the florida society of anesthesiologists … · on behalf of the board of directors of the florida...

12
WWW.FSAHQ.ORG JOINT PROVIDERSHIP This meeting is jointly provided by the American Society of Anesthesiologists and the Florida Society of Anesthesiologists. The Maintenance of Certification in Anesthesiology Program ® logo is a trademark of the American Board of Anesthesiology. REGISTRATION IS OPEN! Meeting “early-bird” registration rates are now available until April 28, 2017. Visit www.fsahq.org/meeting to register online or see Registration Form inside. ANNUAL MEETING & WORKSHOPS “Enhanced Recovery in the Surgical Home, a Pathway Towards Patient Safety” June 9-11, 2017 | The Breakers, Palm Beach, Florida PRESIDENT: Steven Gayer, MD PROGRAM CHAIR: Christopher Giordano, MD CO-CHAIR: Leopoldo Rodriguez, MD, FAAP THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS

Upload: doannguyet

Post on 10-Jul-2018

220 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

WWW.FSAHQ.ORG

JOINT PROVIDERSHIP This meeting is jointly provided by the American Society of Anesthesiologists and the Florida Society of Anesthesiologists.

The Maintenance of Certification in Anesthesiology Program® logo is a trademark of the American Board of Anesthesiology.

REGISTRATION IS OPEN!Meeting “early-bird” registration rates are now available until April 28, 2017. Visit www.fsahq.org/meeting to register online or see Registration Form inside.

ANNUAL MEETING & WORKSHOPS“Enhanced Recovery in the Surgical Home, a Pathway Towards Patient Safety” June 9-11, 2017 | The Breakers, Palm Beach, Florida

PRESIDENT: Steven Gayer, MD PROG R AM CHAIR: Christopher Giordano, MDCO-CHAIR: Leopoldo Rodriguez, MD, FAAP

THE FLORIDA SOCIET Y OF ANESTHESIOLOGISTS

Page 2: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

INVITATION FROM THE FSA PROGRAM CHAIRS

Dear Registrant,

On behalf of the Board of Directors of the Florida Society of Anesthesiologists (FSA), we would like to invite you to the paradise that is the Breakers Resort, home this year to the FSA Annual Meeting.

2017 marks the sixty-ninth year since the founding of our society and we want to thank you for being a member of the FSA and ASA. Our profession has made remarkable strides in safety and it is through the support of physicians like you that we are able to continue our work of advocacy for our patients and our specialty. This weekend, we look forward to meeting all of you, whether in the lectures, exhibit hall, or poolside to get your valuable feedback on where the FSA should be focusing its efforts.

The American Society of Anesthesiologists designates this live activity for a maximum of 17.5 AMA PRA Category 1 Credits™.

The FSA has applied for MOCA credits and is awaiting approval from the American Board of Anesthesiology. The Advance Program will be updated with this information when received.

Also, this year Dynamic ASA leaders will also be here to give us their thoughts on nation-wide issues, and we are very proud to welcome back Andy Harris, MD, the first anesthesiologist in the US Congress, as he presents his unique perspective on what’s happening in Washington DC. His Saturday talk is not to be missed as it will certainly be insightful and entertaining.

The relaxing island lifestyle of this special place lends itself particularly well to networking with your colleagues from around the state. We hope you will also enjoy getting to know your fellow physicians and share your experiences on what’s working to make a successful anesthesia practice. As our specialty faces many pressures, it is refreshing to be in an environment where everyone around us understands our mutual challenges.

It is our sincere hope that this time away from work affords you the chance to relax and learn something new to take back to your group.

Chris Giordano, MD Program Chair Associate Professor Department of Anesthesiology Division Chief of Liver Transplantation Anesthesiology/Critical Care Clerkship Director University of Florida, Gainesville

Leopoldo Rodriguez, MD, FAAP Co-Chair Medical Director and Chief of Anesthesiology Surgery Center of AventuraChair, Sheridan Healthcare Ambulatory Anesthesia Quality Sub-CommitteeTreasurer, Florida Society of Anesthesiologists

YOU

’RE

INV

ITE

D!

WWW.FSAHQ.ORG | 2

Page 3: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

LEARNING OBJECTIVES

At the conclusion of this activity, participants should be able to:

1. Assess the potential application of emerging issues and advances that affect the practice of anesthesia.

2. Apply contemporary practice management skills and knowledge of regulatory issues to the efficient and safe delivery of patient care.

TARGET AUDIENCE

This activity is intended for anesthesiologists. Researchers and other health care professionals with an interest in anesthesiology may also participate.

ACCREDITATION AND DESIGNATION STATEMENTS

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 the American Society of Anesthesiologists and the Florida Society of Anesthesiologists. The American Society of Anesthesiologists is accredited by the ACCME to provide continuing medical education for physicians.

The American Society of Anesthesiologists designates this live activity for a maximum of 16.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

GE

NE

RA

L IN

FO

RM

ATI

ON

MOCA ACCREDITATION STATEMENT 2017 (In Approval Process as of 2.14.17)

Attend select Educational Sessions to Earn Credit Toward MOCA®.

FSA 2017 offers several opportunities to help fulfill your Maintenance of Certification in Anesthesiology (MOCA®) requirements. Sessions marked with the MOC-PS icon will count toward Part 2 Patient Safety requirements. Look for the MOC-PS icon to identify designated sessions.

Please note: In order to claim CME credit for MOCA®, attendees are required to attend the entire session and complete the evaluation form when claiming CME credit.

Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of the American Board of Anesthesiology®.

This patient safety activity helps fulfill the patient safety CME requirement for Part 2 of the Maintenance of Certificate in Anesthesiology Program (MOCA) of The American Board of Anesthesiology (ABA). Please consult the ABA website (www.theABA.org) for a list of all MOCA requirements.

The American Board of Anesthesiology®, Maintenance of Certification in Anesthesiology Program® (MOCA®) has approved the following “Patient Safety Sessions” (listed below) at the FSA 2017 Annual Meeting.

The sessions which are approved for MOCA® Certification are noted with this symbol.

WWW.FSAHQ.ORG | 3

Page 4: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

SC

HE

DU

LE O

F E

VE

NTS

FRIDAY, JUNE 9, 2017

INVITED SPEAKERS AND TITLES SUBJECT TO CHANGE

7:00 am - 7:30 am Brenda Fahy, MD, MCCM Vice President, American Board of Anesthesiology Professor of Anesthesiology Division Chief, Critical Care Medicine Anesthesiology University of Florida, Gainesville Gainesville, FL

7:30 pm – 8:15 pm REGIONAL ANESTHESIA PANEL MODERATOR: Philip Asmar, MD Asmar Anesthesia Providers, PLLCPensacola, FL

Home TKAPhilip Asmar, MDAsmar Anesthesia Providers, PLLCPensacola, FL

Anti-Coagulant Medications and Regional AnesthesiaJavier Lopez, MDChief of Anesthesiology Department of AnesthesiologyKendall Regional Medical CenterMiami, FL

Enhancing Recovery after Surgery with Regional AnesthesiaMatthew Warrick, MDAssistant ProfessorDepartment of AnesthesiologyMedical Director, Acute Pain ServiceProgram Director, Regional Anesthesiology and Acute Pain Management FellowshipUniversity of Florida College of MedicineJacksonville, FL

8:15 am - 9:00 am ENHANCING RECOVERY AFTER SURGERY PANEL MODERATOR: Chris Giordano, MD Associate Professor of Anesthesiology Division Chief of Liver Transplantation Director, Anesthesiology/Critical Care Clerkship University of Florida, Gainesville Gainesville, FL

Using Informatics for Peri-op Glucose ControlMark Rice, MDProfessor and ChiefVice Chair of Clinical AffairsVanderbilt University Medical CenterNashville, TN

Re-Evaluating PONV in Abdominal SurgeryRyan Chadha, MDAssistant Professor of AnesthesiologyDepartment of Anesthesiology and Perioperative MedicineMayo ClinicJacksonville, FL

WWW.FSAHQ.ORG | 4

Page 5: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

9:00 am - 9:30 am AM Break and Poster Session 1 MODERATORS: Thomas Furhman, MD Chief of Anesthesiology Bay Pines VA Healthcare System Bay Pines, FL

William Turnage, MD Clinical Assistant Professor Anesthesiology University of Central Florida COM St. Augustine, FL

9:30 am - 10:30 am Geriatric Patient Safety and POCD Michael Lewis, MD Chair of Anesthesiology Henry Ford Health System Detroit, MI

10:30 am - 11:00 am Jim Grant, MD President-Elect, American Society of Anesthesiologists Chair of Anesthesiology Oakland University William Beaumont School of Medicine Bloomfield Hills, MI

11:00 am - 12:00 pm CREATING A CULTURE OF SAFETY PANEL MODERATOR & SPEAKER: Zachary Deutch, MD Assistant Professor Department of Anesthesiology Medical Director, Operating Room at UF Health North University of Florida College of Medicine Jacksonville, FL

Slow Down While Speeding Up… Increased Push for Efficiency and on Time Start while Maintaining a Culture of SafetyAdam L. Blomberg, MDEnvision Healthcare National Education Director, Anesthesiology DivisionChief of Anesthesiology, Memorial Regional HospitalVice-Chief of Anesthesiology, Memorial Healthcare System

Alberto Ardon, MD, MPHAssistant ProfessorDepartment of AnesthesiologyMedical Director, Acute Pain at UF Health NorthAssistant Medical Director, Operating Room at UF Health NorthUniversity of Florida College of MedicineJacksonville, FL

12:00 pm - 1:00 pm INFORMATICS AND TECHNOLOGY PANEL MODERATOR: Luis Rodriguez, MD Assistant Professor of Clinical Anesthesiology Division of Pediatric Anesthesiology Co-Director, Center for Informatics and Perioperative Management University of Miami Miller School of Medicine Miami, FL

SC

HE

DU

LE O

F E

VE

NTS

INVITED SPEAKERS AND TITLES SUBJECT TO CHANGE

FRIDAY, JUNE 9, 2017 CONTINUED

WWW.FSAHQ.ORG | 5

Page 6: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

Innovating in Mobile Technology: Empowering the Healthcare/Anesthesia ProviderFrank Gencorelli, MDAssistant Professor of Clinical AnesthesiologyDivision of Congenital Cardiac AnesthesiologyUniversity of Miami Miller School of MedicineMiami, FL

ERAS & EHR: Potential Benefits and Learned Pitfalls Vicente Behrens, MDAssistant Professor of Clinical AnesthesiologyFlorida International University/Miami Beach Anesthesiology AssociatesMiami Beach, FL

Computer Controlled Infusions in Anesthesiology Steven Boggs, MD, MBAProfessor of Anesthesiology and Vice Chair for Clinical and Research AffairsThe University of Tennessee Health Science Center, College of Medicine Memphis, TN

1:00 pm – 2:00 pm Lunch with the Exhibitors

1:00 pm – 2:00 pm Poster Session 2

2:00 pm – 5:00 pm Peri-Operative Point of Care Ultrasound Workshop (Additional Fee Applies – See Registration Form) Sean Kiley, MD Assistant Professor Department of Anesthesiology University of Florida College of Medicine Gainesville, FL

This workshop is intended for practitioners of all skill levels who wish to improve their skills in Perioperative Point of Care.

Objectives: • Understand the role of basic Point of Care Transthoracic Echocardiography in the

Peri-Operative Management of the Surgical Patient.• Understand the role of Point of Care Lung Ultrasound in the Peri-Operative

Management of the Surgical Patient.• Become acquainted with the use of Ultrasound of Spine for Epidural Access.• Understand the concept of Ultrasound use for evaluation of NPO status.

3:30 pm - 5:00 pm Posters of Distinction MODERATORS: Thomas Furhman, MD Chief of Anesthesiology Bay Pines VA Healthcare System Bay Pines, FL

William Turnage, MD Clinical Assistant Professor Anesthesiology University of Central Florida COM St. Augustine, FL

5:00 pm – 6:30 pm Welcome Reception in Exhibit Hall

SC

HE

DU

LE O

F E

VE

NTS

INVITED SPEAKERS AND TITLES SUBJECT TO CHANGE

FRIDAY, JUNE 9, 2017 CONTINUED

WWW.FSAHQ.ORG | 6

Page 7: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

7:00 am – 8:00 am “ALBERT EINSTEIN COLLEGE OF MEDICINE & STERLING OPS PRESENTATION” Live 3D Virtual Cadaver Demonstration: Managing Postsurgical Pain at the Source

This presentation will include a faculty presentation, questions and answers and a 3D virtual cadaver demonstration.

Objectives:• Define the goals of enhanced recovery after surgery (ERAS) • Identify individual agents and practices that may be incorporated into ERAS programs

and the evidence supporting them • Outline a rational and practical strategy for implementation of an ERAS program • Demonstrate techniques via 3D virtual cadaver for treating pain at its source • Discuss how to create a seat at the table to drive enhanced recovery to opioid

minimization pathways

Supported by an educational grant from Pacira Pharmaceuticals.

8:00 am – 12:15 pm: OPTION A

8:00 am – 9:00 am WRONG SIDED BLOCK PANEL MODERATOR & SPEAKER: Leopoldo Rodriguez, MD, FAAP Medical Director and Chief of Anesthesiology Surgery Center of Aventura Chair, Sheridan Healthcare Ambulatory Anesthesia Quality Sub-Committee Aventura, FL

Steven Williams, MD Medical Director, Chief of Anesthesiology Melbourne Surgery Center Melbourne, FL

Yury Zasimovich, MD Assistant Professor Department of Anesthesiology University of Florida College of Medicine Gainesville, FL

9:00 am – 10:00 am Building High Reliability throughout the Hospital Relin Yang, MD Chief of Anesthesiology Orlando VA Medical Center Orlando, FL

NORA Management Steven Boggs, MD, MBA Professor of Anesthesiology and Vice Chair for Clinical and Research Affairs The University of Tennessee Health Science Center, College of Medicine Memphis, TN

The Utility of Emergency Management Manuals Jeffery Huang, MD Associate Professor Anesthesiologist of Greater Orlando Orlando, FL

SC

HE

DU

LE O

F E

VE

NTS

INVITED SPEAKERS AND TITLES SUBJECT TO CHANGE

SATURDAY, JUNE 10, 2017

WWW.FSAHQ.ORG | 7

Page 8: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

SATURDAY, JUNE 10, 2017 CONTINUED

10:00 am – 10:30 am AM Break and Poster Session 3 MODERATORS: Thomas Furhman, MD Chief of Anesthesiology Bay Pines VA Healthcare System Bay Pines, FL

William Turnage, MD Clinical Assistant Professor Anesthesiology University of Central Florida COM St. Augustine, FL

10:30 am – 11:30 am LARGE GROUP MANAGEMENTLecture 1: Group Governance: A very Underrated Topic That Deserves More Attention vs. Strategies for Overseeing Sedation in Your FacilityLecture 2: Patient Satisfaction: Show me the Value

Jay Mesrobian, MD Regional Medical Director Team Health Anesthesia Board of Directors, American Society of Anesthesiologists Milwaukee, WI

11:30 am — 12:15 pm Narcotic Addiction and ASA Converse Lecture John Dombrowski, MD CEO, The Washington Pain Center Secretary, American Society of Anesthesiologists Washington, DC

8:00 am – 12:15 pm: OPTION B

UPDATE IN PAIN MANAGEMENT MODERATOR: Steven Barna, MD Assistant Professor, Orthopedics & Sports Medicine University of South Florida Florida Orthopaedic Institute Tampa, FL

8:00 am – 9:00 am Advanced NeuroInterventional Technologies for Chronic Pain Maria de la Pena, MD Aventura Spine and Wellness Center Aventura, FL

9:00 am – 10:00 am Medical Cannabis: Review of Literature and Treatment for the Patient Suffering from Pain Michelle Weiner, DO Spine and Wellness Centers of America Aventura, FL

10:00 am – 10:30 am AM Break

10:30 am – 11:30 am Changes in Healthcare and their Applications to the Pain Practitioner

11:30 am – 12:15 pm Questions and Answer

SC

HE

DU

LE O

F E

VE

NTS

INVITED SPEAKERS AND TITLES SUBJECT TO CHANGE

WWW.FSAHQ.ORG | 8

Page 9: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

12:15 pm – 1:00 pm US Healthcare State of the Union Congressman Andy Harris, MD US House of Representatives Representing the 1st District of Maryland Member, House Committee of Appropriations Member, Sub-Committees

• Agriculture, Rural Development, Food and Drug Administration & Related Agencies• Labor, Health and Human Services, Education & Related Agencies• Homeland Security

1:00 pm – 2:00 pm Lunch with the Exhibitors

1:00 pm – 2:00 pm Poster Session 4 MODERATORS: Thomas Furhman, MD Chief of Anesthesiology Bay Pines VA Healthcare System Bay Pines, FL

William Turnage, MD Clinical Assistant Professor Anesthesiology University of Central Florida COM St. Augustine, FL

2:00 pm – 3:00 pm Women and Leadership Asha Padmanabhan, MD Chief of Anesthesiology Plantation General Hospital Sheridan Health Care, Sunrise Plantation, FL

3:00 pm - 4:00 pm Resident Workshop Networking is one of the major strengths that the FSA can offer residents. To this end, residents will be invited to get together and discuss some of the opportunities within the FSA society, as well as within each university. Residents will have an opportunity to discuss future employment opportunities throughout the state along with group needs. There will be time to discuss ideas about adding to the society that can benefit the residents as well as their future group needs.

4:00 pm - 5:00 pm Anesthesia Resident Jeopardy Competition Join us for this exciting annual event featuring Anesthesiology Resident teams from Florida Training Programs.

Albert Varon, MD, MHPE Miller Professor and Vice Chair for Education Department of Anesthesiology, Perioperative Medicine and Pain Management University of Miami Miller School of Medicine Chief of Anesthesiology Ryder Trauma Center Miami, FL

James S. Ashford, MD Jackson Memorial Hospital Miami, FL

SATURDAY, JUNE 10, 2017 CONTINUED

SC

HE

DU

LE O

F E

VE

NTS

INVITED SPEAKERS AND TITLES SUBJECT TO CHANGE

WWW.FSAHQ.ORG | 9

Page 10: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

5:00 pm - 6:00 pm Networking Happy Hour - Meet and Greet Sponsored by Sheridan Healthcare

6:00 pm - 8:00 pm FSA Family Reception

SUNDAY, JUNE 11, 2017

8:00 am – 11:00 am FSA Annual Business Meeting & Leadership Awards Presentation

SATURDAY, JUNE 10, 2017 CONTINUED

SC

HE

DU

LE O

F E

VE

NTS

WWW.FSAHQ.ORG | 10

Page 11: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

EXHIBIT HALL HOURSFRIDAY, JUNE 9, 2017

9:30 am – 6:30 pm

SATURDAY, JUNE 10, 2017

9:30 am – 1:30 pm

HOTEL RESERVATIONS

Hotel Reservation Process: In order to manage the discounted group rate for our paying registrants, you must register using the enclosed registration form or go to www.fsahq.org/meeting Once your registration is completed and processed you will receive a link and detailed information to make your hotel reservation.

The host hotel for the 2017 FSA Annual Meeting will be “The Breakers” in Palm Beach, FL. The discounted FSA group rate of $255 per night (exclusive of resort fees and taxes) will be offered three days pre and post the conference dates so you can extend your stay!

*Note: The discounted group rate apply until the reservation deadline of May 18, 2017 or until all rooms in the group block have been sold, whichever occurs first. After May 18, 2017, guest rooms and the discounted group rate may not be available. A credit card will be required to guarantee your reservation.

ABOUT THE BREAKERS

A spectacular resort destination on Florida’s Atlantic coast, The Breakers Palm Beach has lured generations of discerning travelers to its idyllic, Italian-Renaissance setting. Experience the irresistible charm and storied history of this legendary oceanfront resort, which seamlessly blends with an amazing range of modern amenities. Feel the allure of its glamorous yet classic ambiance, the warmth and care of its devoted staff…you will quickly discover why The Breakers is a peerless destination, well beyond what you would expect of the finest luxury hotels and beachfront resorts in North America. View the website for more details: www.thebreakers.com.

For more information, please visit www.fsahq.org or contact the FSA office:

FLORIDA SOCIETY OF ANESTHESIOLOGISTS 701 Brickell Avenue, Suite 1550 Miami, FL 33131

PHONE: 786-300-3183FAX: 310-437-0585EMAIL: [email protected] WEB SITE: www.fsahq.org

VISIT ONE OF THE POSTER SESSIONS

View posters of interesting cases from operating rooms, OB suites

and/or ICUs; abstract posters from residents and practicing

anesthesiologists covering a wide variety of challenging clinical cases in general anesthesiology practice.

REGISTRATION IS OPEN!

Meeting "early-bird" registration rates are now available until April 28, 2017. Visit

www.fsahq.org/meeting to register online or see Registration Form on the last page of this brochure.

HO

TEL

RE

SE

RV

ATI

ON

S

WWW.FSAHQ.ORG | 11

Page 12: THE FLORIDA SOCIETY OF ANESTHESIOLOGISTS … · On behalf of the Board of Directors of the Florida Society of Anesthesiologists ... MOCA credits and is awaiting approval from the

RE

GIS

TRA

TIO

N F

OR

M

STEP 1: Registration Categories TOTAL

FEE TYPE Early Bird Registration (Through April 28, 2017)

Regular Registration (April 29 – June 8, 2017)

Onsite Fee (June 9 – 11, 2017)

Member (MD, RN, CRNA) £ $475 £ $550 £ $575

Non-Member (MD, RN, CRNA) £ $625 £ $700 £ $725

Medical Student/Resident/AA £ $200 £ $275 £ $300

STEP 2: Register for the Peri-Operative Point of Care Ultrasound Workshop

FRIDAY, JUNE 9, 2017, 2:00 PM - 5:00 PMPeri-Operative Point of Care Ultrasound Workshop: This workshop is intended for practitioners of all skill levels who wish to improve their skills in Perioperative Point of Care.

£ $25

STEP 3: Register Guests (Children need not be registered as guests.)

Adult #1 Name: £ $100

Adult #2 Name: £ $100

TOTAL AMOUNT DUE

If you would like your spouse/partner to receive information about a new spouse's session being offered at this year's meeting,

please provide his/her email address here:

Special needs or dietary restrictions:

PAYMENT IN FULL MUST ACCOMPANY REGISTRATION

£ Check Enclosed (Payable to Florida Society of Anesthesiologists)

£ Credit Card (FSA accepts Visa, MasterCard and American Express)

Cardholder’s Name: Signature:

Credit Card Number: Expiration Date:

Notifications of Cancellation must be submitted in writing. Cancellations received before May 18, 2017 will be refunded, less a $75 administration fee. No refunds will be available after May 18, 2017. Substitutions are allowed at any time but must be submitted in writing and must be of the same member status. Your FSA membership will be verified; registrations made at the member rate without corresponding FSA status will be charged the non-member fee.

2017 FSA ANNUAL MEETING June 9-11, 2017 ¡ The Breakers, Palm Beach, Florida

Please register online at www.fsahq.org/meeting/2017-annual-meeting or complete the form and mail/fax to:FLORIDA SOCIETY OF ANESTHESIOLOGISTS ¡ 701 Brickell Avenue, Suite 1550, Miami, FL 33131www.fsahq.org ¡ PHONE: 786-300-3183 ¡ FAX: 310-437-0585 ¡ EMAIL: [email protected]

First Name: MI: Last Name: Degrees:

Institution:

Specialty:

Address:

City: State/Providence: Postal Code:

Phone: Fax: Email:

• Main Registration Fees include: Lectures, Continuing Medical Education credits, Welcome Reception, Continental Breakfast Friday and Saturday, Lunch in Exhibit Hall Friday and Saturday, Coffee Breaks, and FSA Family Reception.

• Guest Registration Fees include: Welcome Reception, Continental Breakfast Friday and Saturday, Lunch in Exhibit Hall on Friday and Saturday, Coffee Breaks, and FSA Family Reception.

Please provide your ASA and ABA numbers to ensure proper reporting of your CME and MOCA credits to each accrediting body: ASA #: ABA#:

Meeting “early-bird” registration rates are now available

until April 28, 2017.

WWW.FSAHQ.ORG | 12