no later than september 1. - upike · 2019-05-29 · no later than september 1. ... kentucky...
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(P) 606-218-5413 • (F) 606-218-5168www.upike.edu
Registration FormPlease print clearly. Return in provided envelope
no later than September 1.
Name __________________________________________________
AOA Number ___________________________________________
Address ________________________________________________
_______________________________________________________
City _________________ State __________ ZIP _____________
KYCOM Alumni Class of ________ Fax ______________________
Phone (Work) _________________ (Cell) ____________________
Phone (Home) ________________ Email ____________________
Meeting FeesPlease check the events you plan to attend and
indicate the fees included in your total payment.
______ KYCOM Primary Care CME Program $______________
Early Registration$350 per person if received by September 1
$425 if received after September 1
_____ Registered Nurse $50
_____ Physician Assistant $50
_____ I will attend Founders Dinner. (No Cost) _____ # Tickets Needed for Founders Dinner
KYCOM Alumni ReceptionSaturday, September 14, 6 p.m. – 8 p.m.
Green Meadow Country Club_____ # Tickets needed (No Cost)
Registration Payment ☐ Enclosed is check # _____ in the amount of $ ________
☐ Charge $ ___________ to my credit card: ☐ Master Card ☐ Visa ☐ Discover
Note: There will be a 2.7% usage fee on all credit card charges.
Name __________________________________________________
Credit Card Number ________ - ________ - ________ -________
Security Code:____________________ Exp. Date: _____________
Name on Card: __________________________________________
Address of Cardholder ____________________________________ Street
City _________________ State __________ ZIP _____________
Cardholder Phone Number: ________________________________
Total Amount Charged: $ _______________ (+ 2.7% usage fee)
Signature _____________________________________________
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Primary Care Continuing Medical Education and Alumni Weekend
Contemporary Issues in Practice Management
September 13-15, 2019
147 Sycamore StreetPikeville, KY 41501
Friday-SaturdayHealth Professions Education Building7th Floor Pavilion
SundayCoal Building
9th Floor OPP Lab
RegistrationPlease complete the registration form and return no
later than September 1 to: Deean Skeens, Director
Continuing Medical Education University of Pikeville
Kentucky College of Osteopathic Medicine147 Sycamore StreetPikeville, KY 41501
[email protected]: (606) 218-5168
Early RegistrationRegistration fees are $350 per person if received by September 1 and $425 if received after September 1. Founders Dinner is included. Registered Nurses (RN) and Physicians Assistants (PA) fees are $50
per person.
CancellationsKYCOM must be notified of cancellations in writing by September 1 in order to provide a refund. A $50 processing fee will be assessed on all refunds prior to September 1. Cancellations received after September 1 will not be refunded.
For more information, contact Deean Skeens, Director
Continuing Medical Education University of Pikeville
Kentucky College of Osteopathic Medicine(606) 218-5413
[email protected]: (606) 218-5168
Special EventsFriday, September 13
Founders Dinner andJohn A. Strosnider Memorial Lecture
Reception followed by dinner
Keynote Speaker:Steven R. Harris, Ph.D.
Kentucky College of Osteopathic MedicineFormer Associate Dean of Academic Affairs (1998-2018)
6 p.m.F.A. Bailey Room, Hilton Garden Inn
849 Hambley Blvd., Pikeville, KY 41501
Saturday, September 14
KYCOM Alumni Reception 6 p.m. – 8 p.m.
Green Meadow Country Club6887 North Mayo Trail
Pikeville, KY 41501
AccommodationsA block of rooms has been reserved
at the Hampton Inn.831 Hambley Blvd.Pikeville, KY 41501
(606) 432-8181
Accommodations can be made at the Hampton Inn with a rate of $110 per night if booking before
September 1. Use code “CME19” whenreserving your room.
General Meeting InformationMeeting Hours:
Friday, September 13: 8 a.m. - 5:15 p.m. Saturday, September 14: 8 a.m. - 4:30 p.m.
Sunday, September 15: 8 a.m. - 12 p.m.
This program is anticipated to offer 20 hours of AOA Category 1-A CME credit, pending the approval of the AOA Council on Continuing Medical Education. The Southeastern Kentucky AHEC designates this educational activity for a maximum of 20 PRA Category 1 Credit(s). AAFP accreditation has been applied for.
Program Theme: Contemporary Issues in Practice
ManagementThis Primary Care CME program will offer a comprehensive review of “Contemporary Issues in Practice Management.” Friday and Saturday sessions will include updates in Family Medicine, Infectious Diseases, Neurology and Issues on the Opioid Crisis in Eastern Kentucky. The Sunday morning session will be devoted to hands-on OMT technique workshops taught by KYCOM faculty and alumni.
Note: The event presentations will be paperless and accessible via Dropbox application at the CME event.
Access and log in information to the event presentations will be made available upon check-in at the event.