Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
Westin Galleria
Dallas, Texas
Register on-line at
www.utsouthwestern.edu/paulcpetersurologysymposium
Sponsored by
UT Southwestern Department of Urology
and the Office of Continuing Medical Education
Friday-Sunday
February 1-3, 2013
Urology
Symposium
Westin Galleria
13340 Dallas Parkway
Dallas, TX 75240
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PCPeters_2013_PCPeters_2013 10/22/12 3:34 PM Page 1
PCPeters_2013_PCPeters_2013 10/22/12 3:34 PM Page 2
19th Annual
Paul C. Peters Urology Symposium
Agenda
Friday, February 1, 2013 - Morning
8:00 am
Target Audience
The symposium is designed for urologists and urologic allied health 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 describe and discuss:
• Discuss management of non-muscle invasive bladder cancer
• Discuss management of locally advanced bladder cancer
• Review applications of MRI to management of urologic cancers
• Discuss management of post-prostatectomy sexual dysfunction
• Identify medical issues pertinent to urologic care of a geriatric patient
• Describe medical and surgical approaches to management of
vaginal mesh and sling complications
• Explain minimally invasive approaches in management of kidney
cancer
• Recognize organ sparing options for penile cancer
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
Westin Galleria
13340 Dallas Parkway
Dallas, Texas 75240
(972) 934-9494
(972) 851-2869
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 13 contact hours.
Conflict of Interest
It is UT Southwestern’s policy that participants in CME activities should be made
aware of any affiliation or financial interest that may affect the speaker’s presentation(s).
Each speaker has completed and signed a conflict of interest statement. The faculty
members’ relationships will be disclosed in the course syllabus.
Discussion of Off-Label Use
Because 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
presentations. Speakers have been requested to inform the audience when off-label
use is being 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. We are unable to process
any registration without payment. Please register early. We cannot guarantee course
materials on site to anyone registering later than January 18, 2013.
Refund Policy
A $50 handling fee will be deducted from cancellation refunds. Refund requests
must be received by mail or fax prior to January 18, 2013. No refunds will be
made thereafter.
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 make this necessary.
ADVANCES IN UROLOGIC RECONSTRUCTION AND
PROSTHETICS
8:30 am
FEMALE UROLOGY
Impact of FDA Notifications on Tape and Mesh Placement
- Gary Lemack, Eric Rovner, Philippe Zimmern
9:30 am
PROSTHETICS
Defining Satisfaction with Penile Implant Surgery - John Mulhall
10:00 am
Surgical Videos- Submuscular Reservoir Placement - Allen Morey
Accommodations
10:15 am
Break
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.
10:45 am
CASE DISCUSSIONS - Complex cases…
(participants encouraged to submit their cases in advance of the
meeting)
12:00 pm
Lunch
Optional Lecture, Non-CME:
(title and speaker name to be determined)
A special rate of $189 plus applicable state and local taxes has been secured for this
meeting, for reservations booked before Thursday, January 3, 2013. Reservations made
after Thursday, January 3, 2013 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: 19th Annual Paul C. Peters Urology Symposium”.
Westin Galleria
13340 Dallas Parkway, Dallas, Texas 75240
Phone: 972-934-9494, Fax: 972-851-2869
Rate: $189.00 (Single/Double)
Credit Designation
The University of Texas Southwestern Medical Center designates this
live activity for a maximum of 16 AMA PRA Category 1 Credit(s)™
and 1 hour of medical ethics. Physicians should only claim credit commensurate
with the extent of their participation in the activity.
Registration and Breakfast
Perot Museum of Nature
and Science
2201 N. Field Street
Dallas, TX 75202
www.perotmuseum.org
The Perot Museum of Nature and Science will offer dynamic experiences to stimulate curiosity in visitors of all ages. With 180,000 square feet of space, standing
170 feet tall (equivalent to an average 14-story building) the revolutionary Perot
Museum extends beyond the typical "museum" perception. The extraordinary
HYPERLINK "/explore-the-museum/building/index.html"building and outdoor
space will serve as a living science lesson, offering provocative illustrations of
engineering, technology and conservation.
9:10 am
Upper Urinary Tract Cancer: Tips for Diagnosis, Staging and Maximizing
Oncologic Outcomes - Vitaly Margulis
9:30 am
Non-ED Sexual Dysfunction After Radical Prostatectomy - John Mulhall
10:00 am
Break
10:30 am
Dermatopathology for Urologist: What it Looks Like and What It Is!
- Clay Cockerell
11:30 am
Post-Operative Care of the Geriatric Patient - Vivyenne Roche
Case Discussion – Eric Rovner, Philippe Zimmern
12:30 pm
Lunch
Saturday, February 2, 2013 - Afternoon
1:30 pm
BREAKOUT SESSION:
I.
MALE SEXUAL DYSFUNCTION
a. Management of delayed orgasm: a clinical conundrum
b. A critical analysis of penile length loss and penile rehabilitation in
the prostate cancer patient
c. Surgical management of Peyronie’s disease via penile plication
- Allen Morey, John Mulhall
II. STONE MANAGEMENT – CHALLENGING CASES
– Margaret Pearle
III. FEMALE UROLOGY
a. Contemporary management of the Overactive bladder
– Gary Lemack, Eric Rovner
3:00 pm
Break
3:30 pm
PEDIATRIC UROLOGY
Transitional Adolescent Urological Care - Linda Baker, Warren Snodgrass
4:00 pm
CURRENT STATUS OF FOCAL THERAPY IN PROSTATE CANCER
- Claus Roehrborn
5:30 pm
Adjourn
6:00 pm
Alumni Reception at the Galleria
Friday, February 1, 2013 - Afternoon
12:00 pm
General Session Registration
1:00 am
Chairman Introduction - Claus Roehrborn
1:20 am
THE SPENCE LECTURE– Tribute to Dr Allen - Arthur Sagalowsky
2:00 pm
NON-MUSCLE INVASIVE BLADDER CANCER
Moderator: Yair Lotan
Practical Approach to Urine Markers - Yair Lotan
2:30 pm
Beyond Traditional White Light Cystoscopy – Fluorescence
and Narrow Band Imaging
- Arthur Sagalowsky
3:00 pm
Intravesical Therapy – What, When, and for How Long? - Michael O’Donnell
3:00 pm
Break
4:00 pm
Advanced Urologic Imaging – Clinical Promise VS. Real Life
Applications
- Ivan Pedrosa, Claus Roehrborn
5:00 pm
Adjourn
6:30 pm
Reception - Perot Museum
Saturday, February 2, 2013 - Morning
7:30 am
8:30 am
8:50 am
Breakfast and Business Meeting for Alumni
Continental Breakfast for Course Attendees
Sunday, February 3, 2013 - Morning
7:30 am
Registration & Continental Breakfast
8:15 am
ETHICS LECTURE
Medical Experimentation in Nazi Germany - Zsuzsanna Ozsvát
9:15 am
Tissue Biomarkers and Prostate Cancer: Recent Advances - Franto Francis
10:15 am
Break
10:30 am
CONCLUDING REMARKS - Claus Roehrborn
10:40 am
ADVANCED UROTHELIAL CANCER
Moderator: Ganesh Raj
Robotic Cystectomy – Ready for Prime Time? - Ganesh Raj
MY APPROACH TO MANAGEMENT OF URETHRAL SLING COMPLICATIONS
- Philippe Zimmern, Gary Lemack
11:15 am
CHALLENGING CASES IN PROSTATE CANCER – MANAGEMENT DEBATE
- Claus Roehrborn, Ganesh Raj, Vitaly Margulis
Update on Systemic Therapy: Drugs, Timing, Patient Selection
- Michael O’Donnell
12:00 pm
Adjourn
Additional Information
For additional information, please call The Office of Continuing Medical
Education, 214-648-3138, 1-800-688-8678, or email
cmeregistrations@utsouthwestern.edu.
Course Directors
UT Southwestern Faculty
Claus Roehrborn, M.D.
Professor & Chairman, Department of Urology
UT Southwestern Medical Center, Dallas, TX
Linda Baker, M.D.
Professor, Department of Urology
Philippe Zimmern, M.D.
Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
Vitaly Margulis, M.D.
Assistant Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
To obtain information on other UT Southwestern programs, you can
access the Office of Continuing Medical Education’s home page at
www.utsouthwestern.edu/cme
Guest Faculty
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
John P. Mulhall, M.D.
Professor of Urology
Male Sexual & Reproductive Medicine Program
Memorial Sloan Kettering Cancer Center
New York, NY
Program Accessibility
Michael A. O'Donnell, M.D.
Professor of Urology
Department of Urology
University of Iowa
Iowa City, IA
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.
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.
UT Southwestern is an equal opportunity institution.
Future Meeting Date
20th Annual
Paul C. Peters
Urology Symposium
Westin Galleria
January 31- February 2, 2014
Clay Cockerell, M.D.
Clinical Professor, Department of Dermatology
Franto Francis, M.D., Ph.D.
Assistant Professor, Department of Pathology
Gary E. Lemack, M.D.
Professor, Department of Urology
Yair Lotan, M.D.
Professor, Department of Urology
Allen F. Morey, M.D.
Professor, Department of Urology
Ivan Pedrosa, M.D.
Associate Professor, Department of Radiology
Margaret S. Pearle, M.D., Ph.D
Professor, Department of Urology
Ganesh Raj, M.D., Ph.D
Assistant Professor, Department of Urology
Zsuzsanna Ozsváth, Ph.D.
Professor of Literature and History
Leah and Paul Lewis Chair of Holocaust Studies
University of Texas
Dallas, TX
Vivyenne Roche, M.D.
Associate Professor, Department of Internal Medicine
Eric S. Rovner, M.D.
Professor of Urology
Department of Urology
Medical University of South Carolina
Charleston, SC
Warren Snodgrass, M.D.
Professor, Department of Urology
Arthur I. Sagalowsky, M.D.
Professor, Department of Urology
PCPeters_2013_PCPeters_2013 10/22/12 3:34 PM Page 2
19th Annual
Paul C. Peters Urology Symposium
Agenda
Friday, February 1, 2013 - Morning
8:00 am
Target Audience
The symposium is designed for urologists and urologic allied health 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 describe and discuss:
• Discuss management of non-muscle invasive bladder cancer
• Discuss management of locally advanced bladder cancer
• Review applications of MRI to management of urologic cancers
• Discuss management of post-prostatectomy sexual dysfunction
• Identify medical issues pertinent to urologic care of a geriatric patient
• Describe medical and surgical approaches to management of
vaginal mesh and sling complications
• Explain minimally invasive approaches in management of kidney
cancer
• Recognize organ sparing options for penile cancer
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
Westin Galleria
13340 Dallas Parkway
Dallas, Texas 75240
(972) 934-9494
(972) 851-2869
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 13 contact hours.
Conflict of Interest
It is UT Southwestern’s policy that participants in CME activities should be made
aware of any affiliation or financial interest that may affect the speaker’s presentation(s).
Each speaker has completed and signed a conflict of interest statement. The faculty
members’ relationships will be disclosed in the course syllabus.
Discussion of Off-Label Use
Because 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
presentations. Speakers have been requested to inform the audience when off-label
use is being 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. We are unable to process
any registration without payment. Please register early. We cannot guarantee course
materials on site to anyone registering later than January 18, 2013.
Refund Policy
A $50 handling fee will be deducted from cancellation refunds. Refund requests
must be received by mail or fax prior to January 18, 2013. No refunds will be
made thereafter.
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 make this necessary.
ADVANCES IN UROLOGIC RECONSTRUCTION AND
PROSTHETICS
8:30 am
FEMALE UROLOGY
Impact of FDA Notifications on Tape and Mesh Placement
- Gary Lemack, Eric Rovner, Philippe Zimmern
9:30 am
PROSTHETICS
Defining Satisfaction with Penile Implant Surgery - John Mulhall
10:00 am
Surgical Videos- Submuscular Reservoir Placement - Allen Morey
Accommodations
10:15 am
Break
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.
10:45 am
CASE DISCUSSIONS - Complex cases…
(participants encouraged to submit their cases in advance of the
meeting)
12:00 pm
Lunch
Optional Lecture, Non-CME:
(title and speaker name to be determined)
A special rate of $189 plus applicable state and local taxes has been secured for this
meeting, for reservations booked before Thursday, January 3, 2013. Reservations made
after Thursday, January 3, 2013 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: 19th Annual Paul C. Peters Urology Symposium”.
Westin Galleria
13340 Dallas Parkway, Dallas, Texas 75240
Phone: 972-934-9494, Fax: 972-851-2869
Rate: $189.00 (Single/Double)
Credit Designation
The University of Texas Southwestern Medical Center designates this
live activity for a maximum of 16 AMA PRA Category 1 Credit(s)™
and 1 hour of medical ethics. Physicians should only claim credit commensurate
with the extent of their participation in the activity.
Registration and Breakfast
Perot Museum of Nature
and Science
2201 N. Field Street
Dallas, TX 75202
www.perotmuseum.org
The Perot Museum of Nature and Science will offer dynamic experiences to stimulate curiosity in visitors of all ages. With 180,000 square feet of space, standing
170 feet tall (equivalent to an average 14-story building) the revolutionary Perot
Museum extends beyond the typical "museum" perception. The extraordinary
HYPERLINK "/explore-the-museum/building/index.html"building and outdoor
space will serve as a living science lesson, offering provocative illustrations of
engineering, technology and conservation.
9:10 am
Upper Urinary Tract Cancer: Tips for Diagnosis, Staging and Maximizing
Oncologic Outcomes - Vitaly Margulis
9:30 am
Non-ED Sexual Dysfunction After Radical Prostatectomy - John Mulhall
10:00 am
Break
10:30 am
Dermatopathology for Urologist: What it Looks Like and What It Is!
- Clay Cockerell
11:30 am
Post-Operative Care of the Geriatric Patient - Vivyenne Roche
Case Discussion – Eric Rovner, Philippe Zimmern
12:30 pm
Lunch
Saturday, February 2, 2013 - Afternoon
1:30 pm
BREAKOUT SESSION:
I.
MALE SEXUAL DYSFUNCTION
a. Management of delayed orgasm: a clinical conundrum
b. A critical analysis of penile length loss and penile rehabilitation in
the prostate cancer patient
c. Surgical management of Peyronie’s disease via penile plication
- Allen Morey, John Mulhall
II. STONE MANAGEMENT – CHALLENGING CASES
– Margaret Pearle
III. FEMALE UROLOGY
a. Contemporary management of the Overactive bladder
– Gary Lemack, Eric Rovner
3:00 pm
Break
3:30 pm
PEDIATRIC UROLOGY
Transitional Adolescent Urological Care - Linda Baker, Warren Snodgrass
4:00 pm
CURRENT STATUS OF FOCAL THERAPY IN PROSTATE CANCER
- Claus Roehrborn
5:30 pm
Adjourn
6:00 pm
Alumni Reception at the Galleria
Friday, February 1, 2013 - Afternoon
12:00 pm
General Session Registration
1:00 am
Chairman Introduction - Claus Roehrborn
1:20 am
THE SPENCE LECTURE– Tribute to Dr Allen - Arthur Sagalowsky
2:00 pm
NON-MUSCLE INVASIVE BLADDER CANCER
Moderator: Yair Lotan
Practical Approach to Urine Markers - Yair Lotan
2:30 pm
Beyond Traditional White Light Cystoscopy – Fluorescence
and Narrow Band Imaging
- Arthur Sagalowsky
3:00 pm
Intravesical Therapy – What, When, and for How Long? - Michael O’Donnell
3:00 pm
Break
4:00 pm
Advanced Urologic Imaging – Clinical Promise VS. Real Life
Applications
- Ivan Pedrosa, Claus Roehrborn
5:00 pm
Adjourn
6:30 pm
Reception - Perot Museum
Saturday, February 2, 2013 - Morning
7:30 am
8:30 am
8:50 am
Breakfast and Business Meeting for Alumni
Continental Breakfast for Course Attendees
Sunday, February 3, 2013 - Morning
7:30 am
Registration & Continental Breakfast
8:15 am
ETHICS LECTURE
Medical Experimentation in Nazi Germany - Zsuzsanna Ozsvát
9:15 am
Tissue Biomarkers and Prostate Cancer: Recent Advances - Franto Francis
10:15 am
Break
10:30 am
CONCLUDING REMARKS - Claus Roehrborn
10:40 am
ADVANCED UROTHELIAL CANCER
Moderator: Ganesh Raj
Robotic Cystectomy – Ready for Prime Time? - Ganesh Raj
MY APPROACH TO MANAGEMENT OF URETHRAL SLING COMPLICATIONS
- Philippe Zimmern, Gary Lemack
11:15 am
CHALLENGING CASES IN PROSTATE CANCER – MANAGEMENT DEBATE
- Claus Roehrborn, Ganesh Raj, Vitaly Margulis
Update on Systemic Therapy: Drugs, Timing, Patient Selection
- Michael O’Donnell
12:00 pm
Adjourn
Additional Information
For additional information, please call The Office of Continuing Medical
Education, 214-648-3138, 1-800-688-8678, or email
cmeregistrations@utsouthwestern.edu.
Course Directors
UT Southwestern Faculty
Claus Roehrborn, M.D.
Professor & Chairman, Department of Urology
UT Southwestern Medical Center, Dallas, TX
Linda Baker, M.D.
Professor, Department of Urology
Philippe Zimmern, M.D.
Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
Vitaly Margulis, M.D.
Assistant Professor, Department of Urology
UT Southwestern Medical Center, Dallas, TX
To obtain information on other UT Southwestern programs, you can
access the Office of Continuing Medical Education’s home page at
www.utsouthwestern.edu/cme
Guest Faculty
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
John P. Mulhall, M.D.
Professor of Urology
Male Sexual & Reproductive Medicine Program
Memorial Sloan Kettering Cancer Center
New York, NY
Program Accessibility
Michael A. O'Donnell, M.D.
Professor of Urology
Department of Urology
University of Iowa
Iowa City, IA
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.
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.
UT Southwestern is an equal opportunity institution.
Future Meeting Date
20th Annual
Paul C. Peters
Urology Symposium
Westin Galleria
January 31- February 2, 2014
Clay Cockerell, M.D.
Clinical Professor, Department of Dermatology
Franto Francis, M.D., Ph.D.
Assistant Professor, Department of Pathology
Gary E. Lemack, M.D.
Professor, Department of Urology
Yair Lotan, M.D.
Professor, Department of Urology
Allen F. Morey, M.D.
Professor, Department of Urology
Ivan Pedrosa, M.D.
Associate Professor, Department of Radiology
Margaret S. Pearle, M.D., Ph.D
Professor, Department of Urology
Ganesh Raj, M.D., Ph.D
Assistant Professor, Department of Urology
Zsuzsanna Ozsváth, Ph.D.
Professor of Literature and History
Leah and Paul Lewis Chair of Holocaust Studies
University of Texas
Dallas, TX
Vivyenne Roche, M.D.
Associate Professor, Department of Internal Medicine
Eric S. Rovner, M.D.
Professor of Urology
Department of Urology
Medical University of South Carolina
Charleston, SC
Warren Snodgrass, M.D.
Professor, Department of Urology
Arthur I. Sagalowsky, M.D.
Professor, Department of Urology
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
Westin Galleria
Dallas, Texas
Register on-line at
www.utsouthwestern.edu/paulcpetersurologysymposium
Sponsored by
UT Southwestern Department of Urology
and the Office of Continuing Medical Education
Friday-Sunday
February 1-3, 2013
Urology
Symposium
Westin Galleria
13340 Dallas Parkway
Dallas, TX 75240
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Blvd.30 31
Dallas, Texas 75390-9059
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NONPROFIT ORG.
U.S. POSTAGE
PAID
DALLAS, TEXAS
PERMIT NO.2993
Not printed or mailed at State expense
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PCPeters_2013_PCPeters_2013 10/22/12 3:34 PM Page 1
PCP_Registration_Insert2013_PCP_Registration_Insert2013 10/22/12 3:24 PM Page 1
FAX/SCAN/EMAIL
19th Annual
Paul C. Peters
Urology Symposium
R E G I S T R AT I O N F O R M
February 1-3, 2013
#RP1302A
Register on-line at
utsouthwestern.edu/paulcpetersurologysymposium
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Please indicate preferred method to receive registration confirmation:
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❏ Check here to receive our free monthly email calendar of upcoming CME activities.
Registration Fees:
____
____
____
____
____
$445 (Physicians)
$375 (UT Southwestern Alumni)
$225 (Nurse)
$300 (Baylor Physicians)
Complimentary (UTSW Urology Faculty & UTSW Nurse)
Friday Night Dinner at the Perot Museum of Nature and Science
____ I will be attending – $35
____ I will be attending with a guest – $35 per attendee
____ I will not be attending
Method of Payment:
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❏ CHECK
If paying by check make checks payable to:
UT Southwestern/CME
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 $25 handling fee will be deducted from cancellation refunds. Refund requests must be
received by mail or FAX prior to January 30, 2013. 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.