new orleans corporate - the podiatry institute · 2020-01-02 · astor crowne plaza new orleans,...

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CORPORATE SPONSORS Special thanks to our 2019 Corporate Sponsors for their outstanding support of The Podiatry Institute and the continued development of excellence in post-graduate continuing educa tion. Please support these companies that support your profession. PLATINUM Bako Diagnostics Horizon Therapeutics PICA Televere Systems GOLD Amerx Health Care Arthrosurface CrossRoads Extremity Systems Ortho Dermatologics SILVER Delta Surgical Instruments Marlinz Pharma Quantum Pathology Photo courtesy ©NewOrleansConventionandVisitorsBureau (Richard Nowitz) The Podiatry Institute cannot be held liable for events beyond its control, such as acts of God, government regulations, disasters or weather-related hazards, civil unrest, or any other emergency, making it inadvisable or impossible to hold the conference. The Podiatry Institute will make every effort to inform the participants as soon as possible to enable the participants to cancel hotel and flight arrangements. The entire contents of this brochure are copyrighted by The Podiatry Institute with all rights reserved. Reproduction or use, without permission, of written or graphic content in any manner is prohibited. ©2019 NEW ORLEANS NASHVILLE March 19-22 2020 Stepping Forward— Leading the Way A Comprehensive Women-centric Foot and Ankle Conference PHOENIX April 16-19 2020 Valley of the Sun Conference with Arizona Foot and Ankle Medical Association NEWPORT April 30 - May 3 2020 Surgical Pearls by the Sea with Rhode Island Podiatric Medical Association HILTON HEAD June 18-21 2020 Footprints in the Sand with South Carolina Podiatric Medical Association PHILADELPHIA September 11-13 2020 Insights & Advancements with Penn Presbyterian Medical Center SAN DIEGO September 24-27 2020 UPDATE 2020 with San Diego Podiatric Medical Society MID-ATLANTIC October 15-18 2020 Mid-Atlantic Conference with Mid-Atlantic Podiatric Medical Association SANIBEL November 5-8 2020 Hallux Valgus & Related Forefoot 30th Annual Sanibel Conference CHICAGO December 4-6 2020 Windy City Conference with Illinois Podiatric Medical Association ABOUT YOUR HOSTS UPCOMING CONFERENCES The Podiatry Institute is a non-profit educational foundation that offers a variety of programs, conferences, workshops and postgraduate courses. The Institute has achieved international recognition for its leading role in developing and advancing podiatric medicine and surgery. The faculty members are all volunteers who serve without compensation. They are committed to ongoing education in the area of foot and ankle surgery. The Louisiana Podiatric Medical Association is an active, non-profit organization comprised of podiatric physicians who are both licensed in the state of Louisiana and are also members of the American Podiatric Medical Association. LPMA is the official state component society of the APMA. For practicing podiatrist seeking membership in the association or interested in practicing in the state of Louisiana, more information is available at lpma.info. BRONZE Depuy Synthes Podiatry Content Connection Practice EHR Sammy Systems The Tetra Corporation Wright Medical

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Page 1: new orleanS Corporate - The Podiatry Institute · 2020-01-02 · astor crowne plaza new orleans, louisiana the podiatry institute joint provider with louisiana podiatric medical association

Corporate SponSorS Special thanks to our 2019 Corporate Sponsors for their out standing support of The Podiatry Institute and the continued devel opment of excellence in post-graduate continu ing educa tion. Please support these companies that support your profession.

PLATINUMBako Diagnostics

Horizon Therapeutics

PICA

Televere Systems

GOLDAmerx Health Care

Arthrosurface

CrossRoads Extremity Systems

Ortho Dermatologics

SILVERDelta Surgical Instruments

Marlinz Pharma

Quantum Pathology

THE PODIATRY INSTITUTE JOINT PROVIDER WITH

LOUISIANA PODIATRIC MEDICAL ASSOCIATIONPRESENTS

2020 FRENchQUARTERcONFERENcE

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The Podiatry Institute cannot be held liable for events beyond its control, such as acts of God, government regulations, disasters or weather-related hazards, civil unrest, or any other emergency, making it inad visable or impossible to hold the conference. The Podiatry Institute will make every effort to inform the participants as soon as possible to enable the participants to cancel hotel and flight arrange ments. The entire contents of this brochure are copy righted by The Podiatry Institute with all rights reserved. Repro duction or use, without permission, of written or graphic content in any manner is prohibited. ©2019

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NASHVILLE March 19-22 2020Stepping Forward— Leading the WayA Comprehensive Women-centric Foot and Ankle Conference

PHOENIX April 16-19 2020Valley of the Sun Conferencewith Arizona Foot and Ankle Medical Association

NEWPORT April 30 - May 3 2020Surgical Pearls by the Seawith Rhode Island Podiatric Medical Association

HILTON HEAD June 18-21 2020Footprints in the Sandwith South Carolina Podiatric Medical Association

PHILADELPHIA September 11-13 2020Insights & Advancementswith Penn Presbyterian Medical Center

SAN DIEGO September 24-27 2020UPDATE 2020with San Diego Podiatric Medical Society

MID-ATLANTIC October 15-18 2020Mid-Atlantic Conferencewith Mid-Atlantic Podiatric Medical Association

SANIBEL November 5-8 2020Hallux Valgus & Related Forefoot30th Annual Sanibel Conference

CHICAGO December 4-6 2020Windy City Conferencewith Illinois Podiatric Medical Association

about Your HoStS

upComing ConferenCeS

The Podiatry Institute is a non-profit educational foundation that offers a variety of programs, conferences, workshops and postgraduate courses. The Institute has achieved international recognition for its leading role in developing and advancing podiatric medicine and surgery. The faculty members are all volunteers who serve without compensation. They are committed to ongoing education in the area of foot and ankle surgery.

The Louisiana Podiatric Medical Association is an active, non-profit organization comprised of podiatric physicians who are both licensed in the state of Louisiana and are also members of the American Podiatric Medical Association. LPMA is the official state component society of the APMA. For practicing podiatrist seeking membership in the association or interested in practicing in the state of Louisiana, more information is available at lpma.info.

BRONZE Depuy Synthes

Podiatry Content Connection

Practice EHR

Sammy Systems

The Tetra Corporation

Wright Medical

Page 2: new orleanS Corporate - The Podiatry Institute · 2020-01-02 · astor crowne plaza new orleans, louisiana the podiatry institute joint provider with louisiana podiatric medical association

ASTOR CROWNE PLAZANEW ORLEANS, LOUISIANA

THE PODIATRY INSTITUTE JOINT PROVIDER WITH

LOUISIANA PODIATRIC MEDICAL ASSOCIATIONPRESENTS

2020 FRENch QUARTER cONFERENcE

This is a PICA approved risk management seminar.

®

ThE PODIATRy I N S T I T U T E

2675 North Decatur RoadSuite 309Decatur, GA 30033-6132

A NONPROFIT TEACHING FOUNDATION

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NonprofitOrganizationU.S. Postage

PA I DAtlanta, GA

Permit #1954

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Page 3: new orleanS Corporate - The Podiatry Institute · 2020-01-02 · astor crowne plaza new orleans, louisiana the podiatry institute joint provider with louisiana podiatric medical association

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ASTOR cROwNE PLAZA NEw ORLEANS739 Canal St. at Bourbon, New Orleans, LA 70130 www.astorneworleans.com 877.408.9661 or 504.962.0500 (mention The Podiatry Institute for special rate)

The Astor Crowne Plaza New Orleans’ French Quarter location promises visitors a grand experience in “The Big Easy.” Enjoy a front-row seat to exciting downtown attractions and the New Orleans Riverwalk, with it’s fabulous shopping. The Astor Crowne Plaza offers great perks, including a rooftop pool, Fitness and Business Centers and great dining.Rate: $189 (plus tax, subject to change without notice)*Register online via the New Orleans page at www.podiatryinstitute.com.

A block of rooms has been reserved and will be held until it is full or February 9, 2020, whichever comes first. Please book early to guarantee your reservation. In order to secure our special group rate, advanced reservations are mandatory and you must advise Reservations that you are attending The Podiatry Institute conference. Rates cannot be changed for guests who fail to identify their affiliation at the time the reservation is made. Rate applicable March 3-9, 2020 (based on availability).

ThE FRENch QUARTERA history of international influence with cultural contributions from the French, Spanish, Sicilians, Italians, Africans, Irish and others, is all evident in the development of this global port settlement. So much of what makes New Orleans unique is captured in this melting pot, from the boisterous party vibe of Bourbon Street, to the bohemian elegance of Royal Street, to the popular Canal Street. Throughout the neighbor-hood you will see stunning architecture, intricate ironwork, lush greenery and beautiful fountains.

Life in the Quarter centers around New Orleans’ most famous landmark, Jackson Square, originally known as the Place d’Armes and renamed to honor Andrew Jackson. The square is flanked by historic structures such as the St. Louis Cathedral (www.stlouiscathedral.org), the Presbytere and Cabildo (which house the Louisiana State Museums, louisiana statemuseum.org) and the Pontalba Apartments (the oldest apartment buildings in the U.S.). Walk the beautiful gardens, make a wish as you toss a coin into the fountain and take an iconic New Orleans photograph. Just across the street is the famed Café du Monde (cafedumonde.com), serving up beignets and café au lait. Many visitors choose to explore the Quarter using the neighborhood’s original mode of transportation, the mule-drawn carriage. No trip is complete without a stop at the historic French Market (www.frenchmarket.org) for souvenirs.

Take a cruise on the Steamboat Natchez (steamboatnatchez.com), the last authentic steamboat on the Mississippi River. Housed in the apothecary of America’s first licensed pharmacist, the New Orleans Pharmacy Museum (www.pharmacymuseum.org) documents and illustrates the history of medicine during the 19th century. Celebrate jazz in the city where it was born at the New Orleans Jazz Museum (nolajazzmuseum.org).

cANAL STREETWith two streetcar lines running down the middle of the street and three traffic lanes on either side, Canal has been cited as the widest “street” in America and acts as a major hub for the city. You’ll find bright red streetcars, luxurious hotels and throngs of visitors and locals. Try your luck at Harrah’s Casino (www.caesars.com/harrahs-new-orleans)

or the adventurous can explore the Audubon Butterfly Garden and Insectarium (audubonnatureinstitute.org/insectarium), an interactive museum dedicated to insect-kind set in the old U.S. Customs House. Looming large against the Mississippi River is the extraordinary Audubon Aquarium of the Americas (audubonnatureinstitute.org/aquarium), one of the top museums of its kind in America. Treat yourself to first-class shopping at The Shops at Canal Place (www.canalplacestyle.com).

Catch the St. Charles Avenue streetcar line (norta.com) Uptown to the Garden District, the Canal line to City Park and New Orleans Museum of Art or the Riverfront line to cruise along the Mississippi. At the foot of Canal at the river, you can catch the ferry over to historic Algiers Point.

BOURBON STREETOne of the most recognizable party destinations in the world, the street is home to traditional jazz clubs, upscale lounges and historic restaurants. The street becomes a pedestrian walkway during the evening hours.

At the intersection of Canal Street and Bourbon, brass bands gather almost every night and bystanders dance on the street.

Catch a bit of the rich musical heritage at Music Legends Park (neworleansmusicallegends.com) and the history at Lafitte’s Blacksmith Shop (www.lafittes blacksmithshop.com), one of the

few original French structures to survive the Great New Orleans Fire of 1788. Today, it stands as a lamp lit piano bar, the perfect area to unwind from the frenzy found only a few blocks up.

ROyAL STREETOne of the most beautiful streets in the city and a favorite spot for photography, Royal Street is a perfect daytime destination. Walk beneath balcony after balcony dripping with colorful bouquets. Street performers —a Dixieland jazz band, puppeteer, magician, living statue or vaudeville showman—gather to surprise and delight. This street is also known for its superb shopping and art galleries.

SPEcIAL EVENTAhava Festival March 7-8 This music, art and food festival celebrates love! Woldenbert Riverfront Park www.ahavafest.com

TRAVEL DISCOUNTSTo obtain the best possible rates and make your reservations, please call our official agency:

Travel Leaders 678.689.0176 (A $25.00 seRviCe Fee will APPLY FOR THE FIRST PASSENGER; $15.00 FOR EACH AdditionAl PAssengeR.)

If you have trouble securing hotel accommodations, please call Trish at Travel Leaders.

Visit www.neworleans.com for more information on attractions and activities!

new orleanS to Do & See

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Each speaker is required to disclose the exis tence of any financial and/or other rela tionship(s) (e.g., employee, con sul tant, speaker’s bureau, grant recipient, research support) he/she might have with a) the manu facturer(s) of any com mer cial product(s) to be dis cussed during his/her pre sen ta tion and/orb) the commercial contributor(s) of the activity.

SCIENTIFIC COMMITTEEBrian B. Carpenter, DPMFort Worth, Texas

William H. Dabdoub, DPMSlidell, Louisiana

Mack Jay Groves, IV, DPMCovington, Louisiana

FACULTYThomas A. Brosky, II, DPMOakwood, Georgia

Michelle L. Butterworth, DPMKingstree, South Carolina

Steven R. Carter, DPMCovington, Georgia

David Drummond, DPMShreveport, Louisiana

Tyson E. Green, DPMLake Charles, Louisiana

Henry C. Hilario, DPMShreveport, Louisiana

Chantal B. Lorio, DPMNew Orleans, Louisiana

John T. Marcoux, DPMBrighton, Massachusetts

Steve Mariash, DPMSt. Cloud, Minnesota

Matthew McCabe, DPM Lake Charles, Louisiana

James H. Morgan, DPMMobile, Alabama

Kaleib Pourciau, DPMLake Charles, Louisiana

Timothy Short, DPMOchsner Medical Center, New Orleans, Louisiana

Jon M. Wilson, Jr., DPMAlexandria, Louisiana

NEXT GENERATION FACULTYKevin Alexander, DPMAaron Bradley, DPMEmory Decatur Hospital, Decatur, Georgia

Zachary Lamkin, DPMEast Jefferson General Hospital, Metairie, Louisiana

Brad Jimerson, DPMColin McKay, DPMOchsner Medical Center, New Orleans, Louisiana

up to 25 CeCHsThis activity has been planned and implemented in accordance with the standards and requirements for approval of providers of continuing education in podiatric medicine through a joint provider agreement between The Podiatry Institute and Louisiana Podiatric Medical Association. The Podiatry Institute is approved by the Council on Podiatric Medical Education as a provider of continuing education in podiatric medicine. The Podiatry Institute has approved this activity for a maximum of 25 continuing education contact hours.

tHurSDaY MARCH 5

12:55 PM WELCOME TO NEW ORLEANS

1:00 PM FOREFOOT/MIDFOOTBrachymetatarsia Repair with Callus Distraction: Technique and Pearls

1st MPJ AD

Iatrogenic Forefoot Deformities

Scarf Bunionectomy

Revision of Forefoot Surgery Gone Wrong

Pediatric Digital Deformities

Revisional Bunion Surgery

3:15 PM BREAK WITH THE EXHIBITORS

4:00 PM SPORTS MEDIcINEFunctional Hallux Rigidus

Diagnostic Ultrasound: Podiatric Applications

Ankle Instability

Case Study: A Rare Injury with Repair

High Ankle Sprains

5:35 PM THURSDAY SESSION ADJOURNS

friDaY MARCH 6

7:00 AM BREAKFAST WITH THE EXHIBITORS

7:30 AM ThE DIABETIc FOOTDiagnosis of Osteomyelitis

Transmetatarsal Amputation

Decompression for Painful Neuropathy

Foot and Ankle Fractures in the Diabetic Population

Fifth Metatarsal Head Resection: Not a Throw-away Procedure

Charcot Foot

Tendon Balancing Procedures in Conjunction with Amputation

10:00 AM BREAK WITH THE EXHIBITORS

10:45 AM wORkShOPSNote: you must take the oNe 2-hour workshop or two of the 1-hour workshops. there will be a sigN-iN sheet iN each workshop per rotatioN.

Hands-on workshops featuring latest techniques & technologies

Spring 2020 Podiatric Dermatology Update – “Hands-On Biopsy” Workshop The Podiatry Institute has designated an unrestricted educational grant from Bako Diagnostics to support this workshop session. Note: this is a two-hour workshop

Practicing Evidence-Based Medicine with Shock Waves The Podiatry Institute has designated an unrestricted educational grant from CuraMedix to support this workshop session.

Foot and Ankle Fixation Utilizing Active Stabilization The Podiatry Institute has designated an unrestricted educational grant from CrossRoads Extremity to support this workshop session.

12:45 PM LUNCH & LEARN

1:30 PM cOMPLEx cASE DIScUSSIONSMODERATOR: Brian B. Carpenter, DPM

PANEL: William H. Dabdoub, DPM; Steve Mariash, DPM; Michelle L. Butterworth, DPM; Thomas A. Brosky, II, DPM; John T. Marcoux, DPM

4:00 PM BREAK WITH THE EXHIBITORS

4:45 PM ANkLE ARThRITIS Osteochondral Lesions of the Talus

Total Ankle Replacement: Expanding Indications

Malunited Ankle Fracture: Fibular Lengthening

Gout

Question & Answer

6:15 PM FRIDAY SESSION ADJOURNS

DiStinguiSHeD faCultY

Page 5: new orleanS Corporate - The Podiatry Institute · 2020-01-02 · astor crowne plaza new orleans, louisiana the podiatry institute joint provider with louisiana podiatric medical association

TeNTaTIve PROgRam, subjecT TO chaNge wIThOuT NOTIce

SaturDaY MARCH 7

7:00 AM BREAKFAST WITH THE EXHIBITORS

7:30 AM TRAUMAPosterior Malleolar Fractures

Tendon Lacerations

Metatarsal Fractures

Repair of the 2nd MPJ Deformity

Peroneal Subluxation

Multiple Midfoot Fusions

9:30 AM BREAK WITH THE EXHIBITORS

10:15 AM EXHIBIT HALL CLOSES

10:15 AM FLATFOOT SyMPOSIUMEvans Calcaneal Osteotomy: Surgical Techniques and Pearls

Medial Column Fusion

Soft Tissue Procedures

Complications in Flatfoot Surgery

Question & Answer

12:10 PM LUNCH

12:55 PM cAVUS FOOT SyMPOSIUMTriple vs. Double Arthrodesis

Revisiting the Coleman Block Test

Charcot Marie Tooth: Diagnosis and Management with Multi-disciplinary Approach

Tendon Transfers: Which, When, and Where

Question & Answer

2:35 PM BREAK

3:20 PM NEw INNOVATIONSUpdate on NIVT’s

Orthobiologics in Foot and Ankle Surgery

Arthrodesis Technique: Starting with the Correct Alignment

New Fixation Technology

Update on Microbiology: It’s in the Genes

Question & Answer

5:30 PM RISk MANAGEMENT SESSIONOpioids: This presentation will focus on the current climate in the use of opioids for the podiatric surgical practitioner. This pre-sentation will review current regulations and requirements for safe and effective narcotic prescribing and also look at the pitfalls that some practitioners have stumbled on and how to avoid these.Note: There will be a separate sign-in for this lecture.

6:30 PM SATURDAY SESSION ADJOURNS

SunDaY MARCH 8

7:30 AM BREAKFAST

7:30 AM VARIED TOPIcS OF INTERESTOpioids – Is CBD, Medical Marijuana the Answer to the Epidemic

DVT Prophylaxis

Calcaneal Stress Fractures

Pre-op Work-up / Risk Management Concerns

Triplane Hallux Valgus Correction

Gastroc Recession for Plantar Fasciitis

Question & Answer

10:20 AM BREAK

10:35 AM VARIED TOPIcS OF INTEREST (continued)

Atypical Bone Lesions of the Talus

Platelet-rich Plasma Applications

Common Peroneal Motor Nerve Transfer for the Treatment of Foot Drop

Charcot Reconstruction

Revisiting in office shockwave therapy

Resident Topic

Schwanomma in the Plantar Foot

Question & Answer

12:30 PM CONFERENCE ADJOURNS

ConferenCe objeCtiveSAt the conclusion of the conference, the participant should be able to:

Trauma: The attendee will gain the basic knowledge to recognize, evaluate, diagnose and manage common disorders seen in trauma to the foot and ankle and the long term sequalae in different groups.

Forefoot: The attendee will be exposed to the various options in the repair of hammertoes and to address the options, risks and long term complications of different procedures on the 2nd MPJ.

Hallux Valgus: The attendee will become familiar with all different surgical procedures in the management of hallux valgus and associated deformities and their roles.

Diabetic Foot: The attendee will become familiar with the current treatment options and advanced therapies in treating the diabetic foot.

Heel and Hindfoot: The attendee will discuss the goals and expected outcomes in the rearfoot. This includes soft tissue management, fractures, heel surgery and management of failed tendon surgeries.

Medicine & Topics of Interest: The attendee will gain knowledge and understanding of different products and their cost, diagnosis of carcinoma, understanding of the mechanism of ankle fractures and some less common anatomical variants and procedures.

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CANCELLATION requests must be made in writing, via fax or mail, and postmarked no later than one month before the start date of the confer ence. All cancel lation requests will be assessed a $75 admin is tra tive fee. There will be no refunds for cancel lations made less than one month prior to the start of the con ference. Instead a “certificate of transfer” will be issued, redeem able for any Podiatry Institute con ference of equal price or as partial registra tion fee on any higher price confer ence. The certifi cate will be valid for a period of one year from date of issue. NO cancel lations or trans fers will be accepted within two weeks of the start of the conference. In the event the conference is cancelled by events beyond our control, the participant will receive a full refund or transfer to another conference, without penalty, within 30 days of the notice of cancellation.

ThE PODIATRy INSTITUTE

®OUR MISSIONTo be a supportive global network of members, colleagues, and friends that enhances the quality of life for patients with foot, ankle, and leg disorders through innovative education, research, and service.

BOARD OF DIRECTORSAlfred J. Phillips, DPMCHAIRMAN

Rahn A. Ravenell, DPMIMMEDIATE PAST CHAIRMAN

Michelle L. Butterworth, DPMVICE-CHAIRMAN

Joshua J. Mann, DPMTREASURER

Bradley D. Castellano, DPMSECRETARY

Eugene D. Timpano, DPM Andrea D. Cass, DPM

Daniel F. Vickers, CAE EXECUTIVE DIRECTOR

SEMINAR COMMITTEEJohn A. Ruch, DPM DIRECTOR OF MEDICAL EDUCATION

Michael C. McGlamry, DPM CORPORATE LIAISON

Michelle L. Butterworth, DPM Michael S. Downey, DPM Annette D. Filiatrault, DPM Todd B. Haddon, DPM Donald R. Green, DPM Clifford D. Mah, DPM D. Scot Malay, DPM Alfred J. Phillips, DPM Scott R. Roman, DPM Jay D. Ryan, DPM Joe T. Southerland, DPM

The Podiatry Institute is a non-profit educational foundation that offers a variety of programs including conferences, work-shops and post-graduate courses, in addition to textbooks, DVDs, PowerPoint® presentations and patient education materials. The Institute has achieved national and international recognition for its leading role in developing and advancing the standard of care in podiatric medicine and surgery. The faculty members are all volunteers who serve without compensation. They are committed to ongoing education in the area of foot and ankle surgery.

For more information, please visit www.podiatryinstitute.com

MAkE CHECkS PAYABLE TO: The Podiatry Institute OR USE ❏ M/C ❏ VISA ❏ AX ❏ DISC

Card # _____________________________________________________________ Exp. Date ________________________ MM / YY

Signature _______________________________________________________________ Date ________________________

R E G I S T E R F O R A 2020 S E M I N A R AT T H E R E G U L A R R AT E A N D R E C E I V E 25% O F F YO U R S E C O N D 2020 S E M I N A R

VALID ONLY FOR SEMINARS. DOES NOT APPLY TO RESIDENTS, RETIRED, MILITARY OR APMA YOUNG MEMBERS. DOES NOT APPLY TO EXHIBITOR REGISTRATION OR CADAVER SURGICAL SkILLS COURSES.

CALL BEFORE REGISTERING FOR THE SECOND SEMINAR TO RECEIVE THE DISCOUNT.

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❑ $465 LPMA Member ONLY or before 1/23/20

❑ $565 on or before 1/23/20

❑ $615 on 1/24/20 through 2/20/20

❑ $715 after 2/20/20 or at the door (credit card ONLY)

❑ $340 Retired Podiatrists or Active Military

❑ $125* Residents with letter from Residency Director

*DOES NOT AppLy TO CADAVEr WOrKSHOpS. LeTTeR musT be submITTed bY maIL WiTH yOur COMpLETED rEGiSTrATiON FOrM. rESiDENT rEGiSTrA TiON NOT accEptEd by E-mail or onlinE.

❑ Special Seminar Rate for APMA Young Members. Call 888.833.5682.

❑ Food functions are open to registered attendees only. Additional meal packages can be purchased for family/guests. Includes 3 breakfasts, 2 lunches and 6 breaks.

____ # oF Adults ($100 eACh)

____ # OF CHILDREN 12 & undeR ($50 eACh)

$_ _ _ ___________________ NEW ORLEANS TOTAL

PLEASE PRINT CLEARLY

Name _________________________________________________________________________________________________

Address ________________________________________________________________________________________________

City ____________________________________________ State __________ Zip __________________________________

Phone __________________________________ First Name for Name Tag __________________________________________

Email __________________________________________________________________________________________________ (You Must PRovide eMAil AddRess to ReCeive ConFiRMAtion And CMe CeRtiFiCAte)

___________________________________________________________________________________________________ PLEASE INDICATE ANY SPECIAL NEEDS YOU HAVE AND WE WILL CONTACT YOU

___________________________________________________________________________________________________

If YOu dO NOT ReceIve aN emaIL cONfIRma TION, PLease caLL OuR OffIce TO cONfIRm RegIsTRaTION.

new orleanS regiStrationCHOOSE ONE OF FOUR EASY WAYS TO REGISTER

ONLINE

(BeFoRe 2/20/20) www.podiatryinstitute.com

PHONE

888.833.5682 or 770.939.0393

FAX

404.508.8539

MAIL

The Podiatry Institute 2675 N Decatur Rd, Ste 309 Decatur, GA 30033-6132