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SPONSORED BY HOSTED BY ANNUAL CONFERENCE REGISTRATION NOW OPEN NOVEMBER 4-6, 2015 PEDIATRIC COMPLEX CARE ASSOCIATION 1827 Old Freehold Road Toms River, NJ 08755 732.608.5350 PediatricComplexCare.org NEW BRUNSWICK, PHOTO COPYRIGHT KEVIN KAHN ANNUAL CONFERENCE NEW BRUNSWICK, NOV. 4-6, 2015

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Page 1: BECOME A MEMBER NOVEMBER 4-6, 2015 ......THURSDAY, NOVEMBER 5, 2015 7:00AM Continental Breakfast, Registration & Exhibits 8:00AM Welcome & Introductions 8:15AM KEYNOTE: Half Full of

DON’T MISSTHIS VALUABLE LEARNING EXPERIENCE

ANNUAL CONFERENCE NEW BRUNSWICK,

» Relevant Best Practices» Knowledgeable Presenters» Tremendous Take-Home Potential

NOVEMBER 4-6, 2015

WE ARE DEDICATED TO:• Serving professionals that provide care to children with complex medical needs• Delivering educational and networking opportunities• Providing a platform for peer-to-peer support through online exchange• Promoting partnerships, collaboration and communication among disciplines in the broad fi eld of pediatric complex care• Developing benchmarks and quality indicators• Endorsing cost eff ective, sustainable care for the pediatric complex care population in an era of health care reform• Representing the needs of professionals and the patients they serve before government and regulatory agencies,

professional societies and the public• Researching to develop evidence-based standards of care

BECOME A MEMBERThe Pediatric Complex Care Association welcomes new members to join us in our endeavor to better serve children with complex medical needs. We off er Active memberships, A� liate memberships and Corporate memberships. Talk to one of our Board Members in person this fall or learn more at PediatricComplexCare.org

The vision of the Pediatric Complex Care Association is uniting organizations to provide a combined voice for children with medically complex needs.

We are a national, non-profi t organization whose mission is to create opportunities for professionals to advocate, educate, network, research and promote excellence in providing a continuum of care for children with medically complex needs and their families.

SPONSOREDBY

HOSTEDBY

ANNUALCONFERENCE

REGISTRATION NOW OPEN

NOVEMBER 4-6, 2015

PEDIATRIC COMPLEX CARE ASSOCIATION1827 Old Freehold RoadToms River, NJ 08755732.608.5350

PediatricComplexCare.org

NEW BRUNSWICK,

PHOTO COPYRIGHT KEVIN KAHN

ANNUAL CONFERENCE NEW BRUNSWICK,

NOV. 4-6, 2015

Page 2: BECOME A MEMBER NOVEMBER 4-6, 2015 ......THURSDAY, NOVEMBER 5, 2015 7:00AM Continental Breakfast, Registration & Exhibits 8:00AM Welcome & Introductions 8:15AM KEYNOTE: Half Full of

DON’T MISSTHIS VALUABLE LEARNING EXPERIENCE

ANNUAL CONFERENCE NEW BRUNSWICK,

» Relevant Best Practices» Knowledgeable Presenters» Tremendous Take-Home Potential

NOVEMBER 4-6, 2015

WE ARE DEDICATED TO:• Serving professionals that provide care to children with complex medical needs• Delivering educational and networking opportunities• Providing a platform for peer-to-peer support through online exchange• Promoting partnerships, collaboration and communication among disciplines in the broad fi eld of pediatric complex care• Developing benchmarks and quality indicators• Endorsing cost eff ective, sustainable care for the pediatric complex care population in an era of health care reform• Representing the needs of professionals and the patients they serve before government and regulatory agencies,

professional societies and the public• Researching to develop evidence-based standards of care

BECOME A MEMBERThe Pediatric Complex Care Association welcomes new members to join us in our endeavor to better serve children with complex medical needs. We off er Active memberships, A� liate memberships and Corporate memberships. Talk to one of our Board Members in person this fall or learn more at PediatricComplexCare.org

The vision of the Pediatric Complex Care Association is uniting organizations to provide a combined voice for children with medically complex needs.

We are a national, non-profi t organization whose mission is to create opportunities for professionals to advocate, educate, network, research and promote excellence in providing a continuum of care for children with medically complex needs and their families.

SPONSOREDBY

HOSTEDBY

ANNUALCONFERENCE

REGISTRATION NOW OPEN

NOVEMBER 4-6, 2015

PEDIATRIC COMPLEX CARE ASSOCIATION1827 Old Freehold RoadToms River, NJ 08755732.608.5350

PediatricComplexCare.org

NEW BRUNSWICK,

PHOTO COPYRIGHT KEVIN KAHN

ANNUAL CONFERENCE NEW BRUNSWICK,

NOV. 4-6, 2015

Page 3: BECOME A MEMBER NOVEMBER 4-6, 2015 ......THURSDAY, NOVEMBER 5, 2015 7:00AM Continental Breakfast, Registration & Exhibits 8:00AM Welcome & Introductions 8:15AM KEYNOTE: Half Full of

OPTIONAL EVENTS, BREAKOUTS & FEESPlease select desired conference options below. First come, fi rst served.

11/4 TOURS OF CHILDREN’S SPECIALIZED HOSPITAL MOUNTAINSIDE & NEW BRUNSWICK For advance information, please visit childrens-specialized.org. Bus departs from The Heldrich at 1:30PM and will return approximately by 5:30PM. Bus Personal Transportation

11/5 RECEPTION 5:00-6:00PM AT THE HELDRICH Will Attend Not Able to Attend

REGISTRATION FOR BREAKOUTS – MUST LIST SESSION CHOICE:

2015 ANNUAL CONFERENCE RATES: Association Members: Full Conference 11/5 only 11/6 onlyEarly Bird by 9/4 $400 $200 $200Standard by 10/9 $450 $225 $225On site $500 $250 $250 Other Professionals: Full Conference 11/5 only 11/6 onlyEarly Bird by 9/4 475 $240 $240Standard by 10/9 $525 $265 $265On site $575 $290 $290

WEDNESDAY, NOVEMBER 4, 2015

10:00AM-1:00PM Member Round Table Lunch (invitation only)

12:30-1:30PM Registration

1:30-5:30PM Tours of Children’s Specialized Hospital - Mountainside & New Brunswick, NJIncludes transportation time to/from The Heldrich

CONFERENCE SCHEDULE

GENERAL INFORMATION

REGISTRATION - CONFERENCE & BREAKOUT SESSIONS

TO REGISTER ONLINE, VISIT PediatricComplexCare.org

THURSDAY, NOVEMBER 5, 20157:00AM Continental Breakfast, Registration & Exhibits

8:00AM Welcome & Introductions

8:15AM KEYNOTE: Half Full of It - Activating Optimism and Other Hard Core Soft Skills Tami Evans

9:15AM Break with Exhibits

9:30AM PLENARY: The Next Move - Planning for Successful Transition to Adult PlacementMary A. Long, MSW and Cathie G. Stivers, PhD., M. Div., Children’s Hospital of Richmond at VCU, VA

11:00AM Break with Poster Presenters

11:30AM Breakout Session #1 » 60 minutes

National Testing of the Nursing-Kids Intensity of Care Survey Amanda Hessels, PhD, MPH, RN, CIC, CPHQ and Elaine Larson, RN, PhD, FAAN, CIC, Columbia University, NY

Rules for Travel on Life’s Adventure: How to Make the Most of Your Own Personal Journey Tami Evans

Implementation of An Evidenced Based Algorithm for Feeding Fragile Infants Alison Folliard Chung, M.S., CCC-SLP and Melissa G. Smith, M.S., CCC-SLP, C/NDT, Children’s Specialized Hospital, NJ

12:30PM Lunch & Exhibits

1:30PM Breakout Session #2 » 90 Minutes

The Role of Safety Culture in Pediatric Long Term Care SettingsAmanda Hessels, PhD, MPH, RN, CIC, CPHQ and Elaine Larson, RN, PhD, FAAN, CIC, Columbia University, NY

Creating a Facility Master Plan for Pediatric Long Term CareDaniel S. Connors, M.Ed., St. Joseph Home of Cincinnati and Steve Kenat, B.Arch, GBBN Architects, OH

Soloist or Orchestra, Who Makes Better Music? Managing the Chronically DisabledRick Abbott, MD, Director, Function at Montefi ore, Montefi ore Medical Center, NY

3:00PM Break with Exhibits

3:15PM Breakout Session #3 » 60 Minutes

Clinical Alarm Management in Long-Term Care Janine Defeo, MSN, APN, CPNP, CRRN and Susan Fowler, PhD, RN, CNRN, FAHA, Children’s Specialized Hospital, NJ

Create a Family Faculty Model that is Sustainable, Replicable and Measureable Deidre Genovese and Josanne Pearsall, Family Faculty, Children’s Specialized Hospital, NJ

Disorders of Consciousness in a Pediatric Population: Understanding Severe TBICharles Dillard, MD, Children’s Hospital of Richmond at VCU, VA

4:15PM Adjourn

5:00PM Reception at The Heldrich

FRIDAY, NOVEMBER 6, 20157:00AM Continental Breakfast, Registration & Exhibits

8:15AM Welcome & Announcements

8:30AM PLENARY: Community Outreach and Referral DevelopmentErin Hurley Smith, ChildServe, IA and Jennifer White, MSS, Pediatric Specialty Care, PA

10:00AM Break with Exhibits

10:15AM Breakout Session #4 » 60 Minutes

Transitional Population Outcomes in a Medical HomeSuzie Nair RN, BSN, MA, MPH and Regina Olasin, MPA/DO/FAAP-FACP, Center for Discovery, NY

Medical Complexity+Child Protective Services Involvement=Challenging Care Alex Okun, MD, New Alternatives for Children, NY

Therapeutic Approach to Treating Impaired Level of ConsciousnessTina Gawri, MOTR/L and Kate Vieni, DPT, Children’s Specialized Hospital, NJ

11:15AM Break with Exhibits

11:30AM Breakout Session #5 » 60 Minutes

Best Practices for Viral Respiratory Outbreaks in PediatricLong Term CareMarianne Pavia, MS, BS, MT (ASCP), CIC, St. Mary’s Healthcare System for Children, NY

Fundamentals of Measuring Costs in Pediatric Long-Term Care Facilities Elizabeth Heitkemper, MSN, RN, Columbia University School of Nursing, NY and Natalie Neu, MD, MPH, Columbia University Medical Center

Lifting Champions: Building a Culture of Accountability & Shared Responsibility Paula Lawson, PT and Michelle Rembert, M.S.P.T., ChildServe, IA

12:30PM Lunch, Exhibits & Business Meeting – All are Invited

1:30PM Breakout Session #6 » 90 Minutes

Integrating Assistive & Adaptive Technology in Daily Living Laura Reyes, MOTR/L and Katie Stoneback, CTRS, Broward Children’s Center, FL

Challenging Encounters: Improving Communication across the Continuum of Care Richard Grossberg, MD, Hattie Larlham, UH Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, OH, Nancy A. Murphy, MD, University of Utah SOM, UT and Garey Noritz, MD, Nationwide Children’s Hospital, The Ohio State University, OH

Process Improvements to Reduce Complications of G, J or Trach Tubes James Konzelman, MSN, Voorhees Pediatric Center, NJ and Judy Potter, MAS, BSN, Children’s Specialized Hospital, NJ

3:00PM Break

3:15PM PLENARY: The Lived Experience of Placing a Child Into Care - What Parents Want You to Know Eileen O. Costello, DNP, Mt. Wachusett Community College, MA

4:15PM Closing Comments

4:30PM Adjourn

TARGET AUDIENCEThe conference brings together providers of care for children with medically complex needs that may include Physicians, Nurse Practitioners & Nurses, Pediatric Nursing Home Administrators, Occupational, Physical & Recreation Therapists, Social Workers, Speech Pathologists and Special Educators.

ACCREDITATION & CREDIT DESIGNATIONThe policy of Case Western Reserve University School of Medicine CME Program requires that the Activity Director, planning committee members and all activity faculty (that is, anyone in a position to control the content of the education activity) disclose to the activity participants all relevant fi nancial relationships with commercial interests. Disclosure will be made to activity participants prior to the commencement of the activity. Case Western Reserve University School of Medicine also requires that faculty make clinical recommendations based on the best available scientifi c evidence and that faculty identify any discussion of “off -label” or investigational use of pharmaceutical products or medical devices.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Case Western Reserve University School of Medicine and the Pediatric Complex Care Association. Case Western Reserve University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Case Western Reserve University School of Medicine designates this live activity for a maximum of 12.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Credits pending for NHA by National Association of Long Term Care Administrator Boards (NAB) and separate Nursing CEUs. Please visit PediatricComplexCare.org for the latest information.

SPECIAL SERVICESIf special arrangements are required to attend this conference, including any access needs or dietary restrictions, please contact us by October 9, 2015.

Thursday, 11/511:30 AM ____________________________________________________________1:30 PM _____________________________________________________________3:15 PM _____________________________________________________________

Friday, 11/610:15 AM ____________________________________________________________11:30 AM _____________________________________________________________1:30 PM ______________________________________________________________

PARTICIPANT INFORMATION

Email (required) ________________________________________________________

Name ________________________________________________________________

Title __________________________________________________________________

Company _____________________________________________________________

Address _______________________________________________________________

City/ST/Zip ____________________________________________________________

Phone ( ) ___________________________________________________________

PAYMENT INFORMATION

Total Amount Enclosed __________________________________________________

_____ Check/money order enclosed (payable to Pediatric Complex Care Association)

_____ Charge my credit card: M/C VISA AMEX Discover

Credit Card # __________________________________________________________

Ex. Date _________________________ Verifi cation # ________________________

Name on Card _________________________________________________________

Billing Address _________________________________________________________

City/ST/Zip ____________________________________________________________

Signature _____________________________________________________________

Please complete registration online through PediatricComplexCare.org or mail form with payment to:Pediatric Complex Care Association, 1827 Old Freehold Road, Toms River, NJ 08755

Tear

and

mai

l

SISTER KATHERINE SMITH PHD, RN AND ANDREL HOLLINS AT OUR 2014 CONFERENCE IN SAN DIEGO

REGISTRATIONDaily registration fee includes course syllabus, continental breakfast and lunch.

ACCOMMODATIONSA block of rooms on 11/4 & 11/5 has been reserved at The Heldrich at a special rate of $169 per night for a single or double. This is a peak time in this area, and we encourage early reservations.

The Heldrich10 Livingston AvenueNew Brunswick, NJ 08901Reservations: http://tinyurl.com/2015HeldrichHotel

If you require telephone assistance with your reservation please call 866-609-4700 and give the agent Group Attendee Code 271432. Group Rate Expires 10/9/15 or based on availability by The Heldrich. All hotel reservations are on your own and subject to the policies of The Heldrich.

TRANSPORTATION-Parking: The Heldrich off ers hotel guests valet parking for $25 per day and garage self-parking is $20 per day at 70 New Street, New Brunswick, NJ 08901. -Train from Newark Liberty Airport (EWR): Newark Liberty Rail Station to New Brunswick Station, approximately 35 minutes, $14.50 one-way adult fare. Upon arrival, call The Heldrich for free pick up from New Brunswick Station 732-729-4670.-Car services from EWR to The Heldrich range $65-85 plus gratuity.All parking fees and fares are subject to change.

CANCELLATION POLICYConference cancellations must be received in writing by October 9, 2015, to receive a refund. No refunds will be given after this date. A $50 administrative fee will be assessed on all cancellations.

QUESTIONS? Contact Lisa Bierly 732.608.5350 or email [email protected]

Page 4: BECOME A MEMBER NOVEMBER 4-6, 2015 ......THURSDAY, NOVEMBER 5, 2015 7:00AM Continental Breakfast, Registration & Exhibits 8:00AM Welcome & Introductions 8:15AM KEYNOTE: Half Full of

OPTIONAL EVENTS, BREAKOUTS & FEESPlease select desired conference options below. First come, fi rst served.

11/4 TOURS OF CHILDREN’S SPECIALIZED HOSPITAL MOUNTAINSIDE & NEW BRUNSWICK For advance information, please visit childrens-specialized.org. Bus departs from The Heldrich at 1:30PM and will return approximately by 5:30PM. Bus Personal Transportation

11/5 RECEPTION 5:00-6:00PM AT THE HELDRICH Will Attend Not Able to Attend

REGISTRATION FOR BREAKOUTS – MUST LIST SESSION CHOICE:

2015 ANNUAL CONFERENCE RATES: Association Members: Full Conference 11/5 only 11/6 onlyEarly Bird by 9/4 $400 $200 $200Standard by 10/9 $450 $225 $225On site $500 $250 $250 Other Professionals: Full Conference 11/5 only 11/6 onlyEarly Bird by 9/4 475 $240 $240Standard by 10/9 $525 $265 $265On site $575 $290 $290

WEDNESDAY, NOVEMBER 4, 2015

10:00AM-1:00PM Member Round Table Lunch (invitation only)

12:30-1:30PM Registration

1:30-5:30PM Tours of Children’s Specialized Hospital - Mountainside & New Brunswick, NJIncludes transportation time to/from The Heldrich

CONFERENCE SCHEDULE

GENERAL INFORMATION

REGISTRATION - CONFERENCE & BREAKOUT SESSIONS

TO REGISTER ONLINE, VISIT PediatricComplexCare.org

THURSDAY, NOVEMBER 5, 20157:00AM Continental Breakfast, Registration & Exhibits

8:00AM Welcome & Introductions

8:15AM KEYNOTE: Half Full of It - Activating Optimism and Other Hard Core Soft Skills Tami Evans

9:15AM Break with Exhibits

9:30AM PLENARY: The Next Move - Planning for Successful Transition to Adult PlacementMary A. Long, MSW and Cathie G. Stivers, PhD., M. Div., Children’s Hospital of Richmond at VCU, VA

11:00AM Break with Poster Presenters

11:30AM Breakout Session #1 » 60 minutes

National Testing of the Nursing-Kids Intensity of Care Survey Amanda Hessels, PhD, MPH, RN, CIC, CPHQ and Elaine Larson, RN, PhD, FAAN, CIC, Columbia University, NY

Rules for Travel on Life’s Adventure: How to Make the Most of Your Own Personal Journey Tami Evans

Implementation of An Evidenced Based Algorithm for Feeding Fragile Infants Alison Folliard Chung, M.S., CCC-SLP and Melissa G. Smith, M.S., CCC-SLP, C/NDT, Children’s Specialized Hospital, NJ

12:30PM Lunch & Exhibits

1:30PM Breakout Session #2 » 90 Minutes

The Role of Safety Culture in Pediatric Long Term Care SettingsAmanda Hessels, PhD, MPH, RN, CIC, CPHQ and Elaine Larson, RN, PhD, FAAN, CIC, Columbia University, NY

Creating a Facility Master Plan for Pediatric Long Term CareDaniel S. Connors, M.Ed., St. Joseph Home of Cincinnati and Steve Kenat, B.Arch, GBBN Architects, OH

Soloist or Orchestra, Who Makes Better Music? Managing the Chronically DisabledRick Abbott, MD, Director, Function at Montefi ore, Montefi ore Medical Center, NY

3:00PM Break with Exhibits

3:15PM Breakout Session #3 » 60 Minutes

Clinical Alarm Management in Long-Term Care Janine Defeo, MSN, APN, CPNP, CRRN and Susan Fowler, PhD, RN, CNRN, FAHA, Children’s Specialized Hospital, NJ

Create a Family Faculty Model that is Sustainable, Replicable and Measureable Deidre Genovese and Josanne Pearsall, Family Faculty, Children’s Specialized Hospital, NJ

Disorders of Consciousness in a Pediatric Population: Understanding Severe TBICharles Dillard, MD, Children’s Hospital of Richmond at VCU, VA

4:15PM Adjourn

5:00PM Reception at The Heldrich

FRIDAY, NOVEMBER 6, 20157:00AM Continental Breakfast, Registration & Exhibits

8:15AM Welcome & Announcements

8:30AM PLENARY: Community Outreach and Referral DevelopmentErin Hurley Smith, ChildServe, IA and Jennifer White, MSS, Pediatric Specialty Care, PA

10:00AM Break with Exhibits

10:15AM Breakout Session #4 » 60 Minutes

Transitional Population Outcomes in a Medical HomeSuzie Nair RN, BSN, MA, MPH and Regina Olasin, MPA/DO/FAAP-FACP, Center for Discovery, NY

Medical Complexity+Child Protective Services Involvement=Challenging Care Alex Okun, MD, New Alternatives for Children, NY

Therapeutic Approach to Treating Impaired Level of ConsciousnessTina Gawri, MOTR/L and Kate Vieni, DPT, Children’s Specialized Hospital, NJ

11:15AM Break with Exhibits

11:30AM Breakout Session #5 » 60 Minutes

Best Practices for Viral Respiratory Outbreaks in PediatricLong Term CareMarianne Pavia, MS, BS, MT (ASCP), CIC, St. Mary’s Healthcare System for Children, NY

Fundamentals of Measuring Costs in Pediatric Long-Term Care Facilities Elizabeth Heitkemper, MSN, RN, Columbia University School of Nursing, NY and Natalie Neu, MD, MPH, Columbia University Medical Center

Lifting Champions: Building a Culture of Accountability & Shared Responsibility Paula Lawson, PT and Michelle Rembert, M.S.P.T., ChildServe, IA

12:30PM Lunch, Exhibits & Business Meeting – All are Invited

1:30PM Breakout Session #6 » 90 Minutes

Integrating Assistive & Adaptive Technology in Daily Living Laura Reyes, MOTR/L and Katie Stoneback, CTRS, Broward Children’s Center, FL

Challenging Encounters: Improving Communication across the Continuum of Care Richard Grossberg, MD, Hattie Larlham, UH Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, OH, Nancy A. Murphy, MD, University of Utah SOM, UT and Garey Noritz, MD, Nationwide Children’s Hospital, The Ohio State University, OH

Process Improvements to Reduce Complications of G, J or Trach Tubes James Konzelman, MSN, Voorhees Pediatric Center, NJ and Judy Potter, MAS, BSN, Children’s Specialized Hospital, NJ

3:00PM Break

3:15PM PLENARY: The Lived Experience of Placing a Child Into Care - What Parents Want You to Know Eileen O. Costello, DNP, Mt. Wachusett Community College, MA

4:15PM Closing Comments

4:30PM Adjourn

TARGET AUDIENCEThe conference brings together providers of care for children with medically complex needs that may include Physicians, Nurse Practitioners & Nurses, Pediatric Nursing Home Administrators, Occupational, Physical & Recreation Therapists, Social Workers, Speech Pathologists and Special Educators.

ACCREDITATION & CREDIT DESIGNATIONThe policy of Case Western Reserve University School of Medicine CME Program requires that the Activity Director, planning committee members and all activity faculty (that is, anyone in a position to control the content of the education activity) disclose to the activity participants all relevant fi nancial relationships with commercial interests. Disclosure will be made to activity participants prior to the commencement of the activity. Case Western Reserve University School of Medicine also requires that faculty make clinical recommendations based on the best available scientifi c evidence and that faculty identify any discussion of “off -label” or investigational use of pharmaceutical products or medical devices.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Case Western Reserve University School of Medicine and the Pediatric Complex Care Association. Case Western Reserve University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Case Western Reserve University School of Medicine designates this live activity for a maximum of 12.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Credits pending for NHA by National Association of Long Term Care Administrator Boards (NAB) and separate Nursing CEUs. Please visit PediatricComplexCare.org for the latest information.

SPECIAL SERVICESIf special arrangements are required to attend this conference, including any access needs or dietary restrictions, please contact us by October 9, 2015.

Thursday, 11/511:30 AM ____________________________________________________________1:30 PM _____________________________________________________________3:15 PM _____________________________________________________________

Friday, 11/610:15 AM ____________________________________________________________11:30 AM _____________________________________________________________1:30 PM ______________________________________________________________

PARTICIPANT INFORMATION

Email (required) ________________________________________________________

Name ________________________________________________________________

Title __________________________________________________________________

Company _____________________________________________________________

Address _______________________________________________________________

City/ST/Zip ____________________________________________________________

Phone ( ) ___________________________________________________________

PAYMENT INFORMATION

Total Amount Enclosed __________________________________________________

_____ Check/money order enclosed (payable to Pediatric Complex Care Association)

_____ Charge my credit card: M/C VISA AMEX Discover

Credit Card # __________________________________________________________

Ex. Date _________________________ Verifi cation # ________________________

Name on Card _________________________________________________________

Billing Address _________________________________________________________

City/ST/Zip ____________________________________________________________

Signature _____________________________________________________________

Please complete registration online through PediatricComplexCare.org or mail form with payment to:Pediatric Complex Care Association, 1827 Old Freehold Road, Toms River, NJ 08755

Tear

and

mai

l

SISTER KATHERINE SMITH PHD, RN AND ANDREL HOLLINS AT OUR 2014 CONFERENCE IN SAN DIEGO

REGISTRATIONDaily registration fee includes course syllabus, continental breakfast and lunch.

ACCOMMODATIONSA block of rooms on 11/4 & 11/5 has been reserved at The Heldrich at a special rate of $169 per night for a single or double. This is a peak time in this area, and we encourage early reservations.

The Heldrich10 Livingston AvenueNew Brunswick, NJ 08901Reservations: http://tinyurl.com/2015HeldrichHotel

If you require telephone assistance with your reservation please call 866-609-4700 and give the agent Group Attendee Code 271432. Group Rate Expires 10/9/15 or based on availability by The Heldrich. All hotel reservations are on your own and subject to the policies of The Heldrich.

TRANSPORTATION-Parking: The Heldrich off ers hotel guests valet parking for $25 per day and garage self-parking is $20 per day at 70 New Street, New Brunswick, NJ 08901. -Train from Newark Liberty Airport (EWR): Newark Liberty Rail Station to New Brunswick Station, approximately 35 minutes, $14.50 one-way adult fare. Upon arrival, call The Heldrich for free pick up from New Brunswick Station 732-729-4670.-Car services from EWR to The Heldrich range $65-85 plus gratuity.All parking fees and fares are subject to change.

CANCELLATION POLICYConference cancellations must be received in writing by October 9, 2015, to receive a refund. No refunds will be given after this date. A $50 administrative fee will be assessed on all cancellations.

QUESTIONS? Contact Lisa Bierly 732.608.5350 or email [email protected]