Attendee Name(s): ______________________________________________________________________________________________________

Address:_________________________________________________________________________________________________________________________

City: _________________________________________State/Province: ____________________________Zip/Postal Code: ______________________

Telephone: (___________)_________________________________________ Email: ___________________________________________________

Card Number: _____________________________________________________________________________Expiration Date:_____________________________

Billing Address: ___________________________________________________________________________________________Security Code: _________________

Name on Card: ______________________________________________________________________Signature:________________________________________

To pay by check, send this form to CAFP at 2224 S. Fraser St., Unit 1, Aurora, CO 80014, check payable to CAFP. Please fax a copy of this completed form to 303-696-7224 or scan and email to erin@coloradoafp.org. Questions? Contact Erin Watwood at erin@coloradoafp.org or 303-696-6655 ext. 14.

Cheyenne Mountain Conference Center has something for you and your family. Refl ecting the rugged charm of Colorado, all rooms feature expansive views of Cheyenne Mountain framed by the spectacular Rockies. Visit: http://cheyennemountain.com/ to make your reservation, use group code 9913.

Scholarships are available for two students and two residents! Contact Erin Watwood at erin@coloradoafp.org for more information.

Conference package: Your accommodations and meals are rolled into a package we think you’ll love. Our special group discounted rate is $149 per night (group code 9913), and the following meals are included in each full conference registration:Thursday: Does not include mealsFriday: Breakfast, lunch, all breaks, dinner and receptionSaturday: Breakfast, lunch, all breaks, and barbequeSunday: Breakfast and break

Save $50 by registering online!Register online at:

coloradoafp.org/ASCattendee

Conference Center Reservations

__Student __Resident __Medical Student __Teacher __First Time Attendee __New to Practice __Life member __Family Physician of the Year __Teacher of the Year __Resident of the Year __Past FP of the Year __Past Teacher of the Year __Past President of the Year __Board of Directors __Committee Chair __Chair of the Board __ President __President-Elect __Vice President

__Treasurer __Secretary __Member-at-Large __Alternate Delegate __Delegate __Doctor of the Day __SDC Donor __ AAFP Foundation Donor __Political Committee Contributer

Please check what pertains to your CAFP status:

New Doctor Discount $50 (<5 years)

First Time Attendee Discount $50

5k fun run/walk $10

PALS ACLS BLS

___ Sat. BBQ (extra ticket) $25

___ Child BBQ $15

Total Due: $________________________

MEMBERS

Before 12/30/13 $375

Before 2/28/14 $425

A� er 4/11/14 $475

Single Day $250

Life Member $350

Inactive Member $300

Student/Residents $25/day

Part II, Pain Mgmt SAM $200

DOT Medical Examiner $375

Single Class $50

NON-MEMBERS

Before 12/30/13 $475

Before 2/28/14 $500

A� er 4/11/14 $575

Single Day $350

Single Class $75

Part II, Pain Mgmt, SAM $250

DOT Medical Examiner $375

DISCOUNTS & OTHER EVENTS

O� ce and support sta� : 50% discount o� of regular workshop and/or conference rate if attending with a

CAFP Family Physician member

Look Forward To:

Colorado Academy of Family Physicians2224 S. Fraser St. Unit 1Aurora, CO 80014

24-27272014

April

New Horizons for Family Medicine66th Annual Scientifi c Conference

Child Care

Western BBQ

Daily Door Prizes

5k Fun Run

Child Care

Circus � emed Reception

5k Fun Run/Walk

Excellent CME

Attendee Brochure

Cheyenne Mountain Conference Center Colorado Springs, CO

_____ number of children you will bring to child care. You will pay $5 per hour / per child to GoBaNannies, Inc on-site.

We’ve planned a new and innovative conference format with expanded optional workshop sessions and infoPOEMS updates (“Blast Sessions”) with Mark Ebell, MD, and John Hickner, MD. Don’t worry, you’ll still see traditional lecture style presentations too. Your ASC conference will be more family friendly with activities for all ages and optional child care available. Our Friday reception this year will be a circus theme and will be appropriate for “kids” of all ages. This year bring your kids, spouses and guests to the informal barbeque Colorado style on Saturday!

Connect

Dear Friends of Family Medicine,We invite you to join us at the beautiful Cheyenne Mountain Conference Center in Colorado Springs for our Annual Scientifi c Conference. This is your once-a-year local opportunity to expand and refresh your medical knowledge base while connecting with fellow Family Physicians who share the promises and challenges unique to practicing in Colorado. We would like to see all Colorado Family Physicians, Residents, and Students attend. Please contact Erin Watwood to see if you might qualify for the Residents and Students scholarships. Please join us for another fantastic weekend of medical education, legislative updates, chapter business, and practical pointers for running a successful practice; along with plenty of time for fun and family. Come refresh your enthusiasm for patient care and reinvigorate your confi dence in successfully practicing the art and science of Family Medicine in Colorado at the 2014 ASC!

PreliminarySchedule

Participants will review American Heart Association (AHA) algorithms and guidelines for management of a pre-arrest or arrest situation. This includes respiratory review, BLS with AED and megacode management. Cards are awarded after

course completion. A total of 20 CME are possible, and cost depends on which modules are chosen.

Pre-registration is mandatory; course requires a minimum of 10 pre-registered participants. Register and pay at www.thehen.biz. Contact Kristin Paston at kpaston@thehen.biz or 303-380-6518.

Pediatric Advanced (PALS), Basic (BLS) and Advanced Life Support:

SAM - Part II, Pain Management – 12 CME:Self-Assessment Modules (SAM) are part of your ABFM maintenance of certifi cation process. You must complete these to stay certifi ed, extending your big test window from seven years to ten years. Bring your own wireless-enabled computer to complete your module.

Martha Illige, MDSAM Instructor

Kern Low, MDSAM Instructor

This Live activity, 2014 Annual Scientifi c Conference, with a beginning date of April 24, 2014, has been reviewed and is acceptable for up to 25 Prescribed credits by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Colorado AFP is participating in the AAFP Translation to Practice (t2p) component. Attendees of this meeting will have the opportunity to earn two additional credits following the CME meeting. Information on the t2p pilot will be shared during the meeting.

A total of 59.5 possible CME credits may be earned at the 2014 conference. This year we’re proud to offer a fabulous lineup of nationally recognized educators.

Register before Dec. 30, 2013 to receive $100 off the registration fee, or register before Feb. 28, 2014 to receive $50 off the registration fee.

THURSDAY, APRIL 24 Life Support Courses - ACLS, PALS, BLS

DOT Medical Examiner Training

Self Assesment Module - Pain Management, Part II

FRIDAY, APRIL 25InfoPOEMs* with Mark Ebell, MD and John Hickner, MD

Intro to POEMsType 2 Diabetes MellitusDeep Vein Thrombosis and Pulmonary EmbolismCardiovascular Guideline UpdateAcute Respiratory Tract InfectionScreening and Prevention UpdateInfoPOEMs Editors Choice

Keynote: Cognitive Computing and Healthcare - Martin Kohn, MD

Update on Pertussis: Changing Epidemiology and Vaccine Challenges

Who We Are and How it Affects Our Careers

Connect for Health Colorado and the Evolving Health Insurance Landscape in the State

Exhibit Hall Reception – Circus Theme

SATURDAY, APRIL 26

Sports Concussions: Update 2014

Pediatrics in Pictures to “Peak” Your Passion

Managing Marijuana/Addiction ICD-10-CM: A Primary Care Provider’s Perspective

Awards/Installation and Lunch

Happy Doctors + Happy Patients = Direct Primary Care

Offi ce Procedural Workshops - Gynecological Procedures: IUD Insertion, Edometrial Biopsy, and Bartholin Cyst Incision & Drainage

Western BBQ Dinner

SUNDAY, APRIL 27

5k Fun Run/Walk

Physician Stress/Physician Self Care

Legislative Update

Addressing the Inseparability of Mental Health and Primary Care

Chandra Hartman, MDConference CommitteeCo-Chair

What’s New

DOT Medical Examiner Training:Effective May 21, 2014, all health care professionals who perform physical examination and issue medical certifi cates for CMV drivers will be required to complete accredited certifi cation training and pass an examination. The CAFP is excited to offer the DOT Examiner training on April 24.

Child Care Services:CAFP is pleased to offer childcare (6 months to 12 years old) during our conference. The hours of childcare provided will mirror conference programming times. Child care will be managed by GoBaNannies, Inc. A fee of $5 per child/per hour will be charged on-site. Mark Ebell, MD

Member, USPSTFEditor-in-Chief, Journal of Family Practice

John Hickner, MDChair of Family Medicine, Cleveland Clinic

Anna Wegleitner, MDConference CommitteeCo-Chair

For more information about the SAM, PALS, BLS, DOT Medical Examiner Training, Child Care, please visit coloradoafp.org/ascinfo

*Patient-Oriented Evidence that Matters (InfoPOEMs)™

InfoPOEMs® provides current answers to clinical medicine questions at the point of care.

Martin Kohn, MDChief Medical Scientist, IBM

Visit coloradoafp.org/ascinfo

for up-to-date meeting

information