2015 NATIONAL CONFERENCE

MAY 6-9, 2015 HYATT REGENCY SAVANNAH SAVANNAH, GEORGIA

COLLABORATE CULTIVATE EDUCATE

REGISTRATION BROCHURE

REGISTRATION BROCHURE

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE 2

PurposeThe Pediatric Endocrinology Nursing Society (PENS) is committed to the advancement of the art and science of pediatric endocrinology nursing. This includes the establishment and continued development of standards of practice, the enhancement of nursing research, the advancement of clinical expertise and the promotion of recognition of excellence in nursing practice.

Program DescriptionThe National Conference provides a forum for educational opportunities as well as a chance to interact with colleagues and experts in the field of pediatric endocrinology. The faculty will present information on a variety of pediatric endocrine disorders, as well as topics of general interest to nurses and other health care professionals. Teaching methods will include lectures, interactive sessions, discussions, workshops and poster sessions.

Target AudienceThe conference is designed for nurses and other health care professionals interested in recent developments in the field of pediatric endocrinology nursing, including pediatric diabetes.

Program GoalsIt is PENS’ goal to promote high quality endocrinology nursing practice through this educational offering. Conference participants receive the latest information in basic to advanced practice and the experience and research as demonstrated by pediatric endocrinologists and pediatric endocrinology nurses.

Program Objectives Develop new skills to improve educational and patient

outcomes Provide educational opportunities in pediatric

endocrinology for nurses and others with expertise in the area

Promote the pursuit of nursing practice and research through a research presentation and poster session

Provide educational opportunities in the management and treatment of selected endocrine disorders

Provide direction for understanding health care changes Objectives for each session are listed within the schedule

AccreditationThis activity is being submitted to the Ohio Nurses Association (OBN-001-91) for approval to award contact hours. The Ohio Nurses Association is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

In order to receive contact hours for this conference, participants must complete the evaluation.

NetworkingThe key benefit of attending the PENS Conference is the opportunity to develop relationships with your colleagues through networking. Networking offers many tangible benefits to conference participants, including, but not limited to, validating your experience in providing nursing care and developing a better understanding of your practice and your role in care delivery by discovering that others are dealing with similar circumstances, solving the same problems and confronting the same issues. Take advantage of this international gathering of pediatric endocrinology nurses to learn more about issues and trends.

Message BoardPENS will provide a message board to facilitate networking. Bring your questions and ideas to post for response by your colleagues. If you have a special interest, arrange to meet others with that same interest. Participants are encouraged to post job listings as well.

PostersIn 2015, PENS is offering participants poster presentations to view and discuss on Thursday evening. Visit with the poster presenters and learn about current research that will affect your clinical practice!

Tamara Nenadovich, RN, Chair

Rebecca Crespi, MSN, RN, CPNP, CDE

Meg Keil, PhD, CRNP

Nicole Kirouac, RN, BN, Board Liaison

Cathy Metzinger, AAS, RN, CDE

Cheryl Switzer, MSN, RN, CPNP, CDE

Valerie Verdia, RN

PENS Conference Planning Committee

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE

REGISTRATION BROCHURE

Registration InformationEarly Registration: On or before Feb. 20, 2015

Regular Registration: Between Feb. 21 and April 3, 2015

Onsite Registration: After April 3, 2015

You will receive a confirmation letter approximately two weeks after receipt of your registration form. Confirmation letters will not be sent after April 3, 2015.

Payment must accompany the registration form. Registration forms received without payment will not be processed until payment is received.

Registration fees include the educational program, networking events, and all meal functions.

Cancellation & TransfersCancellations and transfers must be requested in writing and postmarked, faxed or emailed by April 3, 2015. Refunds will be issued following the conference. A $50 administrative fee will be assessed. Cancellation requests must include the reason for the cancellation. If you transfer your registration to another person, please include a completed registration form for that person with your written request. Requests for cancellation postmarked, emailed or faxed after April 3, 2015, are not refundable.

3

Hyatt Regency Savannah2 West Bay St. Savannah, GA 31401

912-238-1234The Hyatt Regency Savannah provides guests with opportunities to connect that satisfy and delight. From foods that feed the mind and body to inspiring spaces for conversation to gyms and spas for re-energizing, this Bay Street hotel combines gracious southern hospitality with contemporary services and amenities to get you to your next idea. Enjoy conveniences, such as the fitness center, indoor pool, and recharge lounge that make it easy to relax, work and recharge. Located on Bay Street, this Savannah riverfront hotel is situated near popular attractions like River Street, City Market, and Tybee Island also known as Savannah Beach. (Courtesy of the Milestone Agency)

Room rate: $162 plus tax per night single/double occupancy including guest room Internet and complimentary fitness center access.

Reservation deadline: Book by Monday, April 13, 2015, to receive the group room rate.

Click here to reserve your room online.

HOTEL INFORMATION

TRANSPORTATION INFORMATIONThe Hyatt Regency Savannah hotel is located 8 miles from the Savannah International Airport (SAV).

Taxi – Taxis are approximately $25 one-way.

Shuttle Service – K Shuttle, the official shuttle service from the Savannah/Hilton Head International Airport, is offering PENS attendees discounted services to and from the airport. To see rates or to book your shuttle service please visit: http://www.kshuttle.com/pens-annual-conference-2015/

Phot

os Co

urtes

y of H

yatt

Rege

ncy S

avan

nah

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE

CONFERENCE PROGRAM SCHEDULE

4

Tuesday, May 5, 20155:00 p.m. – 8:00 p.m. Registration

7:00 p.m. – 8:00 p.m. New Member & Past President Reception

Wednesday, May 6, 20158:00 a.m. – 5:00 p.m. Registration

8:00 a.m. – 9:00 a.m. Breakfast

9:00 a.m. – 9:15 a.m. Welcoming and Opening Remarks Nicole Kirouac, PENS President

9:15 a.m. – 10:30 a.m. Opening Keynote Address: Compassion Fatigue: What’s in Your Tool Box to Stay Healthy? Donna White, RN, PhD, CS, CADAC Describe the condition called stress and how it potentially affects human physiology. Identify two patterns of secondary stress and vicarious traumatization that occur in professionals whose job it is to care for others. Identify at least two ways the everyday work of caring for others may impact self-care and potentially lead to compassion stress and fatigue. List evidenced based strategies that can be utilized to address emerging compassion stress in the professional and facilitate a return to wellness. Discuss two methods of stress reduction techniques that offer a life-balanced response to individuals who care for others.

10:30 a.m. – 10:45 a.m. Break

10:45 a.m. – 11:45 a.m.

GENERAL SESSION 1: New Guidelines for Type 2 Diabetes in Our Youth Describe how to differentiate type 1 from type 2 diabetes. Explain the AAP guidelines for management of type 2 diabetes in childhood. Discuss when and how to deal with the comorbidities in childhood type 2 diabetes.

Janet Silverstein, MD

11:45 a.m. – 1:00 p.m. Leadership Luncheon presented by the Board of Directors, All to Attend

1:00 p.m. – 2:00 p.m.

GENERAL SESSION 2: The CNS Role in the DSD Service in London, UK Describe the referral process for a baby with DSD within the British National Health Service system. Discuss the Great Ormand Street Hospital for Children diagnostic flow chart. Identify the role of the Clinical Nurse Specialist in the DSD multi-disciplinary team.

Kate Davies, RN (Child), Dip HE, BSc (Hons), MSc

2:00 p.m. – 3:00 p.m.

Concurrent 1A: Psychosocial Concerns in DSD Describe the three main categories of DSD. Discuss the medical and surgical management of DSD. Explain the primary psychosocial needs of families affected by DSD during childhood and adolescence. List national support resources for clients with DSD.

Traci Schaeffer, RN, BSN

2:00 p.m. – 3:00 p.m.

Concurrent 1B: Insights into McCune Albright Syndrome: A Complex, Rare Disease with Individual Presentations Name the gene mutation associated with McCune Albright Syndrome. List the three body systems most commonly affected by McCune Albright Syndrome. Discuss the current medical management and medications used to manage endocrinopathies associated with McCune Albright Syndrome. Identify two psychosocial aspects related to the challenges of living with McCune Albright Syndrome.

Lori Guthrie, RN-C, BSN, CCRC Beth Brillante, RN, BSN, MBA

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE 5

2:00 p.m. – 3:00 p.m.

Concurrent 1C: Research Update: Closed Loop/Artificial Pancreas Describe how the closed loop/artificial pancreas system works. Discuss the limitations of the closed loop/artificial pancreas system. Explain at least two research studies using closed loop/artificial pancreas technology and discuss the results.

Neesha Ramchandani, PNP, CDE

3:00 p.m. – 3:15 p.m. Break

3:15 p.m. – 4:15 p.m.

GENERAL SESSION 3: Endocrine Complications Following Pediatric Cancer Therapy Describe normal growth and development in children and adolescents. Identify specific risk factors for altered growth in the pediatric cancer survivor. Discuss the effects that cancer treatment has on the endocrine system.

Elaine Pottenger, MS, RN, CPNP, PMHS Deborah Diotallevi, MS, RN, CPNP, PMHS

4:15 p.m. – 5:30 p.m.

GENERAL SESSION 4: Biosimilars Update Describe the difference between biologic and biosimilar medicines and how they are developed. Discuss the emerging role of biosimilars and the cost involved. Identify the benefits of biosimilars.

Patrick Leary Michael Stetler

5:30 p.m. – 7:30 p.m. Welcome Reception in Exhibit Hall

7:30 p.m. – 10:30 p.m. Evening Event

Thursday, May 7, 20157:00 a.m. – 9:00 a.m. Poster Set-Up

8:00 a.m. – 5:00 p.m. Registration

7:45 a.m. – 9:00 a.m. Breakfast Keynote Address: Living a Life of Awesome: Lessons I learned from My Daughter Lori Earl, This Star Won’t Go Out, The Fault in Our Stars Explain Esther’s family system which resulted in a greater appreciation for patients and their caregivers. Identify cognitive and emotional resources that patients bring into the patient/caregiver relationship, leading to a

greater appreciation and understanding of them as individuals. Describe one or more lessons learned from Esther’s life and how it applies to their own nursing practice, and why

they have a renewed commitment to serve their patients.

9:00 a.m. – 10:00 a.m.

GENERAL SESSION 5: Evolution of a CAH Education Website Describe the process of developing and facilitating patient education using multimedia technology. Identify the process of adapting patient education material resources to meet the needs of families living in developing countries. Discuss the value of running with an idea: “CAHPepTalk.com” now having international exposure, and the concept “follow our dreams and never give up”.

Irene Mitchelhill, NP

10:00 a.m. – 11:00 a.m.

General Session 6: Research Presentations Preliminary Research into a Novel Linear Measurement Process with Application in Pediatric Endocrinology The Faces of Diabetes: The Child Perspective Long Acting Somatostatin Analogues: Early Experience in the Treatment of Five Patients with Congenital Hyperinsulinism

Cynthia K. Snyder, MSN, RN Shari Liesch, APNP, CDE Lisa Truong, MSN, CPNP-AC

11:00 a.m. – 11:25 a.m. Break in the Exhibit Hall

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE 6

11:30 a.m. – 12:30 p.m.

Concurrent Session 2A: Type 2 Diabetes in Youth – A Road Less Traveled Discuss current trends in the incidence of type 2 diabetes in youth. Describe an approach to the management and education of youth with type 2 diabetes. Identify individual factors that may influence the management of youth with type 2 diabetes.

Julie Halipchuk, RN, MN CDE

11:30 a.m. – 12:30 p.m.

Concurrent Session 2B: Strategies and the Nursing Care Management of Adolescents with PCOS Describe both the physical and psychological presentation of teens who have PCOS. Discuss treatment goals and various medical modalities to treat young women diagnosed with PCOS. Identify age-appropriate resources for teens diagnosed with PCOS.

Phaedra Thomas, RN, BSN

11:30 a.m. – 12:30 p.m.

Concurrent Session 2C: Ready. Set. Write a PENS Column. Identify your writing strengths and weaknesses. Describe steps of the writing process. Identify endocrine topics of interest to other pediatric nurses.

Jan M. Foote, DNP, ARNP, CPNP Terri Lipman, PhD, CRNP, FAAN Nicole Kirouac, RN, BN

12:30 p.m. – 2:00 p.m. Lunch with Exhibitors

2:00 p.m. – 3:00 p.m.

Concurrent Session 3A: Novel Cases of Congenital Hyperreninemic Hypoaldosteronism Identify the main actions of aldosterone. Discuss the causes of hypoaldosteronism. Discuss the treatment of hypoaldosteronism.

Jan M. Foote, DNP, ARNP, CPNP

Concurrent Session 3A: Challenges, Successes and Pitfalls of Growth, Development & GH Treatment in Turner Syndrome (TS) Describe general Canadian practices in the treatment and management of growth in TS. Identify and review predictors of poor growth hormone therapy response in TS. Identify and review predictors of good growth hormone therapy response in TS. Compare and contrast literature findings of growth hormone growth response in TS.

Irena Hozjan, RN (EC), BScN, MN, NP-Pediatrics

2:00 p.m. – 3:00 p.m.

Concurrent Session 3B: Type 1 Diabetes Management in a 2-year-old Without a Gallbladder Describe the considerations without a gallbladder for insulin absorption. Explain the teaching strategies to help the mother understand diabetes management. Discuss take away points from this case study.

Heather Rush, MSN, APRN, CDE

Concurrent Session 3B: Use of Continuous Glucose Monitoring (CGM) in an Adolescent with Poorly Controlled Diabetes Describe use of continuous glucose monitoring in children with diabetes. Describe role of CGM in adolescents with poorly controlled diabetes. Describe advantages and disadvantages of CGM use in adolescents with diabetes.

Kevin Lewis, DNP, APRN, PPCNP-BC, CDE

3:05 p.m. – 4:05 p.m.

Concurrent Session 4A: Prader Willi Syndrome (PWS) and Hypogonadism Identify the clinical features of genital hyperplasia and incomplete/delayed puberty in a male PWS patient. Explain the role of Hcg in treatment of hypogonadism in PWS. List current guidelines for male hypogonadism in PWS.

Kathryn Anglin, MSN, BSN, RN

Concurrent Session 4A: What is Causing This Hypoglycemia? The Story of One Hot Mess! Describe the pathophysiology of Postprandial Hypoglycemia (PPH) secondary to Dumping Syndrome post-Nissen Fundoplication. Identify the testing needed to diagnose PPH. Describe the treatment options for PPH.

Linda Steinkraus, PNP

NEWSESSION!

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE 7

3:05 p.m. – 4:05 p.m.

Concurrent Session 4B: Another Possibility: Flatbush Diabetes Describe presenting symptoms of late adolescent male with thirst and weight loss, admitted for severe DKA. Discuss differential diagnosis: on full insulin dose with negative antibodies. Explain “Flatbush Diabetes”

Shari Liesch, APNP, CDE

Concurrent Session 4B: Are You Smarter than a Nursing Student? Identify important components in the evaluation of a child presenting with a possible endocrine disorder. Discuss the challenges with the evaluation and management of a child with newly diagnosed type 1 diabetes mellitus. Discuss challenges in the evaluation and management of children with newly diagnosed diabetes or endocrine disorders.

Meg Keil, PhD, CRNP Cheryl Switzer, MSN, RN, CPNP, CDE

4:05 p.m. – 6:30 p.m. Exhibit Hall Open

4:30 p.m. – 6:30 p.m. Poster Session & Reception

7:30 p.m. – 10:30 p.m. Evening Event

Friday, May 8, 20158:00 a.m. – 5:00 p.m. Registration

7:45 a.m. – 8:45 a.m. Awards Breakfast for All Attendees

8:45 a.m. – 9:45 a.m. Friday Keynote Address: Tapping into Resiliency for You and Your Patients Lori Leyden, PhD, MBA

Discuss the value of tapping on acupuncture points to relieve stress and pain to achieve more resourceful and resilient states of being. Describe how to formulate a “reminder phrase” that is part of this treatment protocol. Identify at least three acupuncture points that can be stimulated by tapping for stress and pain relief.

9:50 a.m. – 10:50 a.m.

Concurrent Session 5A: The Who, What, When, Where, and How of Insulin Pump Therapy Describe insulin pump therapy and how it helps in diabetes management. Discuss the training process for an insulin pump. Explain pump management following initial training. Discuss the specific considerations when managing an insulin pump.

Heather Rush, MSN, APRN, CDE

9:50 a.m. – 10:50 a.m.

Concurrent Session 5B: Satisfy Your Clinical Curiosities: Investigate with Your Own Research Discuss how to recognize research opportunities in your own practice. Describe research design and evidence based practice guidelines. Identify opportunities for funding and disseminating your research.

Carol Howe, PhD, RN, CDE Sharron Close, PhD, MS, CPNP-PC

9:50 a.m. – 10:50 a.m.

Concurrent Session 5C: Tapping Breakout Session List the acupuncture points used for tapping to relieve stress and pain. Practice the formulation of reminder phrases. Practice the art of tapping on acupuncture points.

Lori Leyden, PhD, MBA

10:50 a.m. – 11:05 a.m. Break

11:05 a.m. – 12:05 p.m.

GENERAL SESSION 7: Pediatric Growth Disorders: Identification, Evaluation and Treatment Describe how to be more aware of poor measurement. Discuss accurate measurement techniques. Describe how to perform differential diagnosis for poor growth. Identify normal versus abnormal growth curves. Discuss details of several case studies.

Kent Reifschneider, MD

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE 8

12:10 p.m. – 1:20 p.m. Membership Meeting Luncheon for All Attendees

1:30 p.m. – 2:30 p.m.

GENERAL SESSION 8: Patient Experience: Compassionate Connections that Matter Discuss the evolution of the patient experience. Describe regulatory updates for patient experience measurement including Child CAHPS. Explain the Compassionate Connected Care Framework related to patient suffering. Identify strategies for improving patient experience in different practice settings.

Julie Classen, MSN, RN

2:35 p.m. – 3:35 p.m.

Concurrent Session 6A: Growth Hormone (GH) Stimulation Testing: Considerations in Pediatric and Transition Patients Describe physiology of GH secretion and regulation as it relates to growth hormone stimulation testing. List four possible agents used for growth hormone stimulation testing, and describe primary mode of action in growth hormone release for two agents. Discuss three nursing implications for a child undergoing a growth hormone stimulation test. Discuss two nursing implications for a transition patient undergoing growth hormone stimulation testing.

Joni Fusick, BSN, RN

2:35 p.m. – 3:35 p.m.

Concurrent Session 6B: Endocrine/Diabetes Pharmacology Review Discuss advanced drug treatment plans for endocrine patients. Describe drug therapies available currently for difficult diabetes cases. Identify the benefits of new drugs on the horizon for both endocrine and diabetes patients.

Christopher Winslow, PharmD, MBA

3:35 p.m. – 7:00 p.m. Networking/Free Time

3:45 p.m. – 5:15 p.m. Committee Meetings Education Committee Research Committee Nominating Committee Conference Planning Committee

7:00 p.m. – 10:00 p.m. Evening Event

Saturday, May 9, 20158:00 a.m. – 1:00 p.m. Registration

7:45 a.m. – 9:00 a.m. Breakfast Keynote Address: Nutritional Strategies for Overweight/Obese Pediatric Patients Jennifer Willoughby, RD, LD Describe the incidence of pediatric obesity and related risks in relation to endocrine disorders. Discuss the methods and results of traditional weight loss approaches. Identify the methods and results of emerging mainstream diets in America. Explain the methods and results of medical nutrition therapy.

9:00 a.m. – 10:00 a.m.

GENERAL SESSION 9: Recent Advances in Glucocorticoid Replacement in CAH Explain current available treatment options and challenges in CAH management. Explain recent advances in glucocorticoid replacement and delivery: Delayed/Modified-release formulations

Ashwini Mallapa, MD

2015 NATIONAL CONFERENCE COLLABORATE CULTIVATE EDUCATE 9

10:15 a.m. – 11:15 a.m.

GENERAL SESSION 10: Endocrinology Emergencies in the Newborn List pathophysiology of an inheritance pattern of inborn errors of metabolism. Describe clinical presentation and symptoms of inborn errors of metabolism. Explain studies used to diagnose inborn errors of metabolism and the role of the nurse. Identify neonatal emergencies of the thyroid gland-hypothyroid and Grave’s disease, diagnostic tests, treatment and role of the nurse. Discuss the types of neonatal adrenal disorders and treatment.

Cindy Young, BSN, RN, CPN

11:15 a.m. – 11:30 a.m. Closing Remarks and Boxed Lunch

Kathryn Anglin, MSN, BSN, RN Clinical Nurse Specialist Nationwide Children’s Hospital Columbus, OhioBeth Brillante, RN, BSN, MBA Research Nurse Specialist DHHS/NIH/NIDCR Bethesda, Md.Julie Classen, MSN, RN Patient Experience Advisor Press Ganey Associates, Inc.Sharron Close, PhD, MS, CPNP-PC Clinical Instructor Columbia University School of Nursing Chappaqua, N.Y.Kate Davies, RN (Child), Dip HE, BSc (Hons), MSc Clinical Nurse Specialist Great Ormond Street Hospital London, EnglandDeborah Diotallevi, MS, RN, CPNP, PMHS Pediatric Nurse Practitioner Pediatric Long Term Follow Up Program Memorial Sloan Kettering Cancer Center New York, N.Y.Lori Earl This Star Won’t Go Out (The Fault in Our Stars) Quincy, Mass.Jan Foote, DNP, ARNP, CPNP Pediatric Nurse Practitioner Blank Children’s Endocrinology Clinic Des Moines, IowaJoni Fusick, BSN, RN Senior Clinical Coordinator Genentech, Inc. Tigard, Ore.Lori Guthrie, RN-C, BSN, CCRC Research Nurse Specialist DHHS/NIH/NIDCR Bethesda, Md.

Julie Halipchuk, RN, MN CDE Clinical Nurse Specialist – Pediatric Diabetes Winnipeg, MB, Canada Carol Howe, PhD, RN, CDE Assistant Professor Harris College of Nursing and Health Sciences Texas Christian University Fort Worth, TexasIrena Hozjan, RN (EC), BScN, MN, NP-Pediatrics Pediatric Nurse Practitioner Hospital for Sick Children Toronto, ON, CanadaMeg Keil, PhD, CRNP Senior Nurse Practitioner NICHD, National Institutes of Health Chevy Chase, Md.Nicole Kirouac, RN, BN Pediatric Endocrine Nurse Clinician Health Sciences Centre of Winnipeg, Winnipeg, MB, Canada Patrick Leary Sr. Vice President, Call Center Operations inVentiv Health, Inc. Somerset, N.J.Kevin Lewis, DNP, APRN, PPCNP-BC, CDE Clinical Assistant Professor West Virginia University Department of Pediatrics Charleston, W. Va.Lori Leyden, PhD, MBA Psychotherapist The Tapping Solution Foundation Sandy Hook, Conn.Shari Liesch, MSN, APNP, CDE Nurse Practitioner/Certified Diabetes Educator Children’s Hospital of Wisconsin Neenah, Wis.

Terri Lipman, PhD, CRNP, FAAN Professor of Nursing for Children University of Pennsylvania Philadelphia, Pa. Ashwini Mallapa, MD Staff Clinician DHHS/NIH/NIDCR Bethesda, Md.Irene Mitchelhill, NP Clinical Nurse Consultant – Department of Endocrinology Sydney Children’s Hospital Randwick, NSW, AustraliaElaine Pottenger, MS, RN, CPNP, PMHS Pediatric Nurse Practitioner Pediatric Long Term Follow Up Program Memorial Sloan Kettering Cancer Center New York, N.Y.Neesha Ramchandani, PNP, CDE Pediatric Nurse Practitioner/Diabetes Specialist New York University & Montefiore Medical Center New York, N.Y.Kent Reifschneider, MD Pediatric Endocrinologist Children’s Hospital of The King’s Daughters Norfolk, Va.Heather Rush, MSN, APRN, CDE Pediatric Diabetes Nurse Practitioner Wendy L. Novak Diabetes Care Center Louisville, Ky.Traci Schaeffer, RN, BSN Pediatric Endocrine Nurse Specialist OU Children’s Physicians Oklahoma City, Okla.Janet Silverstein, MD Professor/Pediatric Research University of Florida College of Medicine Gainsville, Fla.

Cynthia K. Snyder, MSN, RN Pediatric Endocrinology Nurse Penn State Hershey Medical Center Hershey, Pa.Linda Steinkrauss, PNP Pediatric Nurse Practitioner A.I. duPont Hospital for Children Newark, Del.Mike Stetler Executive Director, Business Development inVentiv Health, Inc. Somerset, N.J.Cheryl Switzer, MSN, RN, CPNP, CDE Cleveland Clinic Children’s Pediatric and Adolescent Endocrinology Lakewood, OhioPhaedra Thomas, RN, BSN Nurse Educator and Co-Director Center for Young Women’s Health Boston Children’s Hospital Boston, Mass.Lisa Truong, MSN, CPNP-AC Nurse Practitioner Cook Children’s Hyperinsulinism Center Fort Worth, TexasDonna White, RN, PhD, CS, CADAC Addiction Specialist Lemuel Shattock Hospital Boston, Mass.Jennifer Willoughby, RD, LD Registered Dietitian Cleveland Clinic Cleveland, OhioChristopher Winslow, PharmD, MBA Pharmacist Walgreens Garden City, Ga.Cindy Young, BSN, RN, CPN Division of Endocrinology, Metabolism and Diabetes Nationwide Children’s Hospital Columbus, Ohio

FACULTY LISTING

PENS 2015 NATIONAL CONFERENCE REGISTRATION FORM

10

Cancellations & TransfersCancellations and transfers must be requested in writing and postmarked, faxed or emailed by April 3, 2015. Refunds will be issued following the conference. A $50 administrative fee will be assessed. Cancellation requests must include the reason for the cancellation. If you transfer your registration to another person, please include a completed registration form for that person with your written request. Requests for cancellation postmarked, emailed or faxed after April 3 are not refundable.

If you register after April 3, please bring your registration form and payment with you to the conference as it WILL NOT be processed at the PENS Executive Office after that date.

SPECIAL NEEDS

I will need assistance: __________________________________________________

I have the following dietary requirements: Gluten Free Vegetarian

Vegan Other:____________________________

EMERGENCY CONTACT INFORMATION

Name

Relationship Phone Number

This is my first PENS conference.

Do not provide my contact information on vendor lists or on the pre-registration attendee roster.

STEP TWO: RegistrationA. Full Conference Registration On or Between After 4/3 before 2/20 2/21 & 4/3 (on-site)

Member $450 $525 $675 Non-Member $575 $650 $800

Section A Total: __________

B. Single Day RegistrationCheck desired day: Wednesday Thursday Friday Saturday Member $200 Non-Member $325

Section B Total: __________

C. Spouse/Guest Registration (only includes evening events of Wednesday, Thursday and Friday)_____ Spouse/Guest $300 total for all three events. $125 each for Wednesday, Thursday or Friday.My Guest will be attending the evening event on: Wednesday Thursday FridayGuest Name(s):

Section C Total: __________

PENS Executive Office, P.O. Box 14516, Lenexa, KS 66285-4516 Fax 913-895-4652 Register Online: www.pens.org

Final registration deadline is April 3, 2015. If you are registering after April 3, please bring your completed paperwork and payment with you to the conference.

STEP ONE: Registration Information

First Name M.I. Last Name Credentials (LIST 2 ONLY)

Employer

 Home  Work

Preferred Address – please indicate home or work

City State Zip Country

Daytime Telephone Number Fax

Email Address

D. RSVP!Please indicate which concurrent sessions you are interested in attending. Your assistance will help us assign each speaker to an appropriately sized room. Please check one session letter for each column.

Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 A A A A A A B B B B B B C C C Please indicate which functions you will be attending:

Tuesday, May 5 New Member & Past President Reception

Wednesday, May 6 Thursday, May 7 Breakfast Breakfast Session Leadership Lunch Lunch with Exhibitors Welcome Reception Poster Reception Evening Event Evening Event

Friday, May 8 Saturday, May 9 Awards Breakfast Breakfast Session Membership Lunch Boxed Lunch Evening Event

PENS 2015 NATIONAL CONFERENCE REGISTRATION FORM, continued

11

STEP THREE: Total Fees Enclosed

A. Full Conference Registration $____________

B. Single Day Registration $____________

C. Spouse/Guest Registration $____________

TOTAL ENCLOSED: $____________

All fees must be paid in U.S. dollars, with checks drawn in U.S. funds on U.S. banks. Purchase orders are NOT accepted.

Check (made payable to PENS) PENS Tax ID: 38-2757646Register online at www.pens.org.

American Express MasterCard Visa Discover

Card Number

Expiration Date

Cardholder Name

Cardholder Signature

Final registration deadline is April 3, 2015.

Please return this form with the TOTAL AMOUNT DUE to:

Register online at: www.pens.org

By Mail: By Overnight Courier ONLY: By Fax (with credit card information):PENS PENS 913-895-4652P.O. Box 14516 18000 W. 105th St. Lenexa, KS 66285-4516 Olathe, KS 66061

Contact the PENS Executive Office for further information: 913-895-4628.