2011Texas Chapter

Scientific MeetingJointly Sponsored by Scott & White

November 12–13, 2011

AT&T Executive Education Conference Center

Austin, Texas

Internal Medicine: Back to the Future

Fostering Excellence in Internal Medicine

American College of Physicians

Dear Colleague, The Texas Chapter of the American College of Physicians— your partner and champion of internalmedicine— is coming to Austin in November! We invite you to join us and your friends and colleaguesfrom all across our great state for this exceptional meeting. Scientific updates, procedural workshops, andthe latest news and resources from ACP will all be apart of the program to provide you with comprehensivetools for your practice. The 2011 annual meeting isplanned for Saturday and Sunday, November 12–13, atthe beautiful AT&T Executive Education ConferenceCenter in Austin.

Pre-course sessions will provide the opportunity to obtain credit toward American Board of Internal Medicine Maintenance of Certification. ABIM’s Self-Evaluation Process Modules on Office-Based InternalMedicine and Hospital-Based Internal Medicine willbe offered on Friday, November 11, from 1:00–5:30 p.m.Seating will be limited to 30 to provide an interactivelearning format and audience response system. In addition to earning 17 CME credits, you will havethe opportunity to:

• Fulfill the one-hour ethics requirement for renewal ofyour medical license.

• Discuss local and national issues affecting the practice of internal medicine.

• Greet old friends and meet new ones.

• Bring your family and enjoy all that Austin has tooffer.

Robert B. Doherty, Senior Vice President for ACPGovernmental Affairs and Public Policy, will attendour meeting to talk about issues in medicine from thenational perspective. More importantly, he wants tohear from you and understand the unique viewpoint of our Texas chapter members. The annual meetingprovides an opportunity to make your voice heard byACP leadership.

Visit the annual meeting Web site at www.txacp.org to register, or complete the form at the back of thisbrochure and mail or fax it today.

Of course, this meeting is not limited to ACP members. Nonmembers are welcome to join us for this important clinical update and to learn about thebenefits of membership at the same time. We encourageyou to share this information with your colleagues.Sincerely,

Robert E. Jackson, MD, FACPGovernor, Texas Southern Region

Clark R. Gregg, MD, FACPGovernor, Texas Northern Region

Sue S. Bornstein, MD, FACPPresident, Texas Chapter of the American College of Physicians

GOVERNOR’S LETTER

Texas ChapterMeeting Highlights:• Associates’ and Medical

Students’ clinical vignette and postercompetitions

• Awards luncheon torecognize our TexasChapter Laureate andVolunteerism Awardrecipients

• Exhibit hall with thelatest in products andservices for the medicalcommunity

• ABIM SEP modules onOffice-Based InternalMedicine and Hospital-Based Internal Medicine for recertification

This educational activity has been designated for 17 CME credits.

SCIENTIFIC PROGRAM

AND SPECIAL EVENTS

Friday, November 11, 201110:00 a.m.– Clinical Skills Module: Noon Simulation—Procedure Skills

(Advance registration required. Additional registration fee applies. Limited to 30 participants.) Celina Mankey, MD

1:00– ABIM Recertification SEP Module: 3:00 p.m. Office-Based Internal Medicine

(Advance registration required. Additional registration fee applies. Limited to 30 participants.) Stephen J. Sibbitt, MD,FACPCurtis R. Mirkes, DO,FACP

3:30– ABIM Recertification SEP Module: 5:30 Hospital-Based Internal Medicine

(Advance registration required.(Advance registration required. Additional registration fee applies. Limited to 30 participants.)Stephen J. Sibbitt, MD,FACPCurtis R. Mirkes, DO,FACP

Saturday, November 12, 20117:00 a.m. Registration Continental breakfast

with the exhibitors Women in Medicine

Networking BreakfastModerators: Sue S. Bornstein, MD, FACP,and Temple S. Howell-

Stampley, MD, FACP Advancement to

Fellowship BreakfastModerators: Andrew K.Diehl, MD, MSc, FACP,

and Robert E. Jackson, MD, FACP PLENARY SESSION Moderator: Alejandro Moreno, MD,

MPH, JD, FACP, FCLM8:00 Welcome Robert E. Jackson, MD,

FACP8:05 Update in Endocrinology

Mrinalini Kulkarni-Date,MD

8:50 Update in GastroenterologyDwain L. Thiele, MD

9:35 Update in Cardiology Miguel A. Quinones,

MD, FACC

10:20 Break Visit the exhibits and the

College display10:40–11:50 Associates’ Clinical Vignette

Competition Moderator: Suma Pokala,MD, FACP

Whipple’s Disease: An AtypicalPresentation for an Atypical DiagnosisBen Kahn, MD

Left-Sided Pleural Effusion andRespiratory DistressSamantha Goodman, MD

Can Candidiasis Be Sexy? CPT Meridith Hays, DO Gastric Bypass: Lowering More

Than WeightMike McNeal, MD

Dapsone-Induced Methemoglobinemia in Patient with HIV/AIDSAries Gavino, MD

Noon Texas Chapter Annual BusinessMeeting and Awards Luncheon

PLENARY SESSIONModerator: Robert E. Jackson, MD,

FACP1:15 p.m. On Being a Doctor: Work-Life

Balance: Where Does Being a Doctor End and Being Me Begin? Winner of the Associate/Medical Student writingcompetition to be announced

1:30 The Future of Health Care inAmerica, Key Note SpeakerKenneth Shine, MD,MACP

2:15 Lessons From Health Care Reform:Version 2011Robert B. Doherty

2:55 Break3:15 Cutaneous Manifestation of

Diabetes Mellitus Jason Reichemberg, MD

4:00 Atypical Bacterial Infections Richard Wallace, MD,

FACP4:45 Approach to the Patient With the

Chronic CoughDavid Weldon, MD

5:30 Adjourn5:30–7:00 Cocktail Reception and

Awards Presentations

PROGRAM SCHEDULE

Sunday, November 13, 20117:00 a.m. Registration Continental breakfast

with the exhibitors

7:00–7:50 Advocacy Update Moderators: Roger Khetan,

MD, FACP, FHM; Alejandro Moreno, MD,

MPH, JD, FACP, FCLM;and Robert B. Doherty

7:00–7:50 Council of Young Physicians BreakfastModerators:Pete Yunyongying, MDFACP, and Julie Nguyen,MD

PLENARY SESSIONModerator: Alejandro Moreno, MD,

MPH, JD, FACP, FCLM

8:00 a.m. WelcomeRobert E. Jackson, MD,FACP

8:05 The Patient-Centered MedicalHomeSue S. Bornstein, MD,FACP

8:50 The Sunshine ActC.J. Wolf, MD

9:35 Advance Directives Craig Klugman, PhD

10:35 BreakVisit the exhibits and theCollege display

10:55 Film as a Tool to Teach Clinical EthicsKarin Zucker, MA, JD,LLM, FCLM

11:55 Adjourn

Special ConsiderationsWe do try to control the temperature in the meeting room, but for your comfort, please bring a jacket.

OPTIONAL PRE-COURSE LEARNING SESSION

Friday, November 11, 201110:00–Noon Clinical Skills Module:

Simulation—Procedure Skills Celina Mankey, MDThis course offers an opportunity forhands on practice by the participantsand feedback from the faculty. The purpose of the Clinical Skills Modules is to help physicians with the development and refinement of their clinical skills.As such, the appropriate audience forthese workshops includes practicingphysicians, academic faculty, residents,students, and other medical professionals.

1:00–3:00 ABIM Self-Evaluation Process Module:Office-Based Internal Medicine

Stephen J. Sibbitt, MD,FACP, and Curtis R.Mirkes, DO, FACP

3:30–5:30 ABIM Self-Evaluation Process Module:Hospital-Based Internal Medicine

Stephen J. Sibbitt, MD,FACP, and Curtis R.Mirkes, DO, FACP

Each module is limited to 30 participants.Advance registration and additional registration fee required. See registrationform.

Learn in an interactive environment asclinical experts lead discussion of 20 case-based questions from AmericanBoard of Internal Medicine’s Self-Evaluation Process (SEP) Modules onHospital Based Internal Medicine and Office Based Internal Medicine. The primary purpose of the session is to acilitate completion of SEP modules forMaintenance of Certification (MOC)credit. After ordering the modules fromABIM, participants will submit answers at the completion of the session for credittoward the MOC program.

FacultySue S. Bornstein, MD, FACP, President,Texas Chapter of the ACP; Executive Director, Texas Medical Home Initiative,DallasAndrew K. Diehl, MD, MSc, FACP, Former ACP Governor, Texas SouthernRegion; O. Roger Hollan Professor ofMedicine, Department of Medicine;Chief—Division of General Medicine,University of Texas Health Science Center at San Antonio, San AntonioRobert B. Doherty, Senior Vice President,Governmental Affairs and Public Policy,American College of Physicians, Washington, DCAries Gavino, MD, ACP Associate,Winner, Southeast Regional Associates’Clinical Vignette Competition, BaylorCollege of Medicine, HoustonSamantha Goodman, MD, ACP Associate, Winner, Northwest RegionalAssociates’ Clinical Vignette Competition,Texas Tech University Health SciencesCenter, LubbockRobert E. Jackson, MD, FACP, ACP Governor, Texas Southern Region;Clinical Professor of Medicine at theMethodist Hospital, Weill Cornell Medical College, HoustonBen Kahn, MD, ACP Associate, Winner,Northeast Regional Associates’ ClinicalVignette Competition, Baylor UniversityMedical Center, DallasRoger Khetan, MD, FACP, FHM, President, Texas Chapter of the ACP Services; Medprovider Hospitalist, Physician Director of Healthcare Improvement, Baylor Health Care System, DallasCraig Klugman, PhD, Stewart & Marianne Reuter Professor of Medical Humanities,Assistant Director for Ethics Education,Center for Medical Humanities & Ethics,University of Texas Health Science Center at San Antonio, San AntonioMrinalini Kulkarni-Date, MD, AssociateProfessor and Chief of Endocrinology, University of Texas, Southwestern Residency Program at Seton Family ofHospitals, AustinCelina Mankey, MD, Associate Professor,University of Texas, Southwestern Residency Program at Seton Family ofHospitals, AustinMike McNeal, MD, ACP Associate,Winner, Southwest Regional Associates’Clinical Vignette Competition, TexasA&M Health Science Center, Scott &White, TempleCurtis R. Mirkes, DO, FACP, AssistantProfessor of Medicine, Associate ResidencyProgram Director, Department of InternalMedicine, Scott & White Memorial Hospital, Texas A&M University Health Science Center College of Medicine, TempleAlejandro Moreno, MD, MPH, JD,FACP, FCLM, Associate Director of Internal Medicine Residency Program,University of Texas Southwestern Residency Programs at Seton Family ofHospitals, Austin

Julie Nguyen, MD, Methodist AcademicHospitalist, Instructor of Clinical Medicine, Weill Cornell Medical College,HoustonSuma Pokala, MD, FACP, Associate Professor of Medicine, Department of Internal Medicine, Central Texas Veterans’ Health Care System, TexasA&M University System College of Medicine, TempleJason Reichemberg, MD, Associate Professor of Dermatology and Clinical Director, University of Texas, SouthwesternResidency Program at Seton Family ofHospitals, AustinKenneth Shine, MD, MACP, ExecutiveVice Chancellor for Health Affairs, TheUniversity of Texas System, AustinStephen J. Sibbitt, MD, FACP, AssistantProfessor of Medicine, Department of Internal Medicine; Chief Medical Officer,Scott and White Memorial Hospital,Texas A&M University Health ScienceCenter College of Medicine, TempleCPT Meridith Hays, DO, Winner, Far Northwest Regional Associates’ Clinical Vignette Competition, WilliamBeaumont Army Medical Center, El PasoTemple S. Howell-Stampley, MD, FACP,Associate Professor of Internal Medicine,UT Southwestern Medical School, DallasDwain L. Thiele, MD, Senior AssociateDean for Strategic Development, Jan andHenri Bromberg Chair in Internal Medicine, Professor of Internal Medicine,University of Texas Southwestern MedicalSchool, Dallas Miguel A. Quinones, MD, FACC, Professor of Medicine, Weill Cornell Medical College; Chairman, Departmentof Cardiology, The Methodist Hospital,Methodist DeBakey Heart & VascularCenter, HoustonRichard Wallace, MD, FACP, Professorof Medicine/Microbiology, University ofTexas Health Science Center at Tyler,TylerDavid Weldon, MD, Associate Professorof Medicine, Texas A&M College of Medicine, Scott & White, College StationC.J. Wolf, MD, Assistant SystemwideCompliance Officer, The University ofTexas System, AustinPete Yunyongying, MD, FACP, Instructor, Internal Medicine, Universityof Texas Southwestern Medical School,DallasKarin Zucker, MA, JD, LLM, FCLM,Professor of Healthcare Administration atBaylor University; Bioethics Consultant,Brooke Army Medical Center, San Antonio

Program CommitteeRobert E. Jackson, MD, FACP, Governor,Texas Southern Region, Houston, TX

Alejandro Moreno, MD, MPH, JD,FACP, FCLM, Local Program CommitteeChair, Austin, TX

MEETING INFORMATION

MEETING INFORMATION

SPECIAL EVENTS FOR MEDICAL STUDENTSAND ASSOCIATES

SATURDAY, NOVEMBER 12, 2011

6:30–9:00 a.m. Medical Students’ and Associates’ Poster Set-up

9:00–10:30 Medical Students’ Clinical Vignette Competition Moderator: Karen E.

Szauter, MD, FACP

10:40–11:50 Associates’ Clinical Vignette Presentations and Competition (during Plenary Session) Moderator: Suma

Pokala, MD, FACP

1:15 p.m. On Being a Doctor: Work-lifeBalance: Where Does Being a Doctor End and Being Me Begin? The winning author of the On Being aDoctor writing competition for Student and AssociateMembers will give a10-minute oral presentation duringthe Plenary Session.

2:00–4:30 Medical Students’ and Associates’ Poster Exhibitionand Competition Moderators: Karen E.Szauter, MD, FACPSuma Pokala, MD,FACP

5:30–7:00 Cocktail Reception Winners of the poster

and clinical vignettecompetitions will beannounced.

SUNDAY, NOVEMBER 13, 2011

11:30 a.m.– Associates’ Luncheon and 2:00 p.m. Doctor’s DilemmaTM Competition Moderators: George E.

Crawford, MD, MACPSuma Pokala, MD,FACP

Medical Students’ and Associates’ ActivitiesMedical students and residents areinvited to participate in all annualmeeting events, especially those activities designed specifically for their interests. Although registrationis free, students and residents mustregister for the meeting in advance.Winners of the five regional Associates’ clinical vignette competitions will present theircases in the statewide competitionduring the plenary session on Saturday morning. The winnerwill advance to ACP’s nationalcompetition in New Orleans inApril 2012.Medical students will present clinical vignettes in a competition,with the winners to receive cashprizes. The student who achievesfirst place will be eligible for thenational competition at the 2012ACP annual meeting. First place, and second place winners will be named in theMedical Students’ and Associates’poster competitions.Students and Associates are alsoencouraged to submit original proseor poetry dedicated to the theme,“Work-Life Balance: Where DoesBeing a Doctor End and Being MeBegin?,” for the On Being a Doctorwriting competition. The winningauthor of the On Being a Doctorcompetition will share their composition in a 10-minute oralpresentation during the PlenarySession on Saturday.The twelfth annual Doctor’sDilemma™ statewide competitionwill begin with a luncheon onSunday. All Texas residency programs are invited to registertheir team in advance and comejoin in the fun. Visit the TXACP Web site atwww.txacp.org for complete detailson all of the student and residentevents or call the Chapter BusinessOffice at 512-370-1508.

AwardsThe annual business meeting andawards luncheon on Saturday, November 12, will include recognition of the recipients of theTexas Chapter Laureate Award,Texas Chapter Volunteerism andCommunity Service Award, andAdvocate of the Year award.

Chapter ExcellenceAward WinnerWe are pleased to announce thatour Chapter is the recipient of a2010 Chapter Excellence Award.The Chapter Excellence Awardrecognizes thosechapters that excelin reaching thestandards for managing a chapter, such as communicating to members, instituting Medical Students' and Associates' activities and advancing and recruiting members.A Chapter Excellence certificatewill be awarded at the meeting.

Acknowledgements (as of June 2011)This program is supported, in part, byunrestricted grants from:Gold Level• Texas Health Harris Methodist

Foundation

Who Should Attend• General internists• Subspecialty internists• Family physicians• Fellows in subspecialty training• Allied health practitioners• Residents • Medical students interested in

internal medicineIf you are interested in becoming amember of the College, please contact the Customer Service Department at 800-523-1546, ext. 2600, or 215-351-2600 (M–F, 9 a.m.–5 p.m. ET).Attendance at chapter meetingscan help all ACP members meetthe qualifications for advancementto Fellowship. It is especially im-portant for those applying underthe pathway that calls for 5 yearsof activity as a Member.

CME Development and AccreditationThis activity has been plannedand implemented in accordancewith the Essential Areas and Policies of the AccreditationCouncil for Continuing MedicalEducation through the joint sponsorship of Scott & White andthe Texas Chapter of the ACP.Scott & White is accredited by theACCME to provide continuingmedical education for physicians.Scott & White designates this live activity for a maximum of 17AMA PRA Category 1 Credits™. Physicians should claim onlycredit commensurate with the extent of their participation in the activity. The ABIM Recertification SEPmodules on Friday, November 11,from 1:00–3:00 p.m. and 3:30–5:30 p.m., are each approved foran additional 2 AMA PRA Category 1 Credits™. The Clinical Skills Workshop:Simulation—Procedure Skills onFriday, November 11, is approvedfor an additional 2 AMA PRA Category 1 Credits™. One session, limited to 30 people, will be offered.The following sessions are approved for ethics credit: "The Sunshine Act," Plenary

Session-Sunday, November 13,8:50 a.m. (45 minutes)

“Advance Directives,” PlenarySession—Sunday, November 13,9:35 a.m. (1 hour) “Film as a Tool to Teach ClinicalEthics” Plenary Session—Sunday, November 13, 10:55 a.m (1 hour)

The need for this program wasidentified from the results of a survey of evaluations and suggestions from past participants,along with input from the chapter’s Education Committee.The program will consist of lectures supplemented with audiovisual presentations.A course evaluation form will provide participants the opportunity to review each session and speaker.

MEETING INFORMATION

MEETING INFORMATION

Learning ObjectivesAt the conclusion of this activity,the participant will be able to:• Review the diagnostic approach

to the patient with chroniccough and to the diabetic patient with cutaneous lesions.

• Update knowledge about congestive heart failure, diabetes, thyroid disease, inflammatory bowel disease and hepatitis.

• Describe recent developments in health law and ethics, in particular issues related to sunshine provisions, advance directives, and teaching ofbioethics.

• Present the latest clinical andresearch knowledge about atypical mycobacterium.

• Teach procedure skills—lumbarpuncture, arterial line placement,central line placement—throughsimulation exercises.

Hotel AccommodationsSituated conveniently in the heartof Austin activity and on the University of Texas campus, theAT&T Executive Education Conference Center offers inspiringviews of the University, the StateCapitol, and a serene centralcourtyard. Walk to exhibits at the BlantonMuseum of Art and UT’s VisualArt Center or shows from the collections of the Harry RansomCenter of the LBJ Library, andenjoy a performance at the famedPerforming Arts Center. Or explore the Bob Bullock TexasState History Museum, cheer theLonghorns at Texas Memorial Stadium, and shop on colorfulGuadalupe Street— all withinwalking distance.The host hotel is more than just aconvenient place to stay duringthe annual meeting. TXACP contracts with a host hotel eachyear, promising a minimum number of sleeping rooms to thehotel. In return, the hotel offersTXACP complimentary or

reduced meeting room rental and other services that make thechapter meeting a success. Bybooking your room in the hosthotel, you will help to keep registration costs and member dues low.A special block of rooms has beenreserved at the AT&T Executive Education Conference Center1900 University AvenueAustin, TX 78705-5611For online hotel reservations, visit the Annual Meeting page on www.txacp.org. To make reservations by phone, dial 877-744-8822 or 512-404-3600and mention that you are attendingthe TXACP meeting to receivethe group rate. Reservations canalso be made directly via Internetat www.meetattexas.com by accessing reservations tab and entering dates, contact informationas well as the group code: ACPTXC1111.Rates: Single/Double occupancy: $149This rate is available to registrantsuntil the room block is full orTuesday, October 25, 2011. Thespecial group rate is available oneday before and one day after themeeting, based upon availability.

Parking Valet parking is available forovernight guests at the speciallynegotiated rate of $21 per night.Overnight self-parking is $14.

Airport ShuttleThe AT&T Executive EducationConference Center does not offercomplimentary shuttle servicefrom the airport, but the hotelconcierge is available at 512-404-1900 to assist you in making your arrangements forshuttle or limousine services.

DirectionsVisit www.meetattexas.com/ formaps and directions, or call thehotel concierge for assistance at512-404-1900.

How to Register• To register online for the meeting,

go to www.txacp.org, then select“Annual Meeting.”

• To register via fax or mail, completethe attached registration form andreturn it with your check madepayable to Scott & White or withcredit card information to:

Scott & White Department of Continuing Medical Education 2401 South 31st Street Temple, TX 76508 Phone: 800-724-7280 or 254-724-7609 Fax: 254-724-1753• There is an additional $20 fee for

registering on site at the meeting.Save money by registering early.

• Registrations received prior to October 28, 2011, will receiveconfirmation in the mail or by e-mail.

• Refunds (minus a $50 administrationfee) will be provided to registrantswho cancel their registration inwriting prior to October 28. No refunds will be provided for cancellations received after October 28.

• Registration fee includes all scientific plenary sessions and materials, Saturday cocktail reception, continental breakfastsand refreshment breaks, luncheonon Saturday, and CME certificate. An additional registration fee is required for the ABIM SEP modulepre-course and clinical skills module.

• To access online meeting information or to print another registration form for a colleague, go to www.txacp.org, “Annual Meeting.”

• For questions about the meeting,contact:

Texas Chapter Business Office Phone: 512-370-1508 E-mail: gena.girardeau@texmed.org• For information on College-related

issues, contact your Governor: Robert E. Jackson, MD, FACP Texas Southern Region Phone: 713-791-9305 E-mail: rejackson@tmhs.org Clark R. Gregg, MD, FACP Texas Northern Region Phone: 214-857-1150 E-mail: greggacp@sbcglobal.net

How to Register for ABIM SEPObtain credit toward your AmericanBoard of Internal Medicine Mainte-nance of Certification (MOC) on Friday, November 11, from 1:00–5:30p.m., in Austin at the TXACP AnnualChapter Meeting. TXACP faculty willpresent two ABIM Self EvaluationProcess Modules (2011 Updates in Office-Based Internal Medicine andHospital-Based Internal Medicine) as precourses to the annual chaptermeeting. Each SEP module contains 20 to 25 multiple-choice questions tobe completed through group discussionand with the help of an automated audience response system.

Upon completion of the session, attendees will be able to submit theiranswers to ABIM for scoring andpoints toward the self-evaluation ofknowledge requirement associatedwith the MOC Program. Advance registration is required andwill be limited to 30 participants. The fee for each Learning Session is$75 for members and $125 for non-members. The fee covers the costs forthe educational support and refresh-ments provided at the session andshould be paid directly to TXACP. To participate in this session:1) Register in advance by completing

the TXACP Annual Meeting registration form in the brochure or online; select the ABIM SEPModules under “Special Events;”and submit registration fee toTXACP.

2) If you are enrolled in the ABIMMOC process, you may order yourSEP modules from ABIM atwww.abim.org/online/ or call 800-441-2246 prior to the sessionto expedite receiving credit for theSEP modules from ABIM.

3) You may bring your modules withyou to the Learning Session. Notethat we will provide all course registrants with a printed version of the SEP modules on-site.

4) Submit your answers to ABIM forMOC credit after the Learning Session via the ABIM Web site (for immediate results).

For more information about ABIM’sMOC program visit www.abim.org/moc/ or call 800-441-2246.

HOW TO REGISTER

REGISTRATION FORM CMB

American College of Physicians RM1234Texas Chapter Scientific Meeting November 12–13, 2011

This form may be photocopied.

ACP # (found on mailing label)

Name ❏ MD ❏ DO

Address

City/State/ZIP

Daytime Phone

Fax

E-mail

❏ Please check here to indicate a permanent change to your preferred address forall College mailings.

❏ Yes, I do wish to receive information from the meeting exhibitors.

Payment Options:

❏ Check enclosed. (Payable to Scott & White.)

Charge to: ❏ Visa ❏ MasterCard ❏ American Express ❏ Discover

Card #

Name on Card:

Exp. Date ____/____ Security Code____________MM YY (3- or 4-digit number found on front or back of card)

Signature

With credit card payment, register online at www.txacp.org, or fax completed form to 254-724-1753. By mail, make your check payable toScott & White and send to:

Scott & White Department of Continuing Medical Education 2401 South 31st Street Temple, TX 76508

Questions about registering? Please call Scott & White at 800-724-7280 or 254-724-7609.

Special Considerations

� ❏ Check if you are disabled and require assistance. Attach a writtendescription of needs and submit to the CME Department prior toOctober 19.

❏ Check if you require a vegetarian diet.

REGISTRATION FORM CMB

Registration Fees Check one category that best applies. Registration fee includes continentalbreakfast, lunch, all scientific sessions and materials, and a CME certificate.

ACP Categories ❏ Master ❏ Fellow ❏ Member ..................................................................$195❏ Associate (Resident Member) ❏ Medical Student Member..............No Fee❏ Affiliate Member (Allied Health Professional) .....................................$195

Nonmember Categories❏ Nonmember Physician ...........................................................................$245❏ Nonmember Resident .........................................................................No Fee❏ Nonmember Medical Student ............................................................No Fee❏ Nonmember Allied Health Professional ................................................$245

Special Events and Fees: ❏ Clinical Skills Workshop: Simulation—Procedure Skills, 10:00 am,

November 11 ............................................................................................$25❏ ABIM SEP Module Office-Based IM 2011, 1:00 p.m., November 11

(Member rate) .........................................................................................$75❏ ABIM SEP Module Office–Based IM 2011, 1:00 p.m., November 11

(Non-Member rate)................................................................................$125❏ ABIM SEP Module Hospital-Based IM 2011, 3:30 p.m., November 11

(Member rate) ..........................................................................................$75❏ ABIM SEP Module Hospital-Based IM 2011, 3:30 p.m., November 11

(Non-Member rate)................................................................................$125❏ Advancement to Fellowship Breakfast, 7:00 a.m., November 12 ......No fee❏ Women in Medicine Breakfast, 7:00 a.m., November 12 ...................No fee❏ Council of Young Physicians Breakfast, 7:00 a.m., November 13......No Fee❏ Advocacy Update Breakfast, 7:00 a.m., November 13.......................No Fee❏ Guest luncheon ticket, Noon, November 12...........................................$35

GRAND TOTAL $___________

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