Cancer – Urologic Perspective
- Ganesh Raj
12:00 pm
Adjourn
5:30 pm
Adjourn
6:00 pm
Dinner/Speaker - Hall of State, Fair Park, Dallas
Friday Afternoon, January 31, 2014
12:00 pm
1:00 pm
Sunday Morning, February 3, 2014
Registration
7:30 am
Chairman Introduction - Claus Roehrborn
1:20 pm
Live Reconstructive Case - Andrew Peterson
3:00 pm
Cancer Survivorship – What is New for the Urologist - Andrew Peterson
3:30 pm
Live Endoscopy Case - Jodi Antonelli
4:30 pm
Evolving Techniques and Concepts in Nephron Sparing Surgery
- Inderbir Gill
5:30 pm
Adjourn
Alumni Reception - Westin Galleria Dallas
Registration & Continental Breakfast
ETHICS LECTURE: Moderator - Jennifer Wimberly, M.D.
8:30 am
How Patients Choose Us: Medicine's New Era of Transparency and Quality
- Martin Makary
9:30 am
UPDATES ON MANAGEMENT OF A SMALL RENAL MASS
I. ACTIVE SURVEILLANCE
– Vitaly Margulis
II.
Saturday Morning, February 1, 2014
7:30 am
Breakfast and Business Meeting for Alumni
Continental Breakfast for Course Attendees
8:30 am
Live Oncology Cases - Yair Lotan/ Inderbir Gill/Jeffrey Gahan
10:45 am
Break
11:00 am
AUA Guidelines on Prostate Cancer Update
- Yair Lotan
11:30 am
Management of BPH – What is New?
- Claus Roehrborn
Break
11:00 am
The Making of the World Health Organization Surgical Checklist
- Martin Makary
11:45 am
Application of MRI-TRUS Fusion in Management of Prostate Cancer Patients 12:30 pm
- Inderbir Gill
12:30 pm
Lunch
Adjourn
Course Directors
UT Southwestern Faculty
Claus Roehrborn, M.D.
Professor & Chairman, Department of Urology
UT Southwestern Medical Center, Dallas, TX
Jodi Antonelli, M.D.
Assistant Professor, Department of Urology
Vitaly Margulis, M.D.
Assistant Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
To obtain information on other UT Southwestern programs, visit the Office of
Continuing Medical Education’s website at www.utsouthwestern.edu/cme.
Philippe Zimmern, M.D.
Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
For a free email subscription of The Office of Continuing Medical
Education’s monthly calendar, send your name, medical specialty, and current
email address to: cmecalendar@utsouthwestern.edu
Guest Faculty
Inderbir Gill, M.D.
Chair, Department of Urology
Associate Dean for Clinical Innovation
USC Institute of Urology
Los Angeles, CA
Program Accessibility
We accommodate people with disabilities. Please call 214-648-3138 for more
information, or mark the space indicated on the registration form. To ensure
accommodation, please register as soon as possible.
20th Annual
Paul C. Peters
Urology Symposium
THERMAL ABLATION
– Jeffrey Cadeddu
III. SURGICAL APPROACHES
– Jeffrey Gahan
10:30 am
Additional Information
UT Southwestern is an equal opportunity institution.
BREAKOUT SESSION:
I. Challenges in Prosthetic Urology
- Allan Morey/Andrew Peterson
MALE GENITAL RECONSTRUCTION
Lichen Sclerosis: A Paradigm Shift in Treatment Options - Andrew Peterson
9:30 am
For additional information, please call The Office of Continuing Medical
Education, 214-648-3138, 1-800-688-8678, or email
cmeregistrations@utsouthwestern.edu.
The University of Texas Southwestern Medical Center is committed to providing
programs and activities to all persons regardless of race, color, national origin,
religion, sex, age, veteran status, or disability.
1:30 pm
ADVANCES IN UROLOGIC RECONSTRUCTION
Conflict of Interest
All persons in the position to control the content of an education activity are required
to disclose all relevant financial relationships in any amount occurring within the past
12 months with any entity producing, marketing, re-selling, or distributing health care
goods or services consumed by, or used on patients. A primary mechanism to resolve
identified conflicts of interest is a content review that is prior to the activity.
Saturday, February 2, 2014 - Afternoon
Registration and Breakfast
Martin Makary, M.D.
Associate Professor
Surgery and Public Health
Johns Hopkins University
Baltimore, MD
Andrew Peterson, M.D.
Associate Professor of Surgery
Duke Urology
A Division of the Department of Surgery
Duke University School of Medicine
Durham, NC
Jeffrey Cadeddu, M.D.
Professor, Department of Urology
Maude Carmel, M.D.
Assistant Professor, Department of Urology
Jeffrey Gahan, M.D.
Assistant Professor, Department of Urology
Ronald Hoxworth, M.D.
Associate Professor, Department of Plastic Surgery
Gary E. Lemack, M.D.
Professor, Department of Urology
Yair Lotan, M.D.
Professor, Department of Urology
Ryan Mauck, M.D.
Assistant Professor, Department of Urology
Allen F. Morey, M.D.
Professor, Department of Urology
Margaret S. Pearle, M.D., Ph.D.
Professor, Department of Urology
Ivan Pedrosa, M.D.
Associate Professor, Department of Radiology
Ganesh Raj, M.D., Ph.D
Associate Professor, Department of Urology
Arthur I. Sagalowsky, M.D.
Professor, Department of Urology
Jennifer Wimberly, M.D.
Assistant Professor, Department of Urology
20th Annual
Paul C. Peters Urology Symposium
Target Audience
The symposium is designed for urologists and urologic healthcare professionals who
wish to enhance their knowledge of the current diagnostic and therapeutic modalities in urology.
Purpose and Content
This symposium will review current recommendations, issues, and controversies in the
management of urologic conditions, with an emphasis on topics relevant to the general
urologist. Breakout sessions will focus on the management and therapeutic modalities of
selected disease processes. Additionally, management of practical cases in urology will be
reviewed, with audience participation.
Educational Objectives
Upon completion of this symposium, the participants should be able to link the
educational objectives to Core Competencies (Medical Knowledge and Patient Care)
and be able to:
• Discuss management of advanced prostate cancer
• Discuss management of early stage kidney cancer
• Review applications of MRI to management of urologic cancers
• Discuss management of balanitis xerotica obliterans and penile
curvature disorders
• Describe medical and surgical approaches to management of vaginal
mesh and sling complications
• Review the concepts involved in cancer survivorship
• Identify the latest development in care of patients with benign
prostatic disease
• Review the latest developments and treatment strategies for the
overactive bladder
• Identify the need for more hospital transparency in data reporting
to allow better consumer choice regarding their health needs
Accreditation
The University of Texas Southwestern Medical Center is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to provide
continuing medical education for physicians.
Location and
Accommodations
Westin Galleria
13340 Dallas Parkway
Dallas, Texas 75240
(972) 934-9494
(972) 851-2869
The Westin Galleria Dallas puts you in
the middle of everything Dallas has to offer. Enjoy access to the best shopping, dining, and entertainment in prestigious North Dallas. Our hotel is located within the
impressive Galleria shopping center with over 200 shops, restaurants, and attractions
all just an elevator ride away.
A special rate of $189 plus applicable state and local taxes has been secured for this
meeting, for reservations booked before Thursday, January 3, 2014. Reservations made
after Thursday, January 3, 2014 are subject to prevailing rates and availability. All guests
shall make reservations directly with the Hotel or through The Central Reservation Office,
at 1-888-627-8536 on an individual basis, identifying themselves as members of “UTSW
MEDICAL CENTER AT DALLAS: 20th Annual Paul C. Peters Urology Symposium.”
Westin Galleria
Rate: $189.00 (Single/Double)
The Hall of State
3939 Grand Avenue
Dallas, TX 75210
Credit Designation
The University of Texas Southwestern Medical Center designates this live activity for a
maximum of 17.50 AMA PRA Category 1 Credit(s)™ and 1 hour of medical ethics.
Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Texas Southwestern Medical Center designates
the presentation titled "How Patients Choose Us: Medicine's New Era of Transparency
and Quality" for 1 hour in medical ethics and/or professional responsibility.
UT Southwestern University Hospitals is an approved provider of continuing nursing
education by the Texas Nurses Association, an accredited approver by the American
Nurses Credentialing Center’s Commission on Accreditation.
This activity provides 17.50 contact hours.
Its original name was the State of Texas Building. Eventually designed by Donald
Barthelme, the building is a premier example of Cret's Modernism. That is a reference to noted designer Paul Cret, who was the design consultant for the project. The design blends classicism and Art Deco – with a few Texas motifs (cacti,
oil wells) tossed in for good measure. Crafted from Texas limestone, The Hall of
State was, at a cost of $1.2 million, the most expensive building per square foot
built in Texas at the time. The signature element of the building's exterior is the
11-foot-tall statue of a Tejas Indian poised above the main entrance. Artist Allie
Tennant made the statue of bronze and covered it with gold leaf. Meanwhile, the
bronze doors feature designs that represent Texas industries and activities – a
cowboy's lariat, cotton bolls and wheat sheaves, among others. 59 Texans are
honored in the frieze around the top of the building.
Agenda
Friday Morning, January 31, 2014
8:00 am
Discussion of Off-Label Use
This course is meant to educate physicians with what is currently in use and what may
be available in the future. There may be “off-label” use discussed in the activity.
Speakers have been requested to inform the audience when off-label use is discussed.
Registration
The registration fee entitles the participant admission to the conference, all course
materials, continental breakfast, lunch and refreshment breaks during the meeting.
Enrollment is confirmed upon receipt of registration fee. Registration cannot be
processed without payment. Please register early. Course materials are not guaranteed
for registrations received after January 17, 2014.
Refund Policy
A $50 handling fee will be deducted from cancellation refunds. Refund requests
must be received by email or fax prior to January 17, 2014. No refunds will be
made thereafter.
8:30 am
FEMALE UROLOGY
Urodynamic Guidelines - Gary Lemack
Update on Robotics in Female Pelvic Medicine and Reconstructive Surgery
- Maude Carmel
Mesh Controversy - Philippe Zimmern
Cancellation Policy
The Office of Continuing Medical Education reserves the right to limit registration
and cancel courses, no less than one week prior to the course, should circumstances deem necessary.
II.
Challenging Cases in Urothelial Cancer
– Yair Lotan/Vitaly Margulis/Arthur Sagalowsky
III. Contemporary Management of Overactive Bladder
– Gary Lemack/Maude Carmel/Philippe Zimmern
3:00 pm
Break
10:00 am
Buried Penis: Reconstruction Armamentarium - Allen Morey/Ronald Hoxworth
3:30 pm
Advanced Prostatic Imaging – Integration into Clinical Practice
- Claus Roehrborn/Ivan Pedrosa/ Inderbir Gill
10:30 am
Break
10:45 am
Fellows Forum--Reconstructive Urology Case Discussions
- Andrew Peterson
4:30 pm
Metastatic Castration Resistant Prostate Cancer – Urologic Perspective
- Ganesh Raj
12:00 pm
Adjourn
5:30 pm
Adjourn
6:00 pm
Dinner/Speaker - Hall of State, Fair Park, Dallas
Friday Afternoon, January 31, 2014
12:00 pm
1:00 pm
Sunday Morning, February 3, 2014
Registration
7:30 am
Chairman Introduction - Claus Roehrborn
1:20 pm
Live Reconstructive Case - Andrew Peterson
3:00 pm
Cancer Survivorship – What is New for the Urologist - Andrew Peterson
3:30 pm
Live Endoscopy Case - Jodi Antonelli
4:30 pm
Evolving Techniques and Concepts in Nephron Sparing Surgery
- Inderbir Gill
5:30 pm
Adjourn
Alumni Reception - Westin Galleria Dallas
Registration & Continental Breakfast
ETHICS LECTURE: Moderator - Jennifer Wimberly, M.D.
8:30 am
How Patients Choose Us: Medicine's New Era of Transparency and Quality
- Martin Makary
9:30 am
UPDATES ON MANAGEMENT OF A SMALL RENAL MASS
I. ACTIVE SURVEILLANCE
– Vitaly Margulis
II.
Saturday Morning, February 1, 2014
7:30 am
Breakfast and Business Meeting for Alumni
Continental Breakfast for Course Attendees
8:30 am
Live Oncology Cases - Yair Lotan/ Inderbir Gill/Jeffrey Gahan
10:45 am
Break
11:00 am
AUA Guidelines on Prostate Cancer Update
- Yair Lotan
11:30 am
Management of BPH – What is New?
- Claus Roehrborn
Break
11:00 am
The Making of the World Health Organization Surgical Checklist
- Martin Makary
11:45 am
Application of MRI-TRUS Fusion in Management of Prostate Cancer Patients 12:30 pm
- Inderbir Gill
12:30 pm
Lunch
Adjourn
Course Directors
UT Southwestern Faculty
Claus Roehrborn, M.D.
Professor & Chairman, Department of Urology
UT Southwestern Medical Center, Dallas, TX
Jodi Antonelli, M.D.
Assistant Professor, Department of Urology
Vitaly Margulis, M.D.
Assistant Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
To obtain information on other UT Southwestern programs, visit the Office of
Continuing Medical Education’s website at www.utsouthwestern.edu/cme.
Philippe Zimmern, M.D.
Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
For a free email subscription of The Office of Continuing Medical
Education’s monthly calendar, send your name, medical specialty, and current
email address to: cmecalendar@utsouthwestern.edu
Guest Faculty
Inderbir Gill, M.D.
Chair, Department of Urology
Associate Dean for Clinical Innovation
USC Institute of Urology
Los Angeles, CA
Program Accessibility
We accommodate people with disabilities. Please call 214-648-3138 for more
information, or mark the space indicated on the registration form. To ensure
accommodation, please register as soon as possible.
20th Annual
Paul C. Peters
Urology Symposium
THERMAL ABLATION
– Jeffrey Cadeddu
III. SURGICAL APPROACHES
– Jeffrey Gahan
10:30 am
Additional Information
UT Southwestern is an equal opportunity institution.
BREAKOUT SESSION:
I. Challenges in Prosthetic Urology
- Allan Morey/Andrew Peterson
MALE GENITAL RECONSTRUCTION
Lichen Sclerosis: A Paradigm Shift in Treatment Options - Andrew Peterson
9:30 am
For additional information, please call The Office of Continuing Medical
Education, 214-648-3138, 1-800-688-8678, or email
cmeregistrations@utsouthwestern.edu.
The University of Texas Southwestern Medical Center is committed to providing
programs and activities to all persons regardless of race, color, national origin,
religion, sex, age, veteran status, or disability.
1:30 pm
ADVANCES IN UROLOGIC RECONSTRUCTION
Conflict of Interest
All persons in the position to control the content of an education activity are required
to disclose all relevant financial relationships in any amount occurring within the past
12 months with any entity producing, marketing, re-selling, or distributing health care
goods or services consumed by, or used on patients. A primary mechanism to resolve
identified conflicts of interest is a content review that is prior to the activity.
Saturday, February 2, 2014 - Afternoon
Registration and Breakfast
Martin Makary, M.D.
Associate Professor
Surgery and Public Health
Johns Hopkins University
Baltimore, MD
Andrew Peterson, M.D.
Associate Professor of Surgery
Duke Urology
A Division of the Department of Surgery
Duke University School of Medicine
Durham, NC
Jeffrey Cadeddu, M.D.
Professor, Department of Urology
Maude Carmel, M.D.
Assistant Professor, Department of Urology
Jeffrey Gahan, M.D.
Assistant Professor, Department of Urology
Ronald Hoxworth, M.D.
Associate Professor, Department of Plastic Surgery
Gary E. Lemack, M.D.
Professor, Department of Urology
Yair Lotan, M.D.
Professor, Department of Urology
Ryan Mauck, M.D.
Assistant Professor, Department of Urology
Allen F. Morey, M.D.
Professor, Department of Urology
Margaret S. Pearle, M.D., Ph.D.
Professor, Department of Urology
Ivan Pedrosa, M.D.
Associate Professor, Department of Radiology
Ganesh Raj, M.D., Ph.D
Associate Professor, Department of Urology
Arthur I. Sagalowsky, M.D.
Professor, Department of Urology
Jennifer Wimberly, M.D.
Assistant Professor, Department of Urology
E d u c a t i o n a l P ro g r a m s f o r 2014
20th Annual
Paul C. Peters
Urology Symposium
31 1
2
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28
January
FEBRUARY 2014
Urology
Symposium
20th Annual Paul C. Peters
Time Sensitive Material
Not printed or mailed at State expense
Office of Continuing Medical Education
5323 Harry Hines Blvd.
Dallas, Texas 75390-9059
NONPROFIT
US POSTAGE
PAID
TWMS
Friday-Sunday
January 31- February 2, 2014
20th Annual
Paul C. Peters
Westin Galleria
13340 Dallas Parkway
Dallas, Texas
Urology
Symposium
Friday-Sunday
January 31- February 2, 2014
Westin Galleria
Dallas, Texas
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
Sponsored by
UT Southwestern Department of Urology
and the Office of Continuing Medical Education
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
FAX/SCAN/EMAIL
20th Annual
Paul C. Peters
Urology Symposium
R E G I S T R AT I O N F O R M
January 31-February 2, 2014
#RP1401A
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
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Registration Fees:
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$495 (Physicians)
$400 (UT Southwestern Alumni)
$250 (Nurse & Physician Assistant)
$325 (Baylor Physicians)
Complimentary (UTSW Urology Faculty & UTSW Nurse)
Friday Night Dinner at the Hall of State
____ I will be attending – $50
____ I will be attending with a guest – $50 per attendee
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Fax completed registration form to 214/648-4804.
Mail completed registration form to: UT Southwestern
Office of Continuing Medical Education
5323 Harry Hines Blvd., / Dallas, Texas 75390-9059
❏ Dietary Restrictions:
Refund Policy
A $50 cancellation fee will be deducted from cancellation refunds. Refund requests must be
received by mail or FAX prior to January 17, 2014. No refunds will be made thereafter.
ADA Statement ❏ Please check this box if you require assistance because of a disability to make this program
accessible to you. Someone from our office will be in touch with you.