Endorsed byCourse Director

Jihad A. Mustapha, M.D., FACC, FSCAIDirector of Endovascular InterventionsMetro Heart & VascularMetro Health HospitalWyoming, Michigan

A U G U S T 1 0 - 11 , 2 0 1 2 T H E PA L M E R H O U S E H O T E L C H I C A G O , I L L I N O I S

Register now at www.ampsymposium.org

Sponsored by

AMP: THE CLI MEETING

LEAD:

The Atherectomy Meeting

Fellows Course

August 9

Scholarships Available

(see page 2)

LET’S MAKE AMPUTATION A THING OF THE PAST AT THE CLI MEETING.

The incidence of lower limb amputation due to vascular disorders has grown steadily over the years, but the tide is turning. Advances in revascularization will continue to make a dramatic difference in patient treatment in the months ahead by decreasing the need for amputation. Play a role in this important, life-changing trend when you gain the knowledge you need to stop critical limb ischemia in its tracks.

The Amputation Prevention Symposium has an impressive history: Eighty-three percent of physicians who attended last year and completed a three-month post-conference impact survey reported a change in how they manage patients, and 67 percent reported a change in patient outcomes. Led by a course director who has established a model hospital-based amputation prevention program, the Amputation Prevention Symposium promises a revolution in the way physicians approach critical limb ischemia and related problems that otherwise could end in the heartbreak of limb loss.

TELL YOUR FELLOWS ABOUT THIS ATHERECTOMY COURSELatest Endovascular Atherectomy Devices (LEAD)A practical, hands-on experience for fellows in conjunction with the AMP meetingAugust 9, 2012The Palmer House HotelChicago

This full-day educational activity gives new physicians a look at the types of devices they will use in their practices. Equipment options available in support of revascularization and other therapy for peripheral vascular disease will be displayed and discussed in detail. Registration fees, accommodations and travel expenses will be covered for a limited number of fellows-in-training studying in fields related to endovascular intervention. (The scholarships are available on a first-come, first-served basis.) For complete details, go to www.ampsymposium.org

CONTINUING MEDICAL EDUCATION INFORMATION

Learning ObjectivesUpon completion of this activity, the physician should be able to:• Apply a comprehensive, multi-disciplinary best practice approach for patients with advanced peripheral arterial disease (PAD) at risk for major amputation.• Treat chronic total occlusion in tibial and pedal arterial vessels.• Describe arterial angiosome anatomy in conjunction with cutaneous and ultrasonic angiosome mapping in patients with advanced PAD at risk for major amputation.• Implement procedural and technological advances in wound care practices for patients facing major amputation due to PAD and advanced non-healing wounds and gangrene.• Describe the minor surgical approach to limb salvage post-revascularization for patients with advanced PAD at risk for major amputation.• Identify the components necessary to build a multidisciplinary amputation prevention program at their institution.• Implement a diagnostic algorithm including selective angiography as a critical step for patients with severe PAD who are at risk for amputation. • Incorporate advanced tibio-pedal access in combination with antegrade access in limb salvage procedures.• Utilize digital branch access during critical limb ischemia interventions.• Implement transcollateral interventions in below-the-knee and below-the-ankle interventions.

Target Audience The Amputation Prevention Symposium will be of value to vascular surgeons, general surgeons, cardiologists, interventional cardiologists, interventional radiologists, general medicine/primary care physicians, podiatrists and wound care specialists.

AccreditationComplete Conference Management is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit DesignationComplete Conference Management designates this live activity for a maximum of 14.75 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: According to the ANCC, AMA PRA Category 1 CreditsTM meet the ANCC-accredited CNE criteria.

DisclaimerThe information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Faculty DisclosureIn accordance with ACCME® Accreditation requirements, faculty are required to disclose any financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed during this educational activity and with any commercial supporters of this activity.

SCIENTIFIC PROGRAM STEERING COMMITTEE

George Adams, M.D.Rex Health HospitalRaleigh, North Carolina

Gregory Bohn, M.D.Trinity Regional Health SystemBettendorf, Iowa

Tony Das, M.D.Texas Health Presbyterian Hospital, DallasDallas, Texas

Tom Davis, M.D.St. John Hospital and Medical CenterSt. Clair Shores, Michigan

Lawrence Garcia, M.D., FSCAISt. Elizabeth’s Medical CenterBoston, Massachusetts

Michael R. Jaff, D.O., FSCAIMassachusetts General HospitalBoston, Massachusetts

Guy Pupp, DPMLakeview Podiatry Assoc., PCDearborn, Michigan

Venkatesh Ramaiah, M.D.Arizona Heart InstitutePhoenix, Arizona

Craig Walker, M.D.Cardiovascular Institute of the SouthHouma, Louisiana

INVITED FACULTY

Cameron Akbari, M.D.Washington Hospital Center Washington, D.C.

Vlad Alexandrescu, M.D.Metropolitan Health CenterNew York, New York

Jose Almeida, M.D.Miami Vein Center Miami, Florida

Gary Ansel, M.D., FSCAIMidOhio Cardiology & Vascular ConsultantsCircleville, Ohio

Nilesh Balar, M.D.Montefiore Medical CenterBronx, New York

Robert Beasley, M.D.Mt. Sinai Medical CenterMiami, Florida

Josh Beckman, M.D.Brigham and Women’s CardiologyBoston, Massachusetts

Desmond Bell, DPMFirst Coast Diabetic Foot and Wound Management Jacksonville, Florida

Nelson Bernardo, M.D.Washington Cardiology CenterWashington, D.C.

Alan Block, DPMThe Ohio State University Medical CenterColumbus, Ohio

Frank Bunch, M.D., FSCAICardiology Associates of MobileFairhope, Alabama

Scott Covington, M.D.Duke Raleigh HospitalRaleigh, North Carolina

Ray Datillo, M.D.Cardiology Consultants of TopekaTopeka, Kansas

Richard (Rich) de Asla, M.D.Massachusetts General HospitalBoston, Massachusetts

Bob Feezor, M.D.Shands at the University of FloridaGainesville, Florida

Andrew Feiring, M.D., FSCAIColumbia-St. Mary’s Medical CenterMilwaukee, Wisconsin

Alan Hirsch, M.D.Internal Medicine Group of ClevelandBeachwood, Ohio

Jeffrey Indes, M.D.Yale School of MedicineNew Haven, Connecticut

Julian Javier, M.D., FSCAINaples Cardiac and Vascular CenterNaples, Florida

Yazan Khatib, M.D., FSCAIFirst Coast Cardiovascular InstituteJacksonville, Florida

Raghu Kolurri, M.D.Prairie Heart InstituteSpringfield, Illinois

Vinay Kumar, M.D.MetroWest Medical CenterFramingham, Massachusetts

Tammy Leitsinger Cordis Cardiac & VascularBridgewater, New Jersey

Edward G. Mackey, M.D.Dr. Mackey Vein and Laser TherapySt. Petersburg, Florida

Thomas O. McNamara, M.D.David Geffen School of MedicineSalida, California

Carlos Mena, M.D., FSCAIYale School of MedicineNew Haven, Connecticut

ACCOMMODATIONS

The 2012 Amputation Prevention Symposium will be held at the Palmer House Hotel in Chicago. The Palmer House is an iconic, world-class downtown hotel and gateway to Chicago’s rejuvenated Loop scene. A modern Chicago grand hotel, the Palmer House is a lively destination within walking distance of the best attractions the city has to offer, including Millennium Park, Grant Park, Lake Michigan, the Art Institute of Chicago, the theater district and shopping on the Magnificent Mile and famed State Street, among others.

A limited number of sleeping rooms have been reserved for meeting participants at the discounted rate of $199 per night. Please reserve your room by contacting the Palmer House directly and identify yourself as a participant of the Amputation Prevention Symposium (AMP). The deadline to reserve a room at this rate is July 24, 2012, or until all discounted-rate rooms have been reserved, whichever comes first.

Mark Mewissen, M.D.Aurora Health CenterMilwaukee, Wisconsin

Aravinda Nanjundappa, M.D., FSCAIWest Virginia UniversityCharleston, West Virginia

Eryn Quinn, D.O.Health Park Medical SpecialistsWyoming, Michigan

Mahmood Razavi, M.D.Vascular and Interventional SpecialistsOrange, California

Fadi Saab, M.D.Metro Health HospitalWyoming, Michigan

Ronald Sage, M.D., DPM Loyola University Health SystemMaywood, Illinois

Hardayal Singh, M.D.Duke Raleigh HospitalRaleigh, North Carolina

Peter A. Soukas, M.D., FSCAIWarren Alpert School of MedicineProvidence, Rhode Island

Rodney Stuck, M.D.Edward Hines VA HospitalMaywood, Illinois

Eugene Tanquilut, M.D.St. James Hospital and Health CenterOlympia Fields, Illinois

Jim Zidar, M.D., FSCAIRex Health HospitalRaleigh, North Carolina

The Palmer House Hotel17 East Monroe StreetChicago, IL 60603Toll-free Reservations: 1-800-HILTONSDirect Line: 312-726-7500

INVITED FACULTY (continued)

Group rate: $199 per night (Standard room)

P R O G R A MDAY I: FRIDAY, AUGUST 10

Session I: Impact of Amputation in 2012 Moderator: Dr. Mustapha7:55 a.m. Opening Remarks Dr. Mustapha8:00 a.m. Amputation Through the Eyes of a Patient and Her Family Ms. Leitsinger8:10 a.m. Current State of Amputation in CLI Patients: The Amputation Epidemic and Its Impact on Morbidity and Mortality Dr. Datillo8:20 a.m. The Socio-economic Impact of Amputation Dr. Bell8:28 a.m. National Efforts That Address Amputation: Save a Leg, Save a Life Dr. Khatib8:40 a.m. Questions and Answers 8:45 a.m. Keynote Lecture: The Evolution of CLI Therapy Dr. Jaff

Session II: Evaluation of CLI Patients Moderator: Dr. Jaff8:55 a.m. PAD Early Detection: Is It Really Effective? Dr. Hirsch9:05 a.m. History and Physical Examination in Patients With CLI Dr. Beckman9:15 a.m. Diagnostic Testing in PAD: SPP, PVRs, Toe Pressures, PPGs, TCPO2 and More Dr. Kolurri9:25 a.m. Angiosome Directed Anatomical Evaluation and Its Contribution to Therapeutic Decisions Dr. Alexandrescu9:35 a.m. Ischemic Wound Evaluation from A to Z Dr. Jaff9:45 a.m. Diabetic Foot in 2012: A “Critical” Update Dr. Covington9:55 a.m. Diabetic Neuropathy in CLI and Its Effect on Intrinsic Bone and Foot Deformities Dr. De Asla10:05 a.m. PCP: The True Coordinator of Care From All Disciplines. The Patient Medical Home Approach. Dr. Quinn10:15 a.m. Questions and Answers 10:20 a.m. Refreshment Break and Visit Exhibits 10:45 a.m. Cases on Camera: Advanced CLI Cases by a CLI Expert

Session III: Advanced Treatment for CLI Patients Moderator: Dr. Pupp11:05 a.m. Role of Statins, Ace Inhibitors, Beta Blockers and Antiplatelet Therapy in CLI Patients Dr. Nanjundappa11:13 a.m. The Impact of Hemoglobin a1c in Wound Healing Dr. Saab11:21 a.m. Charcot Foot: Limb Salvage’s Greatest Challenge Dr. Pupp11:29 a.m. Is Orthobiologics the New Frontier? A Discussion Including Stem Cell Therapy Dr. Singh11:37 a.m. There Are Always Solutions: Difficult Cases With Positive Outcomes Dr. Bell11:45 a.m. Indications for Major Amputation. Functional Limb Preservation: Balancing Tissue Loss Against Limb Function Dr. Stuck11:53 p.m. “My Patient Is Too Old and Too Sick:” Case Studies in Which Legs Were Saved Dr. Block12:01 p.m. Different Types of Amputation and How to Decide Which Type to Perform Dr. Sage12:09 p.m. Questions and Answers Lunch, Visit Exhibits and Industry Sessions 1:15 p.m. Cases on Camera: Advanced CLI Cases by a CLI Expert

Session IV: Surgical and Endovascular Therapies for the Popliteal and Its Junctions Moderator: Dr. Davis1:40 p.m. Discussion on Outflow Dr. Beasley Fire in Five: Debating Whether Endovascular Therapy or Bypass Is Best for an SFA 1:48 p.m. In Support of Endovascular Therapy Dr. Adams1:53 p.m. In Support of Bypass Dr. Balar

1:58 p.m. The Femoral-Popliteal Segment: What’s Going On? Mechanical Stresses and Characteristics of Plaque for This Region Dr. Bunch2:06 p.m. An Overview of the Most Dynamic Infrainguinal Segments and the Endovascular Therapeutic Options Dr. Akbari2:14 p.m. Does POBA Alone Still Have a Role in Treating the Popliteal in 2012? Dr. Ramaiah2:22 p.m. The Importance of Stent Placement When Treating the Femoral-Pop and Pop-tibial Junctions Dr. Das2:30 p.m. Is the Surgical Option for Treating the Popliteal Junction Still a Viable Alternative? Weighing the Pros and Cons Dr. McNamara2:38 p.m. AMPed and Live: Video Cases that Explore Therapies for the Popliteal and Its Junctions Dr. T. Davis2:55 p.m. Refreshment Break and Visit Exhibits

Session V: Advanced Wound Care Therapies for CLI Patients Moderator: Dr. Bohn3:15 p.m. Prevention Is Key in Limb Salvage Dr. Stuck3:23 p.m. A Case-based Look at Horrors From a Successful Wound Care Clinic: When Is Amputation Warranted? Dr. Block3:31 p.m. Pathophysiology of Wounds: How They Start and Why We Need to Address Them Earlier Dr. Bohn 3:39 p.m. Cutaneous Angiosomes Are as Important as Arterial Angiosomes During the Pre-intervention Evaluation Dr. Alexandrescu3:47 p.m. Clinical Evaluation of Lower Extremity Ulcers: How to Differentiate Venous and Arterial Ulcers Dr. Jaff3:55 p.m. Off-loading in the Treatment of CLI Dr. Sage4:03 p.m. The Role of a Wound Care Center in a Limb Salvage Program Dr. Bohn4:11 p.m. Billing and Coding: Wound Care and Podiatry Dr. Block4:19 p.m. Cases That Explore Advanced Wound Care Therapies for CLI Patients Dr. Pupp4:27 p.m. Questions and Answers Session Faculty

Session VI: Transcatheter Therapy for Amputation Prevention Moderator: Dr. Walker4:35 p.m. Introduction to the Latest Technological Advances for the Treatment of CLI Patients Dr. Walker4:43 p.m. Billing and Coding: Endovascular Dr. Feezor4:41 p.m. A Case-based Look at Transcatheter Therapy Dr. Mewissen4:49 p.m. A Case-based Look at Transcatheter Therapy Dr. Kumar4:57 p.m. A Case-based Look at Transcatheter Therapy Dr. Akbari5:05 p.m. A Case-based Look at Transcatheter Therapy Dr. McNamara5:13 p.m. Questions and Answers Session Faculty5:21 p.m. Closing Remarks Dr. Mustapha5:30 p.m. Adjourn

P R O G R A MDAY II: SATURDAY, AUGUST 11

Session VII: The Good, the Bad and the Ugly of Tibio-pedal CTOs Moderator: Dr. Mustapha8:00 a.m. The Best Therapeutic Options for Crossing Each Type of CTO Dr. Mustapha8:08 a.m. The Best Therapeutic Options for Treating CTO Segments: PTO, Stenting, Atherectomy and Surgery Dr. Ansel8:16 a.m. Get to Know Your BTK Anatomy: Pathophysiology of the Tibio-pedal Vessels and Most Common Sites of CTOs and Calcifications Dr. Razavi8:24 a.m. The Best Invasive Diagnostic Method to Define the Extent of Tibio-pedal Vessel Disease Before a Therapeutic Decision Is Made Dr. Khatib8:32 a.m. When to Treat BTK CTO From a Contralateral Versus Antegrade Approach Dr. Mena8:40 a.m. When All Else Fails, There Is Always Transcollateral and Surgical Hybrid Tibio-pedal CTO Treatment Dr. Indes8:48 a.m. Questions and Answers Session Faculty Session VIII: The Role of Atherectomy in CLI Patients Moderator: Dr. Garcia9:05 a.m. Overview of Atherectomy: Don’t Minimize Its Importance Dr. Garcia9:13 a.m. Tool Talk: Laser Atherectomy Dr. Das9:21 a.m. Tool Talk: Orbital Atherectomy Dr. Adams9:29 a.m. Tool Talk: Rotational Atherectomy Dr. Ramaiah9:37 a.m. Tool Talk: Direct Atherectomy Dr. Garcia9:45 a.m. Tool Talk: Directional Atherectomy Dr. Tanquilut9:53 a.m. Tool Talk: New Atherectomy Tools Dr. DavisFire in Five: Debating Which Is More Effective: Atherectomy or Stenting 10:01 a.m. Stents Dr. Feiring10:06 a.m. Atherectomy Dr. Davis10:11 a.m. The Role of Atherectomy in the Treatment of Popliteal Segments: Are They All Equal? Dr. Mustapha10:19 a.m. Questions and Answers Session Faculty10:25 a.m. Refreshment Break and Visit Exhibits 10:45 a.m. Cases on Camera: Advanced Cases by a CLI Expert Session IX: The Role of Drug-eluting Devices Moderator: Dr. Das11:10 a.m. The Impact of Drug-eluting Devices on the Treatment of the Peripheral Vascular Infrainguinal Tree Dr. Das11:18 a.m. The Antiproliferative Effect of Drug-eluting Devices Dr. Mustapha11:26 a.m. Drug-eluting Stents Below the Knee Dr. Feiring11:34 a.m. Drug-eluting Stents for the SFA: Have We Found the Holy Grail to Treat the Super Dynamic SFA or Are We Just Taming the Beast? Dr. Ansel11:42 a.m. Drug-eluting Balloons for the SFA: What Does the Data Say About Them? Are They Better Than POBA and BMS? Dr. Zidar11:50 a.m. In an Era of Drug-eluting Delivery Devices, How Will Atherectomy Impact the Treated SFA? Dr. Adams11:58 a.m. What Impact Do Drug-eluting Balloons Have on the Treatment of the Femoral-pop and Pop-tibial Junctions? Dr. Zidar12:06 p.m. Questions and Answers Session Faculty12:10 p.m. Lunch, Visit Exhibits and Industry Sessions 1:10 p.m. Cases on Camera: Advanced Cases by a CLI Expert Session X: The Impact of Ulcers Resulting From Advanced Venous Disease Moderator: Dr. Almeida1:35p.m. Deep Venous Stenting in Patients With Venous Congestion and Ulcers Dr. Almeida

1:43 p.m. Superficial Venous Peri-ulcer Varicose Vein Occlusions Dr. Mackey2:51 p.m. The Role of Perforator Occlusions in Patients With Non-healing Ulcers Dr. Javier1:59 p.m. Precise Venous Mapping to Evaluate the Underlying Cause of Venous Ulcers Dr. Almeida2:07 p.m. How to Address CLI Patients With Both Ischemic and Venous Ulcers Dr. Covington2:15 p.m. Basic Ultrasound Physics and the Relationship to Bone, Soft Tissue, Muscle and Calcium Dr. Razavi Session XI: Exotic Access and Management of Access Complications Moderator: Dr. Adams2:20 p.m. Tibio-pedal Access: Learn the When, Why and How Dr. Adams2:28 p.m. Basic Ultrasound Physics and the Relationship to Bone, Soft Tissue, Muscle and Calcium Dr. Razavi2:36 p.m. Tips and Tricks to Prevent Compartment Syndrome: How It Happens and How to Get Out of Trouble Dr. Soukas2:44 p.m. Antegrade and Retrograde Combination Access in Limb Salvage: Which One to Start With and the Safari Technique Dr. Mustapha2:52 p.m. Questions and Answers 3:00 p.m . Refreshment Break and Visit Exhibits

Session XI: Exotic Access and Management of Access Complications (continued) Moderator: Dr. Adams3:30 p.m. Anatomical Description of the Tibio-pedal Arteries, Veins, Nerves and Fascia. How to Isolate the Artery From the Surrounding Veins and Tissue Dr. Bernado3:38 p.m. Tibio-pedal Perforations: How to Avoid and the Best Approach to Treat Them Immediately Dr. Balar3:46 p.m. Complex Limb Salvage Cases: How to Obtain Quick Access Dr. Mustapha3:54 p.m. How to Decide Which Tibial or Pedal Artery to Access and at What Level: Learn Where NOT to Stick a Tibial Artery Dr. Adams4:02 p.m. Learn From the Experts How to Perform Antegrade-Retrograde Intervention Via Single-access and Transcollateral Interventions Dr. Walker4:10 p.m. Learn From an Expert How to Best Access the Tibio-pedal Vessels With Noninvasive Testing Dr. Datillo4:18 p.m. Questions and Answers Session Faculty Session XII: CLI Complication Management Moderator: Dr. Ramaiah4:23 p.m. CLI Interventions: What Not to Do Dr. Garcia4:28 p.m. Dissections and Perforations by Type Dr. Nanjundappa4:36 p.m. Compartment Syndrome Dr. Ramaiah4:44 p.m. Osteomyelitis in CLI Dr. Covington4:52 p.m. Questions and Answers Session Faculty5:00 p.m. AMP 2012 Adjourns

REGISTRATION Five easy ways to register:

Online: www.ampsymposium.org Phone: 800-AMP-0014 (800-267-0014) or 305-279-2263 for international callers E-mail (using the enclosed registration form): registration@ccmcme.com Fax (using the enclosed registration form): 305-279-8221 Mail (using the enclosed registration form and paying by check):

Complete Conference Management, 11440 N. Kendall Drive, Suite 306, Miami, FL 33176

Registration FeesPhysician $649Fellow/Resident* $395 Scholarships available*Allied Health Professional $395Industry Professional, Scientist, Engineer $649

*Fellow/Resident: Anyone who will be enrolled in a fellowship program when the AMP and LEAD meetings take place may apply for a scholarship that covers transportation, hotel and registration costs. Scholarships are limited in number and available on a first-come, first-served basis. For more about the scholarship, go to www.ampsymposium.org.

All on-site registrations will incur an additional $45 administrative fee.

The registration fee covers the following:• Admission to the scientific sessions• Course materials and access to presentations online• Access to the Exhibit Hall• Admission to the Welcome Reception• Daily continental breakfast, refreshment breaks and boxed lunch in the Exhibit Hall• Admission to industry sessions

This educational activity provides training necessary for licensed attendees to maintain state licensing requirements. The tuition for this educational activity is subsidized in part by unrestricted educational grants, including for those attendees who have completed the state licensing requirements for their respective fields. This subsidy is reflected in the registration fees for this activity.

Questions?

Phone: 305-279-2263Toll-free: 888-334-7495

Fax: 305-279-8221Questions@ccmcme.com

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First Name: Last Name: MD DO DPM PhD PA BSN LPN NP RN RT RT(R) RVT CVT Other: Home Address: City: State: Postal Code: Country: Daytime Phone: Mobile Phone: E-mail Address: (Required to receive confirmation & certificate information) Pursuant to the Americans with Disabilities Act, please specify any special services you require: Medical Center/Hospital/Company: State(s) of Professional Licensure: License Number:

REGISTRATION

(For continuing education purposes, we maintain a record of our learners’ licensure numbers. Providing your professional license number is optional but of importance to continuing education efforts.)

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PHYSICIAN ALLIED HEALTH PROFESSIONAL INDUSTRY/NON-CLINICAL Cardiology Cardiothoracic Surgery Endocrinology General Surgery Gerontology Interventional Cardiology Interventional Radiology Nephrology Orthopedics Podiatry Primary Care Vascular Surgery Wound Care Other___________________

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REGISTRATION FEES

Complete Program On-site registration will incur an additional $45 administrative fee.

Fellow/Resident: Active fellows and current residents who will be fellows at the time of the meeting are encouraged to apply for a scholarship. Please contact Complete Conference Management Registration for complete information. A letter from the fellowship director on institutional letterhead confirming the fellowship status is required in order to qualify. Please fax letter to 305-279-8221 or e-mail to registration@ccmcme.com

$649 Physician $395 Fellow/Resident $395 Allied Health Professional $649 Industry Professional, Scientist, Engineer

DEMOGRAPHIC INFORMATION

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Which of these contributed to your decision to register for the upcoming meeting? (Check all that apply)

If you received a mailed postcard or brochure, please provide the 3- or 4-letter code found above your name on the address label: ____________

Visa MC American Express Check (Payable to: Complete Conference Management)Card Number: Expiration Date: Security Code: Name as it appears on card: Billing Address (as it appears on your bill): Authorized Signature: Date: Total Charge: Cancellation requests received in writing on or before July 19 will be refunded, less a $50 administrative fee. Cancellations received after July 19 will not be honored.

PAYMENT INFORMATION

LEAD course for fellows (August 9) Please indicate your participation as a fellow-in-training.

A U G U S T 1 0 - 11 , 2 0 1 2

(Early registration will close August 2 at 11:59 PM EST. Registration will re-open on-site.)

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