January 22-23, 2015Renaissance Baton RougeBaton Rouge, Louisiana

The Fifth Annual

Presented by:The Louisiana Office of Workers’ Compensation in association with the

International Workers’ Compensation Foundation, a nonprofit corporation dedicated to workers’ compensation research and education.

LouisianaWorkers’ CompensationEducational Conference

FIFTH ANNUALLOUISIANA WORKERS’ COMPENSATION

EDUCATIONAL CONFERENCEJanuary 22-23, 2015

The Louisiana Office of Workers’ Compensation and the International Workers’ Compensation Foundationare jointly sponsoring an Educational Conference which is unique in Louisiana. The goal of this conferenceis to educate those who participate in the Louisiana workers’ compensation system regarding current rules,procedures, policies and forms and to provide an opportunity for dialogue among these participants.

Who Should Attend?

All employers, insurance adjusters, self-insurers, third party administrators, safety and human resourcemanagers, plaintiff’s and defense attorneys, health care providers, mediators and medical and vocationalrehabilitation providers are encouraged to attend. In fact, anyone interested in the workers’ compensationsystem in Louisiana will receive valuable information at the conference.

Registration Fee

The cost for attending this informative conference is:$300 Early bird registration through December 15th

$375 Registration after December 15th

Registration fee includes conference materials and special functions, including continental breakfast,evening reception and luncheon. Casual attire is appropriate for all functions.

Location

Renaissance Baton Rouge7000 Bluebonnet Blvd.Baton Rouge, LA 70810

(225) 215-7000

A block of rooms has been reserved at the conference hotel at the conference rate of $139, single or double.The rooms will be held through December 21, 2014, unless this block becomes fully reserved prior to thisdate. Register early! Indicate you are attending the Fifth Annual Louisiana Workers’ CompensationEducational Conference when making your reservations.

Continuing Education Credits

Participants may be eligible for continuing education credits for conference attendance. CEU applicationsare pending for approval in the following disciplines: rehabilitation providers (CEU for CRC, CDMS, CCM)and attorneys (MCLE). Credits approved for Workers’ Compensation Professional, Michigan State University.

EXHIBITOR/SPONSORSHIP REGISTRATION FORM

LOUISIANA WORKERS’ COMPENSATION EDUCATIONAL CONFERENCEJanuary 22-23, 2015

ATTENTION EXHIBITORSFee of $700 includes two (2) complimentary registrationsfor exhibitor representatives. Two (2) additionalregistrants will be accepted at the rate of $300 each.A separate registration form should be completed for eachadditional registrant.

Space is offered on a first come, first serve basis and willonly be reserved upon our receipt of this registrationform, which may be faxed to (386) 677-0155 or emailed toiwcf@bellsouth.net. For additional information regardingexhibit area, contact the IWCF office at (386) 677-0041.Booth setup will be in the exhibitor area on Thursday,January 22, 2015, from 7:00 am to 8:30 am. Teardown willbe on Friday, January 23, 2015, at 12:00 pm.

Refreshment Breaks will be held in the Exhibition area.Registration fee includes one 6’ draped table and twochairs, identification sign, and registration for tworepresentatives. Full fee forfeiture if unable to attend.

EXHIBITOR INSURANCE HOLD/HARMLESS CLAUSEExhibitor assumes entire responsibility and hereby agreesto protect, indemnify, defend, save and hold harmless theInternational Workers’ Compensation Foundation (IWCF),employees and agents, Chelsea Place Meetings and itsemployees and agents, and the Renaissance Baton Rougeagainst all claims, losses and damages to persons orproperty, governmental charges or fines and attorney feesarising out of or caused by exhibitor’s installation,removal, maintenance, occupancy or use of the exhibitionpremises or part thereof, excluding any such liabilitycaused by the sole negligence or concurrent comparativenegligence of the Renaissance Baton Rouge and theiremployees and agents, Chelsea Place Meetings and itsemployees and agents, as well as the IWCF, its members,employees and agents.

In addition, exhibitor acknowledges that the RenaissanceBaton Rouge, Chelsea Place Meetings and the IWCF donot maintain insurance covering exhibitors’ property orpotential liabilities and that it is the sole responsibility ofthe exhibitor to obtain business interruption insurance,property damage insurance and liability insurancecovering such losses by exhibitor. Exhibitor shall obtainand keep in force during the term of the installation anduse of the exhibit premises, policies of comprehensivegeneral liability insurance and contractual liabilityinsurance and specifically referring to contractual liabilityset forth in the foregoing paragraphs hereof, in an amountnot less than $1,000,000.00 combined single limit forpersonal injury and property damage. The RenaissanceBaton Rouge, Chelsea Place Meetings, and the IWCF shallbe included in such policies as additionally namedinsureds for this convention only.

AUTHORIZEDSIGNATURE:__________________________________________

DATE:________________________________________________

SPONSORSHIP OPPORTUNITYYou are invited to register as a sponsor for the LouisianaWorkers’ Compensation Educational Conference. Thefollowing sponsorship levels are available:

Silver: $500 Contribution• Organization name will appear

on a large “Thank You Sponsor” sign in exhibit area.

Gold: $1,000 Contribution• Organization name and contact information

will appear in conference program• Organization name will appear on

a large “Thank You Sponsor” signin exhibit area.

CHECK CATEGORY WHICH APPLIES:� EXHIBITORAND/OR� SPONSORSHIP: � Silver � Gold

Company Name: __________________________________________

Specialty: __________________________________________________

Contact Person: __________________________________________

Title: ______________________________________________________

Address: __________________________________________________

____________________________________________________________

City: ________________________________________________

State:__________________________________ Zip:______________

Telephone: __________________________________________

Fax:__________________________________________________

Email Address: ________________________________________

EXHIBITORS ONLY

Comp Registrant #1: __________________________________

Title: ______________________________________________________

Comp Registrant #2: __________________________________

Title: ________________________________________________(Please print names as you wish them to appear on name tag)

TWO REGISTRATION OPTIONS ARE AVAILABLE.1. Payment by Credit Card (MasterCard, VISA or American Express) - go to www.iwcf.us/iwcfevents.html, scroll down to LOUISIANA

and click on link to Online Registration.2. Payment by Check - complete, copy and return this form, along with a check made payable to the IWCF (International Workers’

Compensation Foundation, Inc.) and mail to IWCF, 570 Memorial Circle, Suite 320, Ormond Beach, FL 32174.For additional information contact the IWCF office at: iwcf@bellsouth.net • (386) 677-0041 • Fax (386) 677-0155

CONFERENCE REGISTRATION FORMFIFTH ANNUAL

LOUISIANA WORKERS’ COMPENSATION EDUCATIONAL CONFERENCEJanuary 22-23, 2015

Registration Fees: $300.00 per person paid through 12/15/14$375.00 paid after 12/15/14

Two registration options are available:

1. Payment by Credit Card (MasterCard, VISA or American Express) - go to www.iwcf.us/iwcfevents.html,scroll down to LOUISIANA, and click on link to Online Registration.

2. Payment by Check - complete, copy and return this form for each attendee, along with a check madepayable to the IWCF (International Workers’ Compensation Foundation, Inc.) and mail to IWCF, 570 Memorial Circle, Suite 320, Ormond Beach, FL 32174.

Name: ___________________________________________________________________________________________

Business Name: ___________________________________________________________________________________

Title_____________________________________________________________________________________________

Address: _________________________________________________________________________________________

City: ______________________________________________________State:__________Zip:____________________

Telephone: _______________________________________ Fax:____________________________________________

Email: ___________________________________________________________________________________________

Area of Interest: � Employer � Employee � Insurer � Attorney � Health Care Provider Other: ______

LODGING - The Renaissance Baton Rouge invites you to enjoy its warm hospitality at its convenient location of 7000Bluebonnet Blvd. A block of rooms has been reserved at the rate of $139.00 single or double plus applicable taxes. Thisrate will be available through December 21, 2014, unless this block becomes fully reserved prior to this date. Indicateyou are attending the Fifth Annual Louisiana Workers’ Compensation Educational Conference when calling to makeyour reservations. Register early by calling (225) 215-7000.

CONTINUING EDUCATION CREDITS - Application will be made for CRC, CDMS, CCM, and MCLE credits. Creditsapproved for Workers’ Compensation Professional, Michigan State University.

CANCELLATION REFUND POLICY - Cancellation of pre-registration must be made before 5:00 pm on January 15, 2015.Substitution of personnel is recommended in lieu of cancellation after that date. The full registration fee will be forfeitedif you fail to attend or cancel timely.

SPECIAL NEEDS - Individuals attending the conference who may need auxiliary aids or special services are requestedto provide notice of their needs in writing no later than 10 working days before the conference so that appropriatearrangements can be made.

DRESS CODE - Casual clothing is appropriate for all events.

For further information contact the IWCF office at (386) 677-0041, Fax (386) 677-0155,or email: IWCF@bellsouth.net.

Net proceeds from this event, if any, go to the International Workers’ Compensation Foundation (FEIN# 35-1737364), a non-profit organization, to further its work in workers’ compensation education and research.

(Please PRINT name as you wish it to appear on your name tag)

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FIFTH ANNUALLOUISIANA WORKERS’ COMPENSATION EDUCATIONAL CONFERENCE

Renaissance Baton Rouge • Baton Rouge, LouisianaJanuary 22-23, 2015

TOPICS

Medicare Set Asides

Recent Legislation on Jurisprudence

Safety

Medical Treatment Guidelines and the 1010 Process

Opioids Epidemic

Affordable Care Act – Workers’ Comp

Wellness Programs – Return To Work

The presenters will be senior officials of the OWCA and other experts.

For final program and additional information, go towww.laworks.net/WorkersComp/OWC_MainMenu.asp.

Thursday - January 22, 2015

7:00 am to 8:30 am Registration/Vendor Setup

8:30 am to 12:15 pm General Sessions

12:15 pm to 1:30 pm Luncheon

1:30 pm to 5:00 pm General Sessions

5:00 pm to 6:00 pm Reception

Friday - January 23, 2015

7:30 am to 8:30 am Continental Breakfast

8:30 am to 12:00 pm General Sessions

January 22-23, 2015Renaissance Baton RougeBaton Rouge, Louisiana

FIFTH ANNUAL

LouisianaWorkers’ Compensation Educational Conference

Early-bird conference registration deadline: December 15thDeadline for hotel reservations at conference rate: December 21st

386-756-3052

I W C F570 Memorial Circle, Suite 320

Ormond Beach, FL 32174

First Class MailUS Postage Paid

Daytona Beach, FLPermit #62