2016 Maintaining Proper Boundaries
Sponsored by Vanderbilt University School of Medicine and the Center for Professional Health.
Vanderbilt University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide
continuing medical Education for physicians.
The cost is $2500 (includes continental breakfast, lunches, and CME fees). You may pay via credit card, check, or money order.
Credit card payments are accepted on line only. We cannot accept credit cards on site. There is an additional
processing fee of $25.00 for credit card transactions. If you wish to pay via check, please make your check payable to VUMC and
mail to the address below.
Target Audience: Physicians and other health care professionals referred to the course by State Medical Boards and Physician
Health Programs for boundary violations and those interested in increasing knowledge regarding State and Federal regulations
regarding appropriate professional boundaries.
You may register on our website: www.mc.vanderbilt.edu/cph or complete this form and mail or fax (615.936.0676) to the CPH.
Each course is limited to 14 participants. Please contact us to confirm availability. Your registration confirmation will
be sent via e-mail.
NAME:
SUFFIX (MD, PhD, etc.): ___________________
SPECIALTY: ____________________________
ADDRESS:
PHONE:
FAX:
E-MAIL:
REFERRED BY:
EMERGENCY CONTACT: __________________________ PHONE: _______________
2016 COURSE DATES: (Please select)
February 17-19
March 30-April 1
August 24-26
October 5-7
We provide a continental breakfast and box lunch daily. If you have special dietary requirements, please let us know.
_______________________________________
The daily course schedule (subject to change), goals, and objectives are available on our website.
Cancellation Policy: Registration must be cancelled at least 30 days prior to the first day of the course to receive a refund. A processing
fee of $300 will be deducted from refund requests. NO REFUNDS WILL BE GIVEN IF CANCELLATION IS RECEIVED LESS THAN 30
DAYS PRIOR TO THE COURSE. Your registration may be transferred to another person or another course date. In the event Vanderbilt
must cancel or reschedule this CME activity due to unforeseen circumstances, Vanderbilt University will refund the registration fee in full.
Vanderbilt University is not responsible for non-transferable, non-refundable airline tickets or hotel accommodations purchased in
connection with attendance at this CME activity. Failure to appear for the event will result in forfeiture of the entire course fee.
Payment Options:
Credit Card (online only) - $2525
Check/money order payable to VUMC - $2500
Vanderbilt Center for Professional Health (CPH)
1107 Oxford House · Nashville TN 37232-4300
E-MAIL: CPH@vanderbilt.edu
WEB SITE: www.mc.vanderbilt.edu/cph
Phone: 615.936.0678