Continuing Education Calendar

Transcription

1 August 2016 Continuing Education Calendar AHEC Offices Statewide Office 1501 S. Joplin, Shirk Hall, 4th Floor Pittsburg, KS (620) phone (620) fax AHEC West Office 205 East 7th, Ste. 130 Hays, KS (785) phone (785) fax AHEC Southeast Office 1501 S. Joplin, Shirk Hall, 4th Floor Pittsburg, KS (620) phone (620) fax In this Issue Brown Bag Webinar Palliative Care Lecture Series CNE/Allied Health Programs Upcoming Events CME Programs Vision Screenings Clinics AHEC Policies Registration Wound Symposium 2016 September 23 9:00 a.m. - 3:30 p.m. (Registration at 8:30 a.m.) Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, Social Workers, Physical Therapists, Occupational Therapists, and Other Allied Health Care Professionals For More Information: See pages 6 or 8. Visit our website Visit our online calendar Find us on Facebook Follow us on Twitter

2 KU Medical Center Area Health Education Center Presents: Brown Bag Webinar Series Pediatric Cluster All sessions will be held from 12-1 p.m. June 14, 2016 Management of Common Respiratory Disorders in Children Speaker Whitney Pressler, M.D.; Department of Pediatrics, KU Medical Center Credit 1 hour - APRNs, Nurses CME: This activity has been approved for AMA PRA Category 1 Credit TM June 21, 2016 HPV Vaccination: A Missed Opportunity for Cancer Prevention Speaker Kevin Ault, M.D.; Department of Obstetrics and Gynecology, KU Medical Center Credit 1 hour - APRNs, Nurses, Social Workers CME: This activity has been approved for AMA PRA Category 1 Credit TM June 28, 2016 Pediatric Diabetes Speaker Angela Lennon, M.D.; Department of Pediatrics Assistant Professor, KU Medical Center Credit 1 hour - APRNs, Nurses CME: This activity has been approved for AMA PRA Category 1 Credit TM July 12, 2016 Prevention and Response to Teen Dating Violence: The Role of the Health Care Professionals Speakers Christie Brungardt, Ph.D.; Assistant Professor of Leadership Studies at Fort Hays State University and Founder of Jana s Campaign and Curt Brungardt, Ph.D.; Omer G. Voss Distinguished Professor of Leadership Studies and Executive Director of CCL at Fort Hays State University and Founder of Jana s Campaign Credit 1 hour - APRNs, Nurses, Social Workers CME: This activity has been approved for AMA PRA Category 1 Credit TM July 19, 2016 Non-Pharmacologic Treatment of ADHD Speaker Stephen Lassen, PhD; Associate Professor for Department of Pediatrics and Psychiatry and Behavioral Sciences, KU Medical Center Credit 1 hour - APRNs, Nurses, Social Workers CME: This activity has been approved for AMA PRA Category 1 Credit TM 2 AHEC Statewide/Southeast, Pittsburg (620) AHEC West, Hays (785) Fee Cost is determined as if attending as an individual participant or an organization. $100 - Organization (multiple employees) $50 - Individual Registration * Call (620) with questions about organization registration. Registration Deadline: June 7, 2016 Registrations turned in after this date will be charged an additional $10. Cancellation Deadline: June 7, 2016 Location These sessions will be broadcast via Zoom. Target Audience Physicians, Advanced Practice Nurses, Nurses, Social Workers, and other allied health professionals To Register Organization contacts may register their organization through one of three methods. us at ahecpitt@kumc.edu and note Registering for BBWS Pediatric Cluster in the subject line. Please include the following information in your Name of organization Mailing address Phone and fax numbers Name and address of organization contact person(s)* Number of employees attending Payment information Phone: Contact the KU Medical Center Area Health Education Center by calling (620) Future Series Schedule August/September: Trauma Cluster Dates: To be determined October/November: Palliative Care Cluster Dates: To be determined For more information: Contact the AHEC Statewide office at (620)

3 Palliative Care Fellowship Series Broadcast via Zoom Webconferencing Thursdays 8 a.m. & 9 a.m. Series Schedule Broadcasts are planned on the following Thursdays: July 14 September 22 December 8 July 28 September 29 December 22 August 11 October 13 December 29 August 25 October 27 September 8 November 10 Please note: Due to the nature of a fellowship series, the need may arise to alter the planned schedule. Participants will be notified of changes as soon as possible should they occur. Individual session information will be updated online by visiting and locating the Palliative Care Fellowship Series tab under the Health Care Professionals tab on the left hand side. Topics of Presentations Topics planned for the 2016 Spring Series include: Imminently Dying Palliative Emergencies Bowel Issues in Palliative Care Spiritual Care - Spiritual Assessments How to Talk to Kids Skin Wounds Communication: Code Status & AD Communication & Prognostication Oncology-Hematology 101 Heart Failure Perinatal and Neonatal Broadcast Times Each broadcast date will have two separate one-hour presentations with the first beginning at 8:00 a.m. and the second beginning at 9:00 a.m. Sessions will begin and end promptly. How To Register Participants may register for the entire series or register for individual sessions To Register for the Series: Please contact the KU Area Health Education Center at (620) or ahecpitt@kumc.edu. To Register for Individual Sessions: We recommend participants register and pay online with a credit card by visiting Registration over the phone is also accepted by calling (620) but payment via credit card will be required at the time of registration. Registration for each session will close 48 hours prior to each session. Fee Series Registration (26 sessions) - $275 Individual One-hour Session Registration - $12.50 per session Individual session registration is available online at For More Information: Contact the AHEC Statewide Office at (620) The University of Kansas Medical Center 3

4 Continuing Education (CNE) August th Annual Physical Therapy Conference: Sports Rehabilitation Location: Whiskey Creek, Conference Room, 3203 Vine Street, Speakers: Robert Manske, PT, DPT, MEd, SCS, ATC, LATC, CSCS; Justin Rohrberg, PT, DPT, ATC; BJ Lehecka, DPT; Doug Bonnesen, MPT, DPT, HBC; Janice Loudon, Ph.D., PT, SCS, ATC Target Audience: Physical Therapists, Physical Therapy Assistants, Occupational Therapists, Occupational Therapy Assistants (no pre approved for OT/OTA credit), Athletic Trainers, Advanced Practice Nurses, Nurses, and Other Allied Health Professionals Credit: PT, OT, Athletic Trainers - 13 hours (Day hours, Day hours); APRNs, Nurses - 15 hours (Day hours, Day hours) Cost: Two-Day: $180 - Must be postmarked by Aug. 12, 2016; $190 thereafter. One-Day (Friday): $110 - Must be postmarked by Aug. 12, 2016; $120 thereafter. One-Day (Saturday): $90 - Must be postmarked by Aug. 12, 2016; $100 thereafter. Cancelation Deadline: August 16, 2016 Contact: Area Health Education Center West at (785) August 25 Pediatric Integrative Medicine Salina, Kan. Location: Donna Vanier Children s Center, Conference Center; 155 N. Oakdale, 8 a.m. - 4 p.m. Salina, Kan. Speakers: Susan Carlson, Ph.D.; Anna Esparham, M.D.; Randy Evans, RD; and Joy Weydert, M.D., FAAP Target Audience: Family Physicians, Pediatricians, Pediatric and School Nurses, Dietitians, Early Intervention Providers, Pediatric PT, OT, ST, ECSE, Mental Health Providers, and Other Allied Health Care Professionals Credit: 7.2 hours - APRNs/Nurses; Cost: Physicians - $100; RN/APRN or Other Health Care Professional - $75; Medical Student/Resident - No Charge; All Others - $50. Registration Deadline: August 15, 2016 To Register: Contact Salina Regional Health Center, Organizational Development at (785) Contact: Emily Walker or Kim Ratcliff, SRHC Infant Child Development at (785) August 26 Trauma Symposium 2016 Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, 9 a.m. - 4 p.m. Speakers: Jerod Grove, M.D.; Scott Hubbell, MS, RRT-NPS,C-NPT; Kyros Ipaktchi, Registration at 8:30 a.m. M.D.; Burt Bote Katubig, M.D.; Jennifer Piece, M.D.; and Tanya Filardi, M.D. Social Workers, Physical Therapists, Occupational Therapists, and Other Allied Health Care Professionals Credit: 6 hours - APRN, Nurses, SW, PT, OT; Cost: HMC/PVCH/SRH Associates - No Cost; CAHs Associates - $30; Non HMC Associates - $60. Must register by August 24, 2016 Cancelation Deadline: August 25, AHEC Statewide/Southeast, Pittsburg (620) AHEC West, Hays (785)

5 Continuing Education (CNE) Cont. Notice of Program Cancellation The following programs have been cancelled. Date Program Title Location August 31 Fetal Heart Monitoring Pieces to the Puzzle: Basic Lyons, Kan. August 31 Fetal Heart Monitoring Putting the Pieces Together: Intermediate Lyons, Kan. September 8 Wound Care Updates McCook, Neb. Location: Community Hospital, 1301 East H Street, McCook, Neb p.m. Speakers: Rhonda Soucek, RN, BSN, CWCN, CFCN and Kay Marshall, WOCN Target Audience: Advanced Practice Nurses and Nurses Credit: 5 hours Cost: There is no cost to attend this program. To Register: contact Monica Wacker, RN, CDE, Community Hospital Education Coordinator at (308) September 9 Wound Care Updates McCook, Neb. Location: Community Hospital, 1301 East H Street, McCook, Neb. 8 a.m. - 1 p.m. Speakers: Rhonda Soucek, RN, BSN, CWCN, CFCN and Kay Marshall, WOCN Target Audience: Advanced Practice Nurses and Nurses Credit: 5 hours Cost: There is no cost to attend this program. To Register: contact Monica Wacker, RN, CDE, Community Hospital Education Coordinator at (308) September 12 Fetal Heart Monitoring Pieces to the Puzzle: Basic Norton, Kan. Location: Norton County Hospital, Conference Room, 102 E. Holme, Norton, Kan. 9 a.m p.m. Speaker: Jessica Seib, RN, BSN Target Audience: RN, LPN Credit: 3 hours Cost: $40 if postmarked by September 5, 2016; $50 thereafter Cancelation Deadline: September 8, 2016 Contact: Area Health Education Center West at (785) September 12 Fetal Heart Monitoring Putting the Pieces Together: Intermediate Norton, Kan. Location: Norton County Hospital, Conference Room, 102 E. Holme, Norton, Kan. 1-4 p.m. Speaker: Jessica Seib, RN, BSN Target Audience: RN, LPN Credit: 3 hours Cost: $40 if postmarked by September 5, 2016; $50 thereafter Cancelation Deadline: September 8, 2016 Contact: Area Health Education Center West at (785) Look ahead online! Want to see what programs are coming up? Visit our online calendar at to see upcoming events, download flyers, and register online. The University of Kansas Medical Center 5

6 Continuing Education (CNE) Cont. September Medical Legal Investigation of Death Location: Fort Hays State University, Memorial Union, Black and Gold Room, 600 8:30 a.m. - 6:00 p.m. Park Street, Registration at 8 a.m. Speakers: Gary Brown; Don Scheibler; Eric Voth, M.D.; Dale Brooks; Jennifer Johnson, MSN, APRN, AFN-BC, CFN, SANE-A, SANE-P; and Tom Drees, JD Target Audience: Physicians, Physician Assistants, Advanced Practice Nurses, Nurses, Emergency Medical Services, Social Workers, ACHA-Res. Care, Law Enforcement, Attorneys, Morticians, Death Investigators, Deputy Coroners, and all other Allied Health Professionals Credit: 9.5 hours - APRN, Nurses, SW, EMS; 8.5 hours - ACHA-Res.; 6 hours - Morticians; 8 hours - Death Investigators Cost: $135 - Physicians and Law Enforcement; $125 - all others A late fee of $10 will be applied after September 12, 2016 Cancelation Deadline: September 14, 2016 Contact: Area Health Education Center West at (785) September 23 Wound Symposium 2016 Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, 9:00 a.m. - 3:30 p.m. Speakers: Todd Meier, Ph.D.; F. Allen Moorhead, M.D.; Teresa Switzer, RN; Chris Registration at 8:30 a.m. Berke, MSN, APRN-NP, CWOCN-AP; and Todd Walburn, RN Physical Therapists, Occupational Therapists, and Other Allied Health Care Professionals Credit: 5 hours - APRN, Nurses, PT, OT; Cost: HMC/PVCH/SRH Associates - No Cost; CAHs Associates - $25; Non HMC Associates - $50. Must register by September 19, 2016 Cancelation Deadline: September 21, October 12 Stroke Symposium 2016 Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, 9:00 a.m. - 4:30 p.m. Speakers: Robert Moser, M.D.; Christine Fisher, M.D.; Alan Reeves, M.D.; Lee Registration at 8:30 a.m. Rosterman, D.O., and Paul Camarata, M.D. and Other Allied Health Care Professionals Credit: 6 hours - APRN and Nurses; Cost: HMC/PVCH/SRH Associates - No Cost; CAHs Associates - $30; Non HMC Associates - $60. Must register by October 3, 2016 Cancelation Deadline: October 7, AHEC Statewide/Southeast, Pittsburg (620) AHEC West, Hays (785)

7 Upcoming Events The following programs have been scheduled, however registration is not yet available. October October Pittsburg, Kan. December 9-10 Pittsburg, Kan. Wheat State Summit: Western Kansas Advanced Nursing Practice Symposium Location: Sternberg Museum of Natural History, 300 Sternberg Dr., Target Audience: Advanced Practice Registered Nurses Contact: Area Health Education Center East at (620) Midwest Region Health Professions Conference: Celebrating Health Care Professions Location: McPherson Hall, Pittsburg State University, Pittsburg, Kan. Target Audience: Advanced Practice Nurses, Nurses, ACHA-Res., ACHA-Admin., EMS, Social Workers, Respiratory Therapists, and Other Allied Health Professionals Contact: Area Health Education Center East at (620) Wheat State Summit: Eastern Kansas Advanced Nursing Practice Symposium Location: McPherson Hall, Pittsburg State University, Pittsburg, Kan. Target Audience: Advanced Practice Registered Nurses Contact: Area Health Education Center East at (620) Continuing Education (CME) August 25 Pediatric Integrative Medicine Salina, Kan. Location: Donna Vanier Children s Center, Conference Center; 155 N. Oakdale, 8 a.m. - 4 p.m. Salina, Kan. Speakers: Susan Carlson, Ph.D.; Anna Esparham, M.D.; Randy Evans, RD; and Joy Weydert, M.D., FAAP Target Audience: Family Physicians, Pediatricians, Pediatric and School Nurses, Dietitians, Early Intervention Providers, Pediatric PT, OT, ST, ECSE, Mental Health Providers, and Other Allied Health Care Professionals Credit: 7.2 hours - APRNs/Nurses Cost: Physicians - $100; RN/APRN or Other Health Care Professional - $75; Medical Student/Resident - No Charge; All Others - $50. Registration Deadline: August 15, 2016 To Register: Contact Salina Regional Health Center, Organizational Development at (785) Contact: Emily Walker or Kim Ratcliff, SRHC Infant Child Development at (785) August 26 Trauma Symposium 2016 Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, 9 a.m. - 4 p.m. Speakers: Jerod Grove, M.D.; Scott Hubbell, MS, RRT-NPS,C-NPT; Kyros Ipaktchi, Registration at 8:30 a.m. M.D.; Burt Bote Katubig, M.D.; Jennifer Piece, M.D.; and Tanya Filardi, M.D. Social Workers, Physical Therapists, Occupational Therapists, and Other Allied Health Care Professionals Credit: 6 hours - APRN, Nurses, SW, PT, OT; Cost: HMC/PVCH/SRH Associates - No Cost; CAHs Associates - $30; Non HMC Associates - $60. Must register by August 24, 2016 Cancelation Deadline: August 25, The University of Kansas Medical Center 7

8 Continuing Education (CME) September Medical Legal Investigation of Death Location: Fort Hays State University, Memorial Union, Black and Gold Room, 600 8:30 a.m. - 6:00 p.m. Park Street, Registration at 8 a.m. Speakers: Gary Brown; Don Scheibler; Eric Voth, M.D.; Dale Brooks; Jennifer Johnson, MSN, APRN, AFN-BC, CFN, SANE-A, SANE-P; and Tom Drees, JD Target Audience: Physicians, Physician Assistants, Advanced Practice Nurses, Nurses, Emergency Medical Services, Social Workers, ACHA-Res. Care, Law Enforcement, Attorneys, Morticians, Death Investigators, Deputy Coroners, and all other Allied Health Professionals Credit: 9.5 hours - APRN, Nurses, SW, EMS; 8.5 hours - ACHA-Res.; 6 hours - Morticians; 8 hours - Death Investigators Cost: $135 - Physicians and Law Enforcement; $125 - all others A late fee of $10 will be applied after September 12, 2016 Cancelation Deadline: September 14, 2016 Contact: Area Health Education Center West at (785) September 23 Wound Symposium 2016 Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, 9:00 a.m. - 3:30 p.m. Speakers: Todd Meier, Ph.D.; F. Allen Moorhead, M.D.; Teresa Switzer, RN; Chris Registration at 8:30 a.m. Berke, MSN, APRN-NP, CWOCN-AP; and Todd Walburn, RN Physical Therapists, Occupational Therapists, and Other Allied Health Care Professionals Credit: 5 hours - APRN, Nurses, PT, OT; Cost: HMC/PVCH/SRH Associates - No Cost; CAHs Associates - $25; Non HMC Associates - $50. Must register by September 19, 2016 Cancelation Deadline: September 21, October 12 Stroke Symposium 2016 Location: HaysMed, Hadley Conference Rooms, 2220 Canturbury Drive, 9:00 a.m. - 4:30 p.m. Speakers: Robert Moser, M.D.; Christine Fisher, M.D.; Alan Reeves, M.D.; Lee Registration at 8:30 a.m. Rosterman, D.O.; and Paul Camarata, M.D. and Other Allied Health Care Professionals Credit: 6 hours - APRN and Nurses; Cost: HMC/PVCH/SRH Associates - No Cost; CAHs Associates - $30; Non HMC Associates - $60. Must register by October 3, 2016 Cancelation Deadline: October 7, AHEC Statewide/Southeast, Pittsburg (620) AHEC West, Hays (785)

9 Vision Screenings August 26 Kansas City, Kan. - Kansas State School for the Blind, Irwin Conference Rm., 1100 State Ave. Registration: 7:30-8:00 a.m. Workshop: 8:00 a.m. - 12:00 p.m. Cost: $75 if postmarked by August 18; $85 thereafter. Cancellation deadline - August 23. Instructor: Mae Claxton, RN, COT September 9 Emporia, Kan. - Emporia State University, Visser Hall, Room 110 Registration: 11:30 a.m. - 12:00 p.m. Workshop: 12:00-4:00 p.m. Cost: $75 if postmarked by September 1; $85 thereafter. Cancellation deadline - September 6. Instructor: Mae Claxton, RN, COT September 30 Salina, Kan. - Salina Regional Health Center, Conf. RM #3, 400 S Santa Fe Ave. This class is currently full. If you wish to be placed on a waiting list, please call (620) Registration: 11:30 a.m. - 12:00 p.m. Workshop: 12:00-4:00 p.m. Cost: $75 if postmarked by September 22; $85 thereafter. Cancellation deadline - September 27. Instructor: Mae Claxton, RN, COT Each program is limited to the first 10 registrants. Payment or PO must accompany registration form to be considered registered for the workshop. To Register: Visit See page 11, or call AHEC Southeast Office at (620) or AHEC West Office at (785) For More Information: Visit AHEC Outreach Clinics HAYS: Pediatric Behavior - Martha Barnard, Ph.D. Pediatric Cardiology - Kenneth Goertz, M.D. ~ Clinics via Telemed ~ August 9, 2016 December 20, 2016 August 19, 2016 November 18, 2016 October 18, 2016 September 16, 2016 December 16, 2016 Pediatric Rheumatology - October 21, 2016 Carol Lindsley, M.D. & Jordan Jones, M.D. November 2, 2016 For more information or to make an appointment, call AHEC West, (785) PITTSBURG: Pediatric Rheumatology - Carol Lindsley, M.D. Pediatric Cystic Fibrosis - Michael Lewis, M.D. November 4, 2016 August 30, 2016 November 15, 2016 Patients can be scheduled through Kelly Sabol, (620) The University of Kansas Medical Center 9

10 AHEC Policies In order to be able to provide quality continuing education programs at an affordable price, The University of Kansas Medical Center Area Health Education Center has the following policies. Registration Policies: 1. By mail - the registration form must be completed and accompanied by check, money order or credit card (MasterCard, Discover or Visa) for the correct amount made payable to KU Medical Center AHEC. 2. By telephone - registrations will only be accepted over the phone with a credit card guarantee (MasterCard, Discover or VISA) or Purchase Order Number. Participants will not be considered registered/enrolled for a program unless the appropriate fee has been paid prior to the offerings preregistration date. 3. Online - online credit card registrations are available at Additional Policies: 1. A late fee of $10.00 will be assessed if the registration is received after the announced preregistration date, or if the payment is made at the door. Registrations at the door will be accepted only if space is available. Preregistration is your only guarantee of space and handout material. 2. Cancellation policy: A registrant may cancel within the cancellation deadline for that program to receive a refund, minus a $15.00 administrative fee. After that time, no refunds are made. The registration fee will not be transferred to future offerings. Refunds are made by mail. KU Medical Center AHEC reserves the right to cancel programs and return all fees in the event of insufficient registration. If a program is cancelled by the AHEC, the paying party will be provided a full refund (refunds are issued from The University of Kansas Medical Center and cannot be issued through the AHEC offices). KU Medical Center AHEC will not be responsible for any losses incurred by registrants, including but not limited to airline cancellation charges or hotel deposits. Cancellation Policy: A registrant may cancel within the cancellation deadline to receive a refund, minus a $15 administrative fee. After that time, no refunds are made. Complete cancellation policy is listed on page 8 under Additional Policies. Program Accessibility: We accommodate persons with disabilities. Please call our office or indicate on the registration form and a continuing education representative will contact you to discuss your needs. In order to assure accommodation, please register at least two weeks before the start of the event. Attendance Policy for Nursing, Social Work and Allied Health Programs: If a participant misses more than 10% of an offering, a certificate of continuing education will not be issued. Partial credit is NOT given unless specifically noted. Equal Opportunity Statement: The University of Kansas prohibits discrimination on the basis of race, color, ethnicity, religion, sex, national origin, age, ancestry, disability, status as a veteran, sexual orientation, marital status, parental status, gender identity, gender expression and genetic information in the University s programs and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Director of the Office of Institutional Opportunity and Access, IOA@ku.edu, 1246 W. Campus Road, Room 153A, Lawrence, KS, 66045, (785) , 711 TTY. Continuing Education Credit: Nursing - The University of Kansas Medical Center Area Health Education Centers - West (KSBN Provider Number LT ) and East (KSBN Provider Number LT ), as approved providers of continuing education by the Kansas State Board of Nursing, present these offerings for the designated credit hours listed applicable for relicensure of APRNs, RNs, and LPNs. Social Work - The University of Kansas Medical Center Area Health Education Center - East (KSBSRB Provider Number ), as an approved provider of continuing education by the State of Kansas Behavioral Sciences Regulatory Board for the designated credit hours listed applicable for relicensure of LASWs, LBSWs, LMSWs, and LSCSWs. As appropriate, application has been made to additional accrediting organizations for continuing education credit. Application does not mean approval has been granted at the time this calendar was printed. Contact the AHECs for more information. AHEC Continuing Education Calendar We strive to keep our mailing list as up-to-date and accurate as possible. If you receive duplicates, have an incorrect address or would like to be removed from the mailing list, please call (620) or rpommier@kumc.edu 10 AHEC Statewide/Southeast, Pittsburg (620) AHEC West, Hays (785)

11 Registration Form TWO WAYS TO REGISTER! Register Online Register for programs online by visiting or by scanning the code to the left on your mobile device. *Online registration not available for all programs Contact Information Name Please check ( ) preferred address: Home Address Street City/State/Zip County Employer Professional License # Home Phone ( ) - Work Phone ( ) - Cell Phone ( ) - Register by Mail/Phone/Fax AHEC Statewide Office 1501 S. Joplin Shirk Hall, 4th Floor Pittsburg, KS Professional Title Work Mailing Address Street City/State/Zip County Position Address Phone: (620) Fax: (620) OFFICE USE ONLY Program Selection Check the program(s) you wish to attend: August 19-20: 15th Annual Physical Therapy Conference: Sports Rehabilitation Two-Day - $180 if postmarked by August 12, 2016; $190 thereafter. Friday Only - $110 if postmarked by August 12, 2016; $120 thereafter. Saturday Only - $90 if postmarked by August 12, 2016; $100 thereafter. Cancellation deadline - August 16, August 26: Vision Screening - Kansas City, Kan. $75 if postmarked by August 18; $85 thereafter. Cancellation deadline - August 23. September 9: Vision Screening - Emporia, Kan. $75 if postmarked by September 1; $85 thereafter. Cancellation deadline - September 6. September 12: Fetal Heart Monitoring Basic Only - $40 if postmarked by September 5, 2016; $50 thereafter. Intermediate Only - $40 if postmarked by September 5, 2016; $50 thereafter. Both Basic and Intermediate - $80 if postmarked by September 8, 2016; $90 thereafter. Cancellation deadline - August 26, September 17: 2016 Medical Legal Investigation of Death Physician and Law Enforcement - $135 if postmarked by September 12, 2016; $145 thereafter. All Others - $125 if postmarked by September 12, 2016; $135 thereafter. Cancellation deadline - September 14, Amount $ $ $ $ $ Method of Payment Check enclosed for $ REGISTRATION TOTAL $ made payable to KU Medical Center AHEC P. O. # (please attach) Charge credit card: MasterCard VISA Discover Card No. Exp. Date 3-digit Security Code Name on Card Billing Address street city state zip Receipt ed to The University of Kansas Medical Center 11