Endorsed by

Presents

Cardiovascular - Thoracic(CVT) Critical Care 2013

Meeting the Challenges of Innovative Technology andthe ICU Community to Increase Speed of Recovery, Safety

& Patient Comfort

Thurs, Oct 10 - Sat, Oct 12, 2013Omni Shoreham Hotel

Washington DC

10th Annual Multi-DisciplinaryCME Conference for theCVT Critical Care Team

TARGET AUDIENCE:Surgeons, Interventionalists, Intensivists, Anesthesiologists, Hospitalists, Critical Care Nurses, Nurse Practitioners, Physician Assistants, Cath Lab Professionals, Perfusionists, Pharmacists, Nutritionists,Respiratory Therapists & Perioperative Nurses

Jointly Sponsored by

We H e l p S a v e L i v e s !

10CEL

EBRATING

YEARS

Welcome to the 10-Year Anniversary Conference of FACTS-Care “Team Building”!

The FACTS-Care CME annual conference is based on the fact that “CVT Critical Care” is a multi-disciplinary specialty that continues to evolve, and that optimal care of the CVT patient depends on coordination of a multi-disciplinary team. The FACTS-Care meetings are constructed to be “team-building” events!

The field of CVT critical care continues to be chal-lenged by the increased acuity of patients, and the complexity of the procedures and supportive technol-

ogy involved in their care. Increasing safety and quality of care are ongoing challenges for all medical centers.

With the ongoing reality of “revolving door” ICU employment, maintaining and building CVT critical care teams continues to be a major challenge. The FACTS-Care conferences provide the latest concepts and protocols to update current leaders of CVT ICU’s, and to develop new leaders for their units.

In order to provide the optimal educational experience, the annual confer-ences feature multi-disciplinary leaders in CVT critical care, who bring their expertise to presentations, panel discussions, and workshops. In addition, patients’ perspectives and concerns are highlighted in a panel presentation by The Mended Hearts.

The Exhibit Hall and the non-CME Focus Groups provide important informa-tion for CVT critical care leaders about specific technology and pharmaceuti-cal advances.

To encourage communication among “CVT critical care teams” around the world, the meeting now features two “Abstract-Based Scientific Sessions,” a Poster Session event, and the annual Andrew Foster Young Investigator presentation.

We look forward to your joining us at the 10-Year Anniversary FACTS-Care CME conference, “CVT Critical Care 2013”!

Nevin M. Katz, MDPresident & Executive DirectorFACTS-Care

This 10th annual multi-disciplinary CME conference is dedicated to further advancing knowledge and expertise in the complex field of Cardiovascular-Thoracic (CVT) Critical Care. It is designed to bring together the entire team of health care professionals that provide care for patients undergoing CVT operations and interventional procedures.

The conference addresses the unique physiology, operations, procedures, andpotential complications of CVT patients. Latest management strategies for challenging clinical problems will be presented and current controversies discussed. Experts and world authorities will focus on the latest concepts, technology, management protocols, and clinical experience in their specialties.

The program includes faculty presentations, abstract-based scientific sessions, symposia regarding major issues, audience-panel discussions and workshops. Approaches and specific protocols will be related to clinical data, so that participants can structure their clinical practice on evidence-based medicine.

With the field of CVT critical care continuing to change rapidly, it is anticipated thatparticipation in the conference will lead to implementation of new concepts, protocols, and technology. The overall goal is to make the recovery of patients from CVT surgery and interventional procedures faster, safer, and more comfortable.

Educational Objectives:

The overall educational objectives of Cardiovascular-Thoracic (CVT) Critical Care 2013” are:

• Apply the latest concepts, technology and developments in CVT critical care to optimize patient outcomes.

• Identify the latest innovations and protocols in cardiac, respiratory and renal support.

• Explain the importance of the multi-disciplinary team approach in CVT critical care and principles of the team coordination.

Team Discount and Early Bird Registration Deadline - September 26, 2013

Register 3 and get a FREE registration for the 4th Team Member!

10CEL

EBRATING

YEARS

Thursday, October 10

7:00 am – 8:00 amLight Breakfast & Registration

SESSION I - Introduction & Cardiovascular8:00 am – 8:05 amWelcome & Introduction to the Program

Nevin M. Katz, MD

8:05 am – 8:20 amWelcome & Perspective from theFACTS-Care Board of Directors

John V. Conte, MD & Mary J. Zellinger, CCRN

8:20 am – 8:40 amThe 10-Year History of FACTS-Care

Nevin M. Katz, MD

8:40 am – 9:10 amManagement of Severe CHF withPharmacologic & Device Support

Michael J. Lim, MD

9:10 am – 9:40 amPermanent Ventricular Assist Device Readmissions & Emergencies – Case Scenarios

John V. Conte, MD, Jonathan W. Haft, MD, & Asser F. Guirgues, CCP

9:40 - 10:00 amAudience Panel Discussion

Moderator: John V. Conte, MD

Panelists: Michael Doll, PA-C, Myra F. Ellis, CCRN, Asser F. Guirgues, CCP, Jonathan W. Haft, MD, Marsha Holton, CCRN & Michael J. Lim, MD

10:00 - 10:30 amRefreshment Break - Exhibit Hall

SESSION II - Cardiac Transplantation10:30 am – 11:00 amCardiac Transplantation – Postoperative Care & Immunosuppression

Jonathan W. Haft, MD

SESSION III - Innovative Approachesto CVT Critical Care - Abstract-Based Scientific Session 11:00 am – 11:45 am

Moderator: Daniel L. Miller, MD

Emergency Use of Cardiopulmonary Bypass in Complicated Transcatheter Aortic Valve Replacement: Importance of a Heart Team Approach

Jahanzaib Idrees, MD, Eric E. Roselli, MD, Samir Kapadia, MD, Murat Tuzcu, MD, Lars G. Svensson, MD. Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH

Discussant: Michael Doll, PA-C

Infection Prevention “Bundles” Improve the Quality of Care in a CTICU

Maureen A Kreider, MSN, Brian S. Koll, MD, Lisa Goto, Cathy Sullivan, MSN, Charles M. Geller, MD, Beth Israel Medical Center, New York, NY

Discussant: Denese Sabatino, CCRN

11:45 am – 12:00 pmIntermission - Exhibit Hall

Professional Networking Luncheon Symposium 12:00 pm – 1:15 pmThe Multi-Disciplinary CVT Support Team – Organization & Case Scenario

Moderators: Charles M. Geller, MD, Robert E. Molyneaux, PA-C & Mary J. Zellinger, CCRN

Panelists: Pharmacist - Robert Warhurst, PharmD, Respiratory Therapist, Physical Therapist, Speech Language Pathologist, Nutritionist, Supportive -Palliative Care Specialist.

1:15 pm – 2:00 pmNon-CME Focus Groups & Exhibit Hall Demonstrations - Latest Technology & Pharmaceuticals

Bedside Point of Care Technology: Advancing Patient Care

Discussion Leader: Charles Oribabor, MD

Location: Hampton Room

Percutaneous Cardiac Assist Devices: Pa-tient and Device Selection

Discussion Leader: Michael J. Lim, MD

Location: Calvert Room

Session IV - Thoracic Surgery &Respiratory Support2:00 pm – 2:30 pmMechanical Ventilation & Weaning after Complex CVT Surgery – Case Scenarios

James P. Lamberti, MD

2:30 pm – 3:00 pmAdult ECMO – Case Scenarios with Latest Strategies

William R. Lynch, MD & Hirose Hitoshi, MD

3:00 pm – 3:30 pmTracheal Surgery & Postop Care

Daniel L. Miller, MD

3:30 pm – 4:00 pmCardiac Surgery Advanced Life Support (CALS) – Protocols & Results

Joel Dunning, PhD

4:00 pm – 4:30 pmRefreshment Break - Exhibit Hall

SESSION V - Multi-Disciplinary Break Out Workshops4:30 pm – 6:00 pmBronchoscopy Simulation

Director: James P. Lamberti, MDCo-Director: Namrata Patil, MD

Cardiac Advanced Life Support (CALS) Protocols

Director: Joel Dunning, PhDCo-Director: S. Jill Ley, RN, CNS

Temporary Circulatory Support / ECMO - Protocols & Bedside Issues

Co-Directors: Jonathan W. Haft, MD, William R. Lynch, MD, & Asser F. Guirgues, CCP

Physicians

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Association for Thoracic Surgery (AATS) and the Foundation for the Advancement of CardioThoracic Surgical Care. The AATS is accredited by the ACCME to provide continuing medical education for physicians.

The American Association for Thoracic Surgery designates this live activity for a maximum of 18.25 AMA PRA Category 1 Credit(s) TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

NursesThis activity is pending approval with TheAssociation of periOperative Registered Nurses.

Perfusionist Accreditation

This activity is pending approval with the Ameri-can Board of Cardiovascular Perfusion (ABCP).

Disclosure policy:

It is the policy of the American Association for Thoracic Surgery that any individualwho is involved in planning, presenting or is an author on a program designatedfor AMA Physician’s Recognition Award Category 1 Credit™ must disclose any financialinterest or other relationship (grant, researchsupport, consultant, etc.) that individual has with any manufacturer(s) of any commercial product(s) that may be discussed in the individual’s presenta-tion. This information is disclosed to the audienceprior to an activity. The AATS has procedures in place if a conflict of interest should arise. Inaddition, faculty members are asked to disclose when any discussion of unapproved use ofpharmaceutical or medical device occurs.

For further information on the Accreditation Council for Continuing Medical Education(ACCME) Standards of Commercial Support, please visit www.accme.org.

Core Competencies:This program will address the following ACGME/ABMS competencies:· Patient care and procedural skills· Medical knowledge

CME Accreditation

Friday, October 11

7:00 am – 8:00 amLight Breakfast & Registration

Session VI – Endocrine Issues 8:00 am – 8:30 am

Moderator: Joseph F. Dasta, MSc

Adrenal & Thyroid Insufficiencies in the CVT ICU Patient

Jacqueline Jonklaas, MD, PhD

8:30 am – 9:00 am Hyponatremia & Hypernatremia –Management in the CVT ICU

Joseph G. Verbalis, MD

Session VII – Ethical Issues9:00 am – 9:30 am

Moderator: Namrata Patil, MD

The Ethics of Advanced Critical Care TechnologyMelissa M. Goldstein, JD

Session VIII – Andrew Foster YoungInvestigator Award

9:30 am – 10:00 amAndrew Foster “Young Investigator” PresentationAward Presenter: Joseph M. Giordano, MDAward Recipient : Sarah Schubert, BS

LAD Coronary Artery Blood Flow& LVUnloading During ECMO Support in a Swine Model of Acute Cardiogenic Shock

10:00 am – 10:30 am Refreshment Break - Exhibit Hall

Session IX – The Patient’s Perspective10:30 am – 11:00 amThe Patient’s Perspective Panel

Mended Hearts Moderator & Representatives & Barbara Jacobs, CCRN

Session X – Innovative Approachesto CVT Critical Care - Abstract-Based Scientific Session11:00 am – 11:45 amModerator: Danielle Blais, PharmD

Continuous Renal Replacement Therapy & Mild Hypothermia for Acute Severe Heart Failure after Cardiovascular Surgery

Haitao Zhang, MM, Yu Du, MM, Xue Feng, MD, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

Discussant: Jonathan W. Haft, MD

The Impact of Frailty on Post-operative Delirium in Patients Undergoing Cardiac Surgery

Rakesh C. Arora, MD, PhD, Michael A. Pereira, BSc, Patrick Jung, BSc, Brett M Hiebert, MSc, Hilary Grocott, MD, Darren H. Freed, MD, PhD, Navdeep Tangri, MD. PhD, St. Boniface Hospi-tal, Winnepeg, Manitoba, Canada

Discussant: Namrata Patil, MD

11:45am – 12:00 pmIntermission - Exhibit Hall

Luncheon Symposium 12:15 pm – 1:15 pmKEYNOTE ADDRESS: The Health Care Evolution: Improving Quality, Safety, & Efficiency of Cardiothoracic Teams

Paul Barach, MD, MPH

1:15 pm – 2:00 pmNon-CME Focus Groups & Exhibit Hall Demonstrations - Latest Technology & Pharmaceuticals

Challenges in CV Critical Care: TailoringTreatment for Thrombotic Complications

Discussion Leader: Charles M. Geller, MD Location: Hampton Room

Renal Replacement Therapy: LatestTechnoloby for the CVT ICU

Discussion Leader: Geoffrey R. Sheinfeld, MD Location: Calvert

A Balancing Act: Achieving a Calm,Comfortable, Patient and Maintaining the Ability to Conduct Assessments

Discussion Leader: Margaret McAndrew Location: Chairman’s Room

Session XI2:00 pm – 2:30 pmThe Challenges of Re-operative Cardiac Surgery

Duke E. Cameron, MD

Session XII – Innovations in Anticoagula-tion & Coagulopathy Management2:30 pm – 3:00 pmLatest Updates in the Use of Novel Oral Anticoagulant and Anti-platelet agents

Jessica Crow, PharmD

3:00 pm – 3:30 pmReversal of Anticoagulation

Jerrold H. Levy, MD

3:30 pm – 4:00 pmRefreshment Break - Exhibit Hall

Session XIII– Multi-Disciplinary Break Out Workshops4:00 pm – 5:00 pm Bedside Echocardiography & Ultrasound Guided Procedures

Director: Haney Mallemat, MDCo-Director: Glenn Whitman, MD

Hemodynamic Simulation – CaseScenarios including Patient with VAD

Director: Nevin M. Katz, MD

Temporary Pacing & PermanentPacemakers in the ICU

Director: Cynthia M. Tracy, MDCo-Director: Myra F. Ellis, CCRN

Session XIV - Abstract-Based Poster Session5:00 pm – 6:00 pmPoster Session – Wine & Cheese Event - Exhibit Hall & Patio

Saturday, October 12

7:00 am – 8:00 amLight Breakfast and Registration

Session XV – Neurologic & Sepsis Issues8:00 am – 8:30 amAcute Pain Management in the CVT ICU

Joseph F. Dasta, MSc

8:30 am – 9:00 amExtended Antibiotic Infusion Therapy

Robert Warhurst, PharmD

9:00 am – 9:30 amSurviving Sepsis Guidelines – Latest Challenges & Protocols

Philip S. Barie, MD

Session XVI - Renal & Neurologic Issues &Best Practices

9:30 am – 10:00 am Management of the CVT ICU Patient with Acute Renal Dysfunction & Failure

Mitchell H. Rosner, MD

10:00 am – 10:30 amGeneral Surgical Complications after CVT Procedures – Diagnosis & Management

Philip S. Barie, MD

10:30 am – 11:15 am Best Practices & Controversies: Pros & ConsAudience - Multi-Disciplinary PanelDiscussion

Moderator: Nevin M. Katz, MD

Panelists: Philip S. Barie, MD, Michael Doll, PA-C, Donnie Goodwin, ACNP, Barbara Jacobs, CCRN, Mitchell H. Rosner, MD, Denese Sabatino, CCRN, Steven Simms, RN & Robert Warhurst, PharmD

11:15 amClosing Comments

Nevin M. Katz, MD

*Program Agenda subject to change

Team Discount &Early Bird

Registration DeadlineSeptember 26, 2013

Register 3 and geta free registration fora 4th team member!

Omni Shoreham HotelGroup Rate

Book by Sept 10, 2013

The Health Care Evolution: Improving Quality, Safety & Efficiency of Cardiothoracic Teams

High value, safe and reliable cardiothoracic patient care is all about enabling cohesive and trusting teams. Improving patient safety in a reliable and sustained manner requires developing a structure and process to address the gaps in care, using a methodology for improvement, and selecting appropri-ate, sustainable process and outcome measures. Genuine teamwork in most of healthcare remains elusive. Surgical teams fall prey to five pitfalls which cannot be addressed effectively in isolation. In reality these five themes are interrelated and fundamental to achieving reliable performance financially, ethically and organizationally. The themes are building trust, conflict man-agement, engagement, accountability, and measurement.

After this session, participants will be able to:

• Describe the fundamentals of building healthcare for reliable outcomes

• Identify the best methods for exploring and implementing team training and assessment of surgical teams

• Explain the central role of a safe and nurturing culture

• Discuss how to enable and support cohesive, engaged and reliable teams

KEYNOTE SPEAKER

Paul Barach, MD, MPHAssociate Professor College of Public HealthUniversity of South FloridaTampa, FL

Conference Director

Nevin M. Katz, MDPresident & Executive Director, FACTS-CareAssociate Professor of SurgeryJohns Hopkins UniversityThe Johns Hopkins HospitalBaltimore, MD

Conference Co-Directors

Joseph F. Dasta, MScProfessor EmeritusThe Ohio State University College of PharmacyColumbus, OHAdjunct ProfessorUniversity of Texas College of PharmacyRound Rock, TX

Jerrold H. Levy, MD, FAHA, FCCMProfessor of AnesthesiologyCo-Director, Cardiothoracic ICUDuke University Medical CenterDurham, North Carolina

Daniel L. Miller, MDChief, General Thoracic SurgeryProfessor of Thoracic SurgeryEmory UniversityAtlanta, GA

Mary J. Zellinger, RN, MN, ANP-BC, CCRN-CSCClinical Nurse SpecialistCardiovascular & Critical Care ServicesEmory University HospitalAtlanta, GA

Invited Faculty

Paul Barach, MD, MPHAssociate Professor College of Public HealthUniversity of South FloridaTampa, FL

Philip S. Barie, MDChief of Critical Care & TraumaProfessor of SurgeryWeill Cornell Medical CenterNew York, NY

Danielle Blais, PharmD, BCPSClinical Assistant ProfessorThe Ohio State University Medical CenterColumbus, OH

Duke E. Cameron, MDCardiac Surgeon-In-ChargeThe Johns Hopkins HospitalProfessor of SurgeryJohns Hopkins University Baltimore, MD

John V. Conte, MDDirector, Mechanical Circulatory SupportThe Johns Hopkins HospitalProfessor of SurgeryJohns Hopkins University Baltimore, MD

Jessica R. Crow, PharmDClinical SpecialistCardiac Surgical Intensive Care &Nutrition Support ServiceThe Johns Hopkins Hospital Department of PharmacyBaltimore, MD

Michael C. Doll, MPAS, PA-CChief Physician AssistantDivision of Cardiac SurgeryGeisinger Medical CenterDanville, PA

Joel Dunning, PhDConsultant Cardiothoracic SurgeonJames Cook University HospitalMiddlesbrough, UK

Myra F. Ellis, RN, MSN, CCRN-CSCClinical Nurse IV – CT ICUDuke University HospitalDurham, NC

Charles M. Geller, MDDivision of Cardiac SurgeryBeth Israel Medical CenterNew York, NY

Joseph M. Giordano, MDProfessor EmeritusDepartment of SurgeryThe George WashingtonUniversity Washington, DC

Melissa M. Goldstein, JDAssociate ProfessorDepartment of Health PolicySchool of Public Health & Health SciencesThe George WashingtonUniversityWashington, DC

Donnie Goodwin, ACNPCardiac Surgery Nurse Practitio-ner CoordinatorWest Virginia University Heat InstituteMorgantown, WV

Asser F. Guirgues, MBA, CCPChief PerfusionistMedStar Heart InstituteWashington, DC

Jonathan W. Haft, MDDirector, Extra-Corporeal LifeSupport ProgramAssociate Director Cardiovascular Intensive Care UnitsAssociate Professor of Surgery & AnesthesiaUniversity of MichiganAnn Arbor, MI

Hitoshi Hirose, MDAssociate Professor of SurgeryDivision of Cardiothoracic SurgeryThomas Jefferson UniversityPhiladelphia, PA

Marsha Holton, CCRN, RCIS, FSICPPresident, Cardiovascular Orien-tation ProgramsClinical CoordinatorIndian Head, MD Barbara S. Jacobs, RN, MSN, CCRN, CENPSenior Director, Nursing Opera-tionsSuburban Hospital Johns Hopkins MedicineBethesda, MD

Jacqueline Jonklaas, MD, PhDAssociate Professor of MedicineDivision of EndocrinologyGeorgetown UniversityWashington, DC

James P. Lamberti, MDMedical DirectorRespiratory Care ServicesINOVA Fairfax HospitalFalls Church, VA

S. Jill Ley, RN, MS, CNSClinical Nurse SpecialistAdult & Pediatric Cardiac SurgeryCalifornia Pacific Medical CenterSan Francisco, CA

Michael J. Lim, MDDirector, Division of CardiologyDirector, Cardiac Catheterization LaboratoryAssociate Professor of Internal MedicineSaint Louis University School of MedicineSt. Louis, MO

William R. Lynch, MDAssociate Professor of SurgerySection of Thoracic SurgeryUniversity of MichiganAnn Arbor, MI

Haney Mallemat, MDAssistant ProfessorDepartment of Critical Care MedicineDepartment of Emergency MedicineUniversity of Maryland Medical CenterBaltimore, MD

Robert E. Molyneaux, PA-CChief Physician AssistantSurgical Critical Care ServicesWashington Hospital CenterWashington, DC

Namrata Patil, MD, MPHDirector, Thoracic Intermediate Care UnitAssociate SurgeonBrigham & Women’s HospitalInstructor in SurgeryHarvard Medical SchoolBoston, MA

Mitchell H. Rosner, MDChair, Department of MedicineProfessor of MedicineUniversity of VirginiaCharlottesville, VA

Denese Sabatino, MSN, ARNP, NP-C, CCRNClinical Nurse SpecialistDepartment of Critical CareCleveland Clinic FloridaWeston, FL

Steven Simms, RN, BSNCath Lab Patient Care DirectorVirginia Hospital CenterArlington, VA

Cynthia M. Tracy, MDDirector of Cardiology ServicesProfessor of MedicineThe George Washington Uni-versityWashington, DC

Joseph G. Verbalis, MDChief Division of Endocrinology &MetabolismProfessor of Medicine & PhysiologyGeorgetown UniversityWashington, DC

Robert D. Warhurst, PharmClinical Pharmacy SpecialistDepartment of PharmacyIU Health Saxony HospitalFishers, IN

Glenn Whitman, MDDirector, Cardiac SICUThe Johns Hopkins HospitalAssociate Professor of SurgeryJohns Hopkins UniversityBaltimore, MD

SAVE THE DATE!Cardiovascular-Thoracic (CVT)

Critical Care 2014

Meeting the Challenges ofInnovative Technology, and

The ICU Community to Increase Speed of Recovery, Safety, and

Patient Comfort

11th Annual CME Team-Building Multi-Disciplinary Cardiovascular-Thoracic (CVT) Critical Care 2014

October 9-11Omni Shoreham Hotel

Washington, DC

Call for Abstracts: Abstract-Based Scientific Session, Poster Session &

Andrew Foster YoungInvestigator AwardMarch 15, 2014

TO REGISTER, PLEASE VISIT www.facts-care.orgor return the following form by mail to:

ATTN: Mowahib F. VermillionFACTS-Care1912 Foxhall Road, McLean, VA 22101Phone: 703.992.9948

Registration not accepted over the phone.

PLEASE PRINT CLEARLY

FIRST NAME + INITIAL _________________________________________________________________________________

LAST NAME ___________________________________________________________________________________________

ORGANIZATION ____________________________________TITLE/CERT. ________________________________________

PRIMARY ADDRESS ____________________________________________________________________________________

______________________________________________________________________________________________________

CITY ____________________ STATE/PROVINCE _______________________ ZIP/POSTAL CODE ___________________

COUNTRY ____________________________________________________________________________________________

TELEPHONE__________________________________ EMAIL __________________________________________________

REGISTRATION FEES

❑ *PHYSICIAN ❑ $557 ❑ $655 (After 9/26) $______________

❑ PHYSICIAN ❑ $655 ❑ $755 (After 9/26) $______________

❑ *ALLIED HEALTH ❑ $387 ❑ $455 (After 9/26) $______________

❑ ALLIED HEALTH ❑ $455 ❑ $555 (After 9/26) $______________

❑ *FELLOW/STUDENT ❑ $293 ❑ $455 (After 9/26) $______________

❑ FELLOW/STUDENT ❑ $345 ❑ $455 (After 9/26) $______________

TAX DEDUCTIBLE DONATION TO SUPPORT FACTS-CARE $______________

TOTAL $______________

*AATS, FACTS-Care & STS members receive 15% discount.

PAYMENT

❑ CHECK/ M.O. ENCLOSED

❑ VISA ❑ MASTERCARD ❑ AMERICAN EXPRESS

CARD NAME ________________________________________________________

CARD NUMBER _____________________________________________________

EXP. DATE __________________________________________________________

SIGNATURE ________________________________________________________

For further information or to register, visit www.facts-care.org or email Mowahib F. Vermillion at info@facts-care.org

Register 3 and get a free registration for a 4th team member!Omni Shoreham Hotel Group Rate - Book by Sept 10, 2013

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