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JOIN US

VENUEThe Ritz-Carlton Orlando, Grande Lakes 4012 Central Florida Parkway Orlando, Florida 32837 The Florida Society of Reproductive

Endocrinology and Infertility (FSREI) will hold their Annual Meeting – Reproductive Medicine Update: Including ART, PCOS

and Endometriosis in conjunction with the ACOG District XII 2014 Annual District Meeting on Saturday, August 16. This one-day conference will offer attendees CME, CE and Laboratory credit. FSREI attendees will receive a discounted rate to attend the ACOG District XII 2014 ADM on Friday and Sunday. For more details on the FSREI meeting or faculty visit: www.fsrei.org.

Florida Society of Reproductive Endocrinology and Infertility 2014 Annual Meeting

Robert W. Yelverton, MDACOG District XII Florida, Chair

Four-hour Coding Course for physicians and practice administrators focused on important coding and reimbursement topics; including discussion on the recent ICD-10 delay, led by coding expert Emily Hill, PA

Office Administrator Course designed specifically for the OB/GYN practice administrator

Medical Student Session—Navigating the Transition Between Student and PhysicianSaturday, August 16 | 2:45–4:45 pm

$50 per Medical StudentThe Medical Student Session will provide attendees with an introduction to the specialty of OB/GYN. This session will include a special presentation and panel discussion that will outline the training process, fellowships available, and career tracks available at the conclusion of training. The session will conclude with a variety of skill stations that will allow the students to actively participate and simulate many of the daily activities of an OB/GYN resident.

To make your reservations today, please call 1-800-266-9432 and ask for the ACOG room rate that starts at $169/night. The special discounted rate cannot be guaranteed after July 18, 2014.

Conference Parking: Parking for ACOG attendees is being offered at a special discounted rate of $24/day (valet) and $12/day (self ). Please indicate you are with the ACOG group to receive this discount.

ANCILLARY COURSESMEETING HIGHLIGHTS

Make plans today to join your fellow OB/GYN colleagues for the second ACOG District XII Annual District Meeting to be held August 15-17 at the luxurious Ritz-Carlton, Grand Lakes Hotel in the heart of Florida. Your District XII Scientific Program Committee has planned another terrific program featuring a variety of timely educational topics presented by a world class faculty. In addition to the scientific program, there are interesting breakout sessions, super exhibits, and great food in a city famous for its entertainment capabilities. Bring the kids. As you know, in Orlando there is plenty for them to do as well. I am looking forward to seeing all of you once again, so please register and reserve your room today.

• Featured Lectures:• Hypertensive Crisis in Pregnancy Management presented by James N. Martin, Jr., MD• The Annual Exam—If Not for Pap Smear, Then What? presented by Ashlyn H. Savage, MD, MSCR• Access to Abortion presented by David A. Grimes, MD

• Two Sessions of Breakout Programs Tailored for a Personalized Learning Experience

Session 1• Ovarian Cancer Debate—Chemotherapy vs. Surgery• The Girlology Experience • Medical Malpractice Updates

Session 2• Social Media and the Physicians Practice• Screening Tests• Centering Pregnancy

• ACOG National Update Presented by President, John Jennings, MD

• State Mandated Courses to Satisfy State Requirements— Domestic Violence and Prevention of Medical Errors

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SCHEDULE-AT-A-GLANCE

FRIDAY SATURDAY SUNDAY

7:00 am–6:00 pm

Registration Open• Coding Course• Scientific Sessions

7:00 am–5:00 pm

Registration Open• Scientific Sessions• Office Administrators

7:00 am–12:45 pm

Registration Open• Scientific Sessions

8:00 am–12:15 pm

Coding Course

1:15–5:30 pm Scientific Sessions

8:00 am–12:00 pm

Scientific Sessions

2:45–4:45 pm

Medical Student Skills Session

7:45 am–9:45 am State Mandated Courses

• Domestic Violence• Prevention of Medical Errors

9:50 am–12:45 pm Scientific Sessions

6:30–8:00 pm

Exhibitors Welcome Reception7:00–7:45 am

Breakfast

10:00–10:30 am

Morning Break–Physicians/Nurses

2:15–3:00 pm

Dessert Reception

Closed – No Exhibit Hours

5:30–6:00 pm Junior Fellows Business Meeting

12:00–12:30 pm

ACOG National Update

12:30–1:00 pm

District XII Business Meeting

1:00–2:15 pm

Legislative Luncheon

7:00–10:00 pm

Citrus Garden Dinner

9:00–11:00 pm

The After Party

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WHAT THE DELAY IN ICD-10 MEANS–AND OTHER CODING TIPS

Course InstructorEmily Hill, PAPresidentHill & AssociatesWilmington, NC

Target AudienceThis program has been designed for physicians, coders, technicians and administrators with a basic understanding of CPT and ICD-9.

Learning ObjectivesAt the conclusion of this activity, the attendee can expect to be able to:

• Discuss ICD-10 code structure• Apply the key ICD-10-CM guidelines applicable to

the female genitourinary system and maternity care• Demonstrate the clinical documentation specificity

necessary to appropriately assign ICD-10-CM codes for OB/GYN services

• Describe ICD-10 coding conventions and principles

AccreditationACCME AccreditationThe American College of Obstetricians and Gynecologists is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA PRA Category 1 Credit(s)™The American College of Obstetricians and Gynecologists designates this live activity for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

College Cognate Credit(s)The American College of Obstetricians and Gynecologists designates this live activity for a maximum of 4 Category 1 College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to be equivalent to College Cognate Credits.

Disclosure of Faculty and Industry RelationshipsIn accordance with College policy, all faculty and planning committee members have signed a conflict of interest statement in which they have disclosed any financial interests or other relationships with industry relative to topics they will discuss at this program. At the beginning of the program, faculty members are required to disclose any such information to participants. Such disclosure allows you to evaluate better the objectivity of the information presented in lectures. Please report on your evaluation form any undisclosed conflict of interest you perceive.

Criteria For SuccessStatements of credit will be awarded based on the participant’s attendance and submission of the activity evaluation form. A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.obgpathways.com/cme.

Commercial SupportFull notification of commercial support will be provided in the final course syllabus.

7:00–8:00 am RegistRation and BReakfast

8:00–10:00 am Introduction a. Understanding the Change b. History of ICD-10 c. Key Differences between ICD-9 and ICD-10 d. Structure and Format of ICD-10 e. Impact on Reimbursement and Future Reimbursement Models

General Guidelines a. Key Guidelines and Definitions b. Inpatient Guidelines vs. Outpatient Guidelines

Outpatient Guidelines a. Selecting the First-Listed Diagnosis b. Coding for Uncertain Conditions c. Signs and Symptoms vs. Condition Specific Codes d. Coding for Multiple Diagnoses

10:00–10:15 am BReak

10:15 am–12:00 pm Chapter Specific Guidelines a. Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC i. Key Changes ii. Examples for Specific Areas b. Chapter 21: Factors Influencing Health Status and Contact with Health Services i. Key Changes ii. Examples for Specific Areas c. Chapter 14: Diseases of the Genitourinary System i. Key Changes ii. Examples for Specific Areas iii. Case Presentations d. Chapter 15: Pregnancy, Childbirth and the Puerperium i. Key Changes ii. Examples for Specific Areas iii. Case Presentations

Coding and Reimbursement Update a. Evaluation and Management Coding and the EHR b. CMS Initiatives c. Third-Party Payer Initiatives

12:00–12:15 pm Q&A Session

12:15 pm Adjourn

Friday, August 15

CODING PROGRAM

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NATIONALLY FEATURED FACULTY

ADJUNCT FACULTYTeresa A. Drake, JDDirectorThe Source Program University of Florida Levin College of LawGainesville, FL

William Hambsh, CPA, CMPE, MACCChief Executive OfficerPractice Administrator North Florida Women’s CareTallahassee, FL

Steven Lubell, JD Attorney-PartnerLubell and Rosen Fort Lauderdale, FL

Richard S. Legro, MDProfessor Department of Obstetrics and Gynecology Penn State University College of MedicineHershey, PA

James N. Martin, Jr., MDProfessor of Obstetrics and GynecologyVice Chair Research/Academic DevelopmentChief of Maternal-Fetal MedicineThe University of Mississippi Medical CenterJackson, MS 

Elissa Meites, MD, MPHLCDR, U.S. Public Health ServiceDivision of STD PreventionNational Center for Hepatitis, HIV/AIDS, STD and TB PreventionCenters for Disease Control and PreventionAtlanta, GA

Ashlyn H. Savage, MD, MSCRAssistant Professor Obstetrics and GynecologyMedical University of South CarolinaCharleston, SC

Patrice M. Weiss, MD Chair and ProfessorDepartment of Obstetrics and GynecologyCarilion Clinic/ Virginia Tech Carilion School of

Medicine Roanoke, VA

Dennis S. Chi, MDGynecology ServiceDepartment of SurgeryMemorial Sloan-Kettering Cancer CenterNew York, NY

Julie Zemaitis DeCesare, MDClinical Associate ProfessorOBGYN Residency Program DirectorFlorida State University-College of MedicinePensacola, FL

Ricardo Estape, MDVoluntary Associate Professor University of Miami Miller School of MedicineSouth Miami Gynecologic Oncology GroupMiami, FL

David A. Grimes, MD Clinical Professor Department of OB/GYNUniversity of North Carolina School of MedicineChapel Hill, NC

Melisa Holmes, MDFounderGirlology & GuyologySimpsonville, SC

Jay D. Iams, MDF. P. Zuspan Professor Emeritus of Obstetrics and GynecologyThe Ohio State University Wexner Medical Center Columbus, OH

Mark L. Rosen, JD Attorney-PartnerLubell and Rosen Fort Lauderdale, FL

Donald Wood, ARNP, CRNA, LHRMPatient Safety/Risk ManagerThe Doctors CompanyJacksonville, FL

SCIENTIFIC SESSIONS

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SCIENTIFIC PROGRAM AGENDA

Friday, August 15

7:00 am RegistRation opens

1:15–1:30 pm Welcome/Introductions/Housekeeping

1:30–2:15 pm Emotional Intelligence Patrice M. Weiss, MD

2:15–3:00 pm Hypertensive Crisis in Pregnancy Management James N. Martin, Jr., MD

3:00–3:30 pm Q&A Session

3:30–3:45 pm BReak

3:45–5:30 pm Resident Research Presentations

5:30–6:00 pm District XII Junior Fellows Business Meeting

6:30–8:00 pm Welcome Reception With exhiBitoRs

Saturday, August 16

7:00–7:45 am RegistRation/BReakfast With exhiBitoRs

7:45–8:00 am Welcome/Introductions/Housekeeping

8:00–8:35 am Preterm Birth & Infant Mortality—The Obstetrician’s Responsibility Jay D. Iams, MD

8:35–9:10 am Managing Abnormal Pap Smears—Incorporating Biomarkers and New Guidelines into Your Practice Ashlyn H. Savage, MD, MSCR

9:10–9:45 am Access to Abortion David A. Grimes, MD

9:45–10:00 am Q&A Session

10:00–10:30 am BReak With exhiBitoRs

10:30–11:15 am Breakout Sessions (Select one session to attend on the registration form)

• The Girlology Experience: Changing the Culture of Sexuality Education Melisa Holmes, MD• Debate

Neoadjuvant Chemotherapy for Advanced Ovarian Cancer—Is Cytoreduction Overrated? Ricardo Estape, MD Primary Debulking Surgery vs. Neoadjuvant Chemotherapy Dennis S. Chi, MD • Medical Malpractice Update Steven Lubell, JD and Mark Rosen, JD

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11:20 am–12:00 pm Joint Plenary Session with FSREI

Polycystic Ovary Syndrome: From the Stein Age to the PresentRichard S. Legro, MD

12:00–12:30 pm Update from ACOG President John Jennings, MD

12:30–1:00 pm District XII Business Meeting

1:00–2:15 pm Legislative Luncheon (See page 9 for details)

2:15–3:00 pm desseRt Reception With exhiBitoRs

2:45–4:45 pm Medical Student Skills Session

7:00–10:00 pm citRus gaRden dinneR (See page 9 for details)

Sunday, August 17

7:00–7:30 am BReakfast

7:30–7:45 am Welcome/Introductions/Housekeeping State Mandated Courses7:45–8:45 am Intimate Partner Violence (IPV) and the Medical Community Teresa A. Drake, JD

8:45–9:45 am Prevention of Medical Errors Donald Wood, ARNP, CRNA, LHRM

9:50–10:35 am Breakout Sessions (Select one session to attend on the registration form)

• Social Media and Your Practice William Hambsh, CPA, CPME, MACC

• Screening Tests: How to Ruin a Perfectly Good Marriage David A. Grimes, MD

• Centering Pregnancy —Benefits for Your Practice Julie Zematis DeCesare, MD

10:40–11:20 am The Annual Exam—If Not for Pap Smear, Then What? Ashlyn H. Savage, MD, MSCR

11:20–11:55 am Update in the Management of Ovarian Cancer Dennis S. Chi, MD

11:55 am–12:30 pm HPV Vaccine—An Opportunity for Prevention in Men Elissa Meites, MD, MPH

12:30–12:45 pm Q&A Session 12:45 pm Meeting Adjourns

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LEARNING OBJECTIVES

Target AudienceThis program has been designed to meet the educational needs of physicians and nurses who have a specialized interest in the field of obstetrics and gynecology.

Learning ObjectivesAt the conclusion of this activity, the attendee can expect to be able to:

• Discuss medical error reduction and prevention strategies

• Describe the standard management surgically of early and advanced ovarian cancer

• Critically analyze the prospective study co-pairing PDS vs. NACT

• Assess the clinical outcomes of patients receiving neoadjuvant chemotherapy for advanced stage ovarian cancer

• Discuss how and why to screen for intimate partner violence in a medical setting

• Describe the HPV vaccine recommendations for men

• Summarize the evidence concerning abortion and prematurity

• Develop a practice-specific care algorithm for prescribing progesterone

• Design an evidence-based infertility treatment plan for patients with PCOS

• Review up-to-date information on changes in the law and legal trends specific to the field of OB/GYN

• Develop a plan to have in place to handle the pregnant patient who is non-responsive to standard management of acute severe hypertension

• Identify the age appropriate components of the well women visit

• Access and apply new ASCCP guidelines for managing abnormal pap smears and cervical cancer precursors

• Implement an emotional intelligence (EI) focus into medical education

• Demonstrate practice and guidelines on how centering pregnancy can be incorporated

• Describe the impact of disease prevalence on predictive values

• Incorporate social media platforms for patient engagement

• Apply recent research findings on adolescent neuro development to strategies for promoting healthy behaviors among teens

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ACCREDITATION

ACCME Accreditation The American College of Obstetricians and Gynecologists is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA PRA Category 1 Credit(s)™ The American College of Obstetricians and Gynecologists designates this live activity for a maximum of 12.5 AMA PRA Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity. College Cognate Credit(s) The American College of Obstetricians and Gynecologists designates this live activity for a maximum of 12.5 Category 1 College Cognate Credits. The College has a reciprocity agreement with the AMA that allows AMA PRA Category 1 Credits™ to be equivalent to College Cognate Credits.

Nursing CE Credit provided by AKH Inc., Advancing Knowledge in Healthcare

Nursing AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is awarded 12 Contact Hours. FL Nursing AKH Inc., Advancing Knowledge in Healthcare is an approved provider for nursing continuing education by the Florida Board of Nursing #50-2560. AKH Inc., Advancing Knowledge in Healthcare designates this educational activity for 12 contact hour (.12 CEU). The maximum allocation for participants attending the Domestic Violence course is 1 contact hour and the maximum allocation for participants attending the Prevention of Medical Errors course is 1 contact hour. Criteria For Success Statements of credit will be awarded based on the participant’s attendance and submission of the activity evaluation form. A statement of credit will be available upon completion of an online evaluation/claimed credit form available at www.obgpathways.com/cme. Please remember to sign the CME/CE sheet upon checking in at the registration desk each day of the meeting. If you have any questions regarding this CME/CE activity, please contact AKH at trish@akhealthcare.com. Disclosure of Faculty and Industry Relationships In accordance with College policy, all faculty and planning committee members have signed a conflict of interest statement in which they have disclosed any financial interests or other relationships with industry relative to topics they will discuss at this program. At the beginning of the program, faculty members are required to disclose any such information to participants. Such disclosure allows you to evaluate better the objectivity of the information presented in lectures. Please report on your evaluation form any undisclosed conflict of interest you perceive. DisclaimerThis course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. and ACOG specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content. Commercial SupportFull notification of commercial support will be provided in the final course syllabus. *Hours subject to change. Please see syllabus for final hours.

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SPECIAL EVENTS

RESORT ACTIVITIES

FLORIDADistrict XIIWelcome Reception with Exhibitors Friday, August 15 | 6:30–8:00 pm Join us for an opening reception with the 2014 exhibitors and supporters on Friday evening in the exhibit hall. Take some time to visit with your colleagues and over 70 exhibiting companies. Wines will be available for tasting as well as hors d’oeuvres.

Legislative LuncheonSaturday, August 16 | 1:00–2:15 pm

The Legislative Luncheon has been organized by the District XII State Legislation and Professional Liability Committee to update members on political and women’s healthcare issues specifically related to what is happening in the state of Florida. The 2014 Legislative Luncheon’s special guest speaker will be George LeMieux, former US Senator, Chief of Staff for Charlie Christ and Florida Deputy Attorney General. The luncheon is free for District XII members; however non-District XII members and guests are welcome to attend, but they must purchase a ticket. Tickets are $65 for non-District XII members and guests, and may be purchased on the registration form.

Exhibitor Dessert ReceptionSaturday, August 16 | 2:15–3:30 pm

Conclude your lunch the right way...with dessert. Join the exhibitors in the exhibit hall for a delicious dessert reception just

prior to the hall closing. An array of sweet delights will surely please the masses! The exhibitor passport drawing will take place at the end of the dessert reception, please be sure to turn in your completed passport to the registration desk, no later than 3:15 pm.

Saturday Citrus Garden Dinner Saturday, August 16 | 7:00–10:00 pm $75 per personAfter the program concludes on Saturday, join your friends and colleagues for dinner in the Citrus Garden surrounded by Florida’s native citrus and palm trees. This dinner is NOT

included in the attendee registration fee. Guests and children are welcome to attend; please purchase tickets on the registration form.

The After PartySaturday, August 16 | 9:00–11:00 pm

The fun will not end at the Citrus Garden! The evening will continue on at the “After Party!” Challenge your friends and colleagues to some friendly competition with giant life-size games like Connect Four®, Jenga® or Corn Hole. The After Party will also feature a DJ and a cash bar. So, make plans today to attend - there is no fee for you or your guest to attend; you just have to be willing to let your “inner kid” out for a late night of fun and games!

Breakfast at the Ritz-Carlton Orlando, Grande LakesSaturday, August 16 & Sunday, August 17The ACOG District XII is offering breakfast buffet vouchers for spouses and guests of attendees. Each voucher can be redeemed for one breakfast buffet at the restaurant determined by the hotel. You must purchase one voucher per person, per day. Adults are $33.93 and children are $18.68 and prices are inclusive of tax and gratuity. You may purchase ticket(s) on the registration form.Please note: this voucher is NOT for the exhibit hall food functions. ACOG DXII is only supplying the voucher; any specific questions regarding the breakfast buffet should be directed to the hotel staff.

The Ritz-Carlton Golf Club® Orlando, Grande LakesThe golf club provides an experience not typically found in Florida. The design, by two-time British Open Champion Greg Norman, blends a variety of hazards to

provide a challenging but fair test of a golfer’s abilities.

Meeting attendees receive a 10% discount on greens fees! Call the Golf Shop to set up your tee time at (407)393-4900.

The Ritz-Carlton Spa® Orlando, Grande LakesEscape to an Orlando spa resort where the subtle, refreshing bouquet of citrus inspires renewal. The spa features 40

treatment rooms, a private 4,000-square-foot heated outdoor lap pool, a Carita salon, boutique, Scrub Bar, and café. Meeting attendees receive a 10% discount on spa treatments! To book your Orlando spa package, please call (407) 393-4200.

Tennis at The Ritz-Carlton Orlando, Grande LakesIf tennis is your sport of choice, then the Ritz-Carlton has you covered. The Ritz-Carlton offers three lighted tennis courts and has extended a 10% discount on tennis court fees to our meeting attendees. To reserve court time, please call (407)206-2400.

Ritz Kids® The hotel offers the Ritz Kids program, an exclusive supervised children’s program designed specifically for the younger guests ages 4 through 12. The Ritz Kids program allows parents to play while children stay with trained and certified counselors. The program is open Wednesday – Sunday from 12:30 pm–10:00 pm. The cost is $20 per hour, per child for children aged 4 - 12.

Kids Night Out Join Ritz Kids for dinner, arts & crafts, games and movies while mom and dad enjoy a night out. Kids Night Out is available on Wednesday, Friday & Saturday from 6:00–10:00 pm. The cost for Kids Night Out is $80 per child and includes dinner. For reservations or more information on all the new programs they offer, please call (407) 393-4977.

Children’s Events

FLORIDADistrict XII

www.obgpathways.com

2014 ANNUAL DISTRICT MEETINGAugust 15–17, 2014

The Ritz-Carlton Orlando, Grande Lakes • Orlando, FL

Degree

PROGRAM REGISTRATION EARLY BIRD GENERAL

CODING PROGRAM up to 6/20/14 after 6/20/14(Friday, August 15) District XII Member Rate $150 $200Non-Member Rate $250 $300PAs and ARNPs $150 $200Residents & Fellows* $0 $0

SCIENTIFIC SESSIONS (Friday, August 15–Sunday, August 17)District XII Member Rate $395 $445Non-Member Rate $595 $645PAs and ARNPs $395 $445Medical Student (Fri-Sat) $50 $50Medical Student (Sat Session only) $0 $0Residents & Fellows* $0 $0

COMBINED COURSE REGISTRATION CODING PROGRAM & SCIENTIFIC SESSIONS(Friday, August 15–Sunday, August 17)District XII Member Rate $470 $520Non-Member Rate $670 $720PAs and ARNPs $470 $520Residents & Fellows* $0 $0*Must fax in registration form with proof of Florida Resident/Fellow status from Program Director.

BREAKOUT SESSIONSPlease select the breakout sessions you would like to attend. There is no additional fee.

Saturday, August 16 Sunday, August 17 r The Girlology Experience r Social Media and Your Practice r Ovarian Cancer Debate: Surgery vs. Chemo r Screening Tests r Medical Malpractice Update r Centering Pregnancy

SPECIAL EVENTS Member/Nurse Non-Member Resident/Fellow

r I will attend the Legislative Luncheon $0 $65 x____ $0 (The Legislative Luncheon is included in the Member and Resident/Fellow registration fee. However, you MUST pre-register to attend this event.) r I will NOT attend the Legislative Luncheon

r Saturday Citrus Garden Dinner Ticket $75 x____ $75 x____ $75 x____ (Ticket NOT included in your registration fee.)

ADULT & CHILDREN GUEST TICKETS**

r Adult Guest Ticket $80 x ___ = $_____(Includes one badge for unlimited access to the exhibit hall,breakfasts, breaks and reception on Friday.)

r Child Guest Ticket $50 x ___= $_____ (Includes unlimited access to the exhibit hall and admission tothe Saturday Dinner– ages 0-12 must have a badge.)

r Legislative Luncheon Ticket $65 x ___ = $_____(Includes one ticket for the guest to attend the Legislative Luncheon.)

r Breakfast Voucher Ticket $33.93 x ___= $_____ (This is a hotel voucher for breakfast at one of the restaurants in $18.68 x ___= $_____ the hotel, NOT in the exhibit hall. Must purchase one ticket per person, per day. Available on Saturday and Sunday.)

r Saturday Citrus Garden Dinner Ticket $75x ___= $_____ (Must purchase one ticket per guest.)

**Badges required for access to the exhibit hall and receptions.

TOTAL (Combine sections 1-4 for total amount) $_____________

Full Name____________________________________________________________ First Name to appear on badge_______________________________________

Address_________________________________________________________________ City______________________________________ State____ Zip_________

Phone_____________________________ Fax_____________________________ Email______________________________________________________________

GUEST NAME(S) TO APPEAR ON BADGE:NOTE: Your badge is your pass to all exhibit hall events. Only registered attendees and guests will receive a badge.___________________________________________________

___________________________________________________

SPECIAL ASSISTANCEI have special needs or diet. Please explain below:_______________________________________________

ADA COMPLIANCE: Attendees who need special reasonable accommodations or who have special needs should contact the meeting organizers at 904-309-6265.

PAYMENT INFORMATIONChecks and money orders must be made payable to the ACOG. If your institution is paying your registration fee, please ensure that the check is appropriately identified with your name.

r Check r MasterCard r Visa r AMEXCredit card issued in name of:

______________________________________________

Card Number:___________________________________

Exp. Date:_____________

Signature:_______________________________________

REGISTRATION DEADLINERegistration and payment must be received no later than August 1, 2014 in order to have a name badge and syllabus materials available. On-site registration will only be accepted on a space available basis.

CANCELLATION POLICYTelephone cancellations cannot be accepted. A written notice of cancellation must be received no later than two weeks prior to the meeting for a refund. A $25 administration fee will be deducted. No refunds will be made after August 1, 2014.

3 CONVENIENT WAYS TO REGISTER:

Fax: (904)-998-0855Mail: ACOG Distrixt XII 6816 Southpoint Parkway, Suite 1000 Jacksonville, FL 32216Online: www.obgpathways.com

HOTEL RESERVATIONSThe Ritz-Carlton Orlando, Grande Lakes 4012 Central Florida ParkwayOrlando, FL 32837To make your reservations, please call 1-800-266-9432 and ask for the ACOG room rate that starts at $169/night. The special group rate is available until July 18, 2014 or until the ACOG room block is filled.

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ACOG District XII6816 Southpoint Pkwy, Suite 1000

Jacksonville, FL 32216Phone: 904-309-6265

Fax: 904-998-0855

www.obgpathways.com