Advancing Patient Care throughinnovation

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1 54TH ANNUAL MEETING ATTENDEE REGISTRATION CATEGORIES AND FEES Please refer to the following information when completing the Attendee Registration Form. All registration fees are in U.S. dollars. FULL CONFERENCE REGISTRATION Includes admission to all ASTRO sessions, the Exhibit Hall, Poster Viewing Session and Reception, Lunch Voucher* and Virtual Meeting** access. Member (1) $525 $605 $675 Emeritus Member (3) $360 $410 $475 Member-in-Training (4) $360 $410 $475 Nurse/Nurse Practitioner Member (5) $360 $410 $475 Dosimetrist/RT/Physician Assistant Member (7) Physicists do not qualify for this rate and must register at the Member (1) rate. $360 $410 $475 Nonmember (2) $925 $975 $1,050 Nurse/Nurse Practitioner Nonmember (6) $500 $550 $615 Dosimetrist/ RT/ Physician Assistant (8) Nonmember Physicists do not qualify for this rate and must register at the Nonmember (2) rate. $500 $550 $615 Resident/Fellow Nonmember (12) $360 $410 $475 Student (9) This rate is only available online only. $175 $200 $225 ONE-DAY CONFERENCE REGISTRATION Includes one-day admission to ASTRO sessions, the Exhibit Hall and Lunch Voucher*. This registration type does not include the Virtual Meeting. The Virtual Meeting will be available for purchase via the ASTRO website after the meeting. If you would like to attend events on Saturday, you must register for those events separately; it will not count against your one-day registration. If you would like to attend more than one day of the meeting (exception of Saturday) you must register at the full conference rates. Member (All categories) $250 $290 $325 Nonmember (All categories) $450 $475 $515 ASRT/SROA FULL CONFERENCE (FULL) ASRT and SROA attendees who have already registered directly with ASRT or SROA may attend ASTRO sessions by paying a reduced registration fee. In order to receive this reduced rate, you MUST provide the registration confirmation number that you received from ASRT or SROA when you registered. Registered ASRT or SROA attendees may visit the ASTRO Exhibit Hall for free. Your ASRT or SROA badge will provide access into the Exhibit Hall. You do not need to register with ASTRO if you are planning to visit the Exhibit Hall only. ASRT Registrant (10) $150 $160 $195 SROA Registrant (11) $150 $160 $195 SPOUSE/FAMILY REGISTRATION Includes admission to the Exhibit Hall, Poster Viewing Session and Reception and Lunch Voucher.* Does not include access to ASTRO sessions and spouse/family attendees are not eligible for continuing medical educational credits. Only full conference attendees are eligible to register one spouse/family member. Spouse/Family (SG01) $75 $100 $125 *Lunch Voucher Full conference, one-day conference and spouse/family registrants will receive a $10 voucher that can be used at any concession stand in the Exhibit Hall. **Virtual Meeting The Virtual Meeting allows you to extend your learning experience by providing access to the ASTRO sessions after the meeting is over. You will receive streaming content that has been digitally recorded live and published as audio synchronized to faculty presentations. *** Full conference attendees will receive a link approximately six weeks after the meeting for unlimited access to the Virtual Meeting. ***Presentations are included in the Virtual Meeting as approved per faculty. VISAS In most cases citizens of foreign countries will need a visa to enter the United States. It may take up to three months to obtain a visa. For additional information, please visit To receive your visa letter, you must be registered and paid in full before ASTRO will send you a letter. To inquire about letters of invitation, please contact astroregistration@jspargo.com.

2 ATTENDEE REGISTRATION CATEGORIES AND FEES Please refer to the following information when completing the Attendee Registration Form. All registration fees are in U.S. dollars. TICKETED EVENTS The following events require separate registration and an additional fee. Only full and one-day conference attendees are eligible to register for these events. One-day conference attendees may only register for events on the day that they register to attend the meeting (except Saturday events). Space is limited, so please register early. Saturday, October 27 Young Physicians Session (TE7) The educational focus is targeted towards young physicians with 10 years or less practice experience. 1:00 p.m. 4:00 p.m. Member/Nonmember FREE Nurses Welcome Orientation Luncheon (TE2) Open to Nurse/Nurse Practitioner registrants only. 12:45 p.m. 1:45 p.m. Member/Nonmember $ Radiation Oncology Coding and Reimbursement Update and Discussion on the Challenges Aecting the Specialty in the Current Reimbursement Environment (TE8) 12:45 p.m. 1:45 p.m. Member/Nonmember $30 Nurses Reception (TE10) Open to Nurse/Nurse Practitioner registrants only. 5:30 p.m. 6:30 p.m. Member/Nonmember FREE AAWR/ASTRO Luncheon (TE4) 12:30 p.m. 1:45 p.m. Member/Nonmember $35 NCI-ASTRO Diversity Symposium and Reception (TE9) 5:30 p.m. 6:30 p.m. Member/Nonmember FREE MEMBER-IN-TRAINING EVENTS The following events are oered to ASTRO Member-in-Training/Association of Residents in Radiation Oncology (ARRO) members, resident-fellow nonmembers and students only. Saturday, October 27 ARRO Career Seminar (JM1) 10:00 a.m. 5:30 p.m. Member-in-Training/Resident-Fellow Nonmember/Student $30 ARRO Annual Luncheon (JM2) 12:45 p.m. 1:45 p.m. Member-in-Training/Resident-Fellow Nonmember/Student $35 How to Review a Scientific Paper Workshop (JM3) 12:30 p.m. 1:45 p.m. Member-in-Training/Resident-Fellow Nonmember/Student $30 Poster Walk With a Professor Expert faculty lead groups through selected posters. Only nine (9) slots per category. 12:30 p.m. 1:45 p.m. Member-in-Training/Resident-Fellow Nonmember/Student $30 Professor* Professor* Professor* Biology (W01) Breast (W02) CNS (W04) Gastrointestinal (W05) Genitourinary (W06) Kevin Camphausen, MD National Cancer Institute Julia R. White, MD Ohio State University Comprehensive Cancer Center Eric L. Chang, MD University of Southern California Andre A. Konski, MD, MBA Wayne State University School of Medicine Howard M. Sandler, MD, FASTRO Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center Gynecological (W08) Head and Neck (W09) Lung (W10) Lymphoma (W12) Pediatrics (W13) Akila Viswanathan, MD, MPH Dana-Farber/Brigham and Women s Hospital Jonathan J. Beitler, MD, MBA Emory University Hak Chay, MD UT Southwestern Medical Center Louis S. Constine, MD, FASTRO University of Rochester Medical Center Larry E. Kun, MD, FASTRO St. Jude Children s Research Hospital Physics I (W14) Physics II (W15) QOL/Outcomes (W16) Sarcoma (W17) Zhe (Jay) Chen, PhD Yale University School of Medicine Jay Burmeister, PhD Wayne State University School of Medicine Stephen T. Lutz, MD Blanchard Valley Regional Cancer Center D. Jerey Demanes, MD, FASTRO David Geen School of Medicine - UCLA *Please note that professors are subject to change. Please visit for updated information.

3 ATTENDEE REGISTRATION CATEGORIES AND FEES MEMBER-IN-TRAINING EVENTS (CONTINUED) The following events are oered to ASTRO Member-in-Training/Association of Residents in Radiation Oncology (ARRO) members, resident-fellow nonmembers or students. Wednesday, October 31 Meet the Professor Luncheon Only seven (7) slots per professor. 12:30 p.m. 1:30 p.m. Member-in-Training/Resident-Fellow Nonmember/Student $35 Meet the Professor Faculty* Professor Professor Professor Professor Thomas F. DeLaney, MD (MT01) Massachusetts General Hospital Theodore L. DeWeese, MD (MT02) Johns Hopkins University Patricia J. Eifel, MD, FASTRO (MT03) MD Anderson Cancer Center Bruce G. Haty, MD, FASTRO (MT04) UMDNJ Robert Wood Johnson Med Stephen M. Hahn, MD (MT05) University of Pennsylvania Hospital Paul M. Harari, MD (MT06) University of Wisconsin Cancer Center Jay R. Harris, MD, FASTRO (MT07) Brigham and Women s Hospital Louis B. Harrison, MD, FASTRO (MT08) Beth Israel Medical Center Lisa Ann Kachnic, MD (MT09) Boston Medical Center Mark P. Langer, MD (MT10) Indiana University School of Medicine Quynh-Thu Le, MD (MT11) Stanford University Nancy Lee, MD (MT12) Memorial-Sloan Kettering Cancer Center Minesh P. Mehta, MD, FASTRO (MT13) Northwestern Memorial Hospital Arno J. Mundt, MD (MT14) University of California San Diego Carlos A. Perez, MD, FASTRO (MT15) Washington University Alan Pollack, MD, PhD (MT16) University of Miami Mohan Suntharalingam, MD (MT17) University of Maryland Joel E. Tepper, MD, FASTRO (MT18) University of North Carolina Chapel Hill Timothy R. Williams, MD, FASTRO (MT19) Boca Raton Community Hospital Terry J. Wall, MD, JD, FASTRO (MT20) St. Luke s Hospital *Please note professors are subject to change. Please visit for updated information. econtouring LEARNING LAB The econtouring Learning Lab will only be available to those who bring their own personal computer. There will be no ASTRO provided computers available on-site. You will need to register and pay an additional fee to attend these sessions. We do not allow attendees to observe the econtouring sessions. Changes to sessions can be made until September 21, 2012., 2012, session changes may not be made. Because of the high popularity of these sessions, registration fees are nonrefundable. Please note that you will be charged per session. Member (All Categories) $150 $175 $200 Nonmember (All Categories) $250 $275 $350 Saturday, October 27 Esophageal Cancer (EL1) 8:00 a.m. 9:30 a.m. Head and Neck Cancer (EL8) 8:00 a.m. 9:30 a.m. Lymphoma (EL6) 10:30 a.m. 12:00 p.m. Gynecologic Cancer (EL7) 10:30 a.m. 12:00 p.m. Lung Cancer (EL5) 1:00 p.m. 2:30 p.m. Gastrointestinal Cancer (EL4) 1:00 p.m. 2:30 p.m. Head and Neck Cancer (EL2) 3:30 p.m. 5:00 p.m. Prostate Cancer (EL3) 3:30 p.m. 5:00 p.m. LIVE SAMS SESSION A number of sessions at the Annual Meeting have been designated for Live SAMs. Self-assessment Modules (SAMs) meet part of the Component Two: Lifelong Learning and Self-assessment requirement of the American Board of Radiology s (ABR) Maintenance of Certification. Attendees that register to participate in the Live SAMs oered will complete the related assessment and evaluation at the conclusion of the lecture. Changes to Live SAM sessions can be made until September 21, 2012., 2012, no changes can be made to sessions online or on-site. Only a limited number of Live SAM tickets are available at these high-demand sessions, so we encourage you to register early to secure your seat at these sessions. Please note that Live SAM registration fees are nonrefundable. Pancreatic Cancer: Current Treatment Approaches and Controversies (SE1) 4:15 p.m. 5:45 p.m. $35 Integration of Systemic Treatment with Radiation Therapy for Head and Neck Cancer (SE2) 11:00 a.m. 12:30 p.m. $35 Brachytherapy Fundamentals and Evolving Paradigms (SE3) 4:00 p.m. 5:30 p.m. $35 Tuesday, October 30 Low/High Grade Gliomas An Update (SE4) 1:15 p.m. 2:45 p.m. $35 Wednesday, October 31 d Treatment of Non-small Cell Lung Cancer: Using All the Tools (Imaging, Motion Correction and IMRT) Promises and Pitfalls- A Case Based Approach (SE5) 11:00 a.m. 12:30 p.m. $35 FOREIGN LANGUAGE POSTER WALKS WITH A PROFESSOR Foreign Language Poster Walk will be oered in Chinese and Spanish and will review selected abstracts based on disease site. Only 10 spots per walk. Foreign Language Poster Walk - Chinese (WI01) with Ken Zheng, MD, University of Nebraska Medical Center 11:00 a.m. - 12:00 p.m. Member/Nonmember FREE Foreign Language Poster Walk - Spanish (WI02) with TBD 11:00 a.m. - 12:00 p.m. Member/Nonmember FREE

4 2012 ATTENDEE REGISTRATION FORM Page 1 of 3. (All pages required) STEP 1. OCCUPATION (PLEASE SELECT ONLY ONE.) Administrator (42) Biologist (43) Clinical Oncologist (44) Diagnostic Radiologist (45) Medical Dosimetrist (47) STEP 2. PROFESSIONAL SUFFIX Medical Oncologist (48) Medical Physicist (49) Nuclear Medical Physician (50) Nurse (51) Nurse Practitioner (52) Physician Assistant (55) Radiation Oncologist (56) Radiation Therapist/Technologist (57) Resident/Fellow (253) Surgical Oncologist (60) Urologist (61) Veterinarian (62) (54) BS BSN ChB CMD DO DSc DVM MB MBA MD MS MSN OCN PhD RN RT N/A STEP 3. PRIMARY EMPLOYER (PLEASE SELECT ONLY ONE.) Academic/University System Community Based System Government/Public Sector Independent Contractor/Locum Tenens Industry Private Practice STEP 4. PRIMARY PRACTICE LOCATION (PLEASE SELECT ONLY ONE.) Freestanding/Satellite Clinic Hospital STEP 5. PROFESSIONAL ACTIVITY (PLEASE SELECT ONLY TWO.) Basic Science Research Clinical Patient Care Clinical Trials Outcomes and Health Services Research STEP 6. SPECIAL ACCOMMODATIONS ASTRO is committed to making the Annual Meeting accessible to all individuals. If you have a disability as identified in the Americans with Disabilities Act, please let us know. You will be contacted by ASTRO. Check here if you require auxiliary aids or services. STEP 7. REGISTRANT INFORMATION (ALL FIELDS REQUIRED) ASTRO MEMBER NUMBER (REQUIRED TO RECEIVE MEMBER RATE) FIRST NAME M.I. LAST NAME SUFFIX (JR., III, IV) TITLE PHONE MOBILE PHONE FAX PRIMARY SECONDARY COMPANY OR INSTITUTION STREET CITY STATE ZIP/POSTAL CODE COUNTRY

5 2012 ATTENDEE REGISTRATION FORM Page 2 of 3. (All pages required) STEP 8. ELECTRONIC BUSINESS CARD You will be issued an electronic business card with your business contact information. This card can be used in the Exhibit Hall to request information on products/services oered by exhibitors. If you would like your contact information to include your address, please check here. STEP 9. EMERGENCY CONTACT INFORMATION (REQUIRED) EMERGENCY CONTACT S FULL NAME EMERGENCY CONTACT S RELATION EMERGENCY CONTACT S PHONE NUMBER EMERGENCY CONTACT S MOBILE NUMBER EMERGENCY CONTACT S PLEASE REFER TO THE REGISTRATION CATEGORIES AND FEES FOR MORE DETAIL. STEP 10. SELECT REGISTRATION TYPE (REQUIRED. PLEASE CHOOSE ONE.) Full Conference (FULL): Includes admission to ASTRO sessions, the Exhibit Hall, Poster Viewing Session and Reception and Lunch Voucher. Full conference attendees also receive the Virtual Meeting at no additional cost. One-day: Includes one-day admission to ASTRO sessions, Exhibit Hall and Lunch Voucher. If you would like to attend more than one day of the meeting (exception of Saturday events), you must register at the full conference rate. This registration does not include the Virtual Meeting. Choose a day: Saturday (SAT) Sunday (SUN) Monday (MON) Tuesday (TUE) Wednesday (WED) ASRT/SROA Full Conference (FULL): Receives all the same registration benefits as a full conference attendee. ASRT/SROA Confirmation No.: (REQUIRED) IMPORTANT NOTICE FOR RADIATION THERAPISTS/TECHNOLOGISTS Please note that due to attendance verification guidelines set forth by the American Society for Radiologic Technologists (ASRT), we are currently unable to oer A continuing education credits for the 2012 Annual Meeting. If you have any questions, please contact Lisa Cheak at lisac@astro.org or STEP 11. SPOUSE/FAMILY REGISTRATION (OPTIONAL) Spouse/Family Registration (SG01): Includes admission to the ASTRO Exhibit Hall, Poster Viewing Session and Reception, and Lunch Voucher. Does not include access to ASTRO sessions and spouse/family are not eligible for continuing medical educational credits. Only full conference attendees are eligible to register one spouse/family member. Spouse/Family Name: Spouse/Family STEP 12. TICKETED EVENTS 2013 Radiation Oncology Coding and Reimbursement Update and a Discussion on the Challenges Aecting the Specialty in the Current Reimbursement Environment (TE8) AAWR/ASTRO Luncheon (TE4) Foreign Language Poster Walk-Chinese (WI01) Foreign Language Poster Walk-Spanish (WI02) NCI-ASTRO Diversity Symposium and Reception (TE9) Nurses Reception (TE10) Open to Nurse/Nurse Practitioner registrants only. Nurses Welcome Orientation Luncheon (TE2) Open to Nurse/Nurse Practitioner registrants only. Young Physicians Session (TE7) The educational focus is targeted towards young physicians with 10 years or less practice experience however, registration is open to all attendees. Total Ticketed Events Amount:

6 2012 ATTENDEE REGISTRATION FORM Page 3 of 3. (All pages required) STEP 13. MEMBER-IN-TRAINING TICKETED EVENTS ARRO Career Seminar (JM1) ARRO Annual Luncheon (JM2) How to Review a Scientific Paper Workshop (JM3) Poster Walk With a Professor Please indicate ONE poster discussion that you would like to attend. Meet the Professor Luncheon Please indicate ONE professor. Total Member-in-Training Ticketed Events Amount: $ STEP 17. PAYMENT INFORMATION Check payable to ASTRO (U.S. dollars drawn on U.S. bank) Credit Card: American Express Discover MasterCard Visa Full payment must be submitted with this form. Forms without payment will not be accepted. I agree to the terms and conditions of the cancellation policy and authorize ASTRO to charge my credit card for registration and ticketed event fees to attend the 2012 ASTRO Annual Meeting. ASTRO reserves the right to charge the correct amount if dierent from the total listed above. The following information is required in order to process your registration. STEP 14. econtouring LEARNING LAB Please select the sessions you are planning to attend (Required) CREDIT CARD NUMBER EXPIRATION DATE Saturday, October 27 Esophageal Cancer (EL1) 8:00 a.m. 9:30 a.m. Lymphoma (EL6) 10:30 a.m. 12:00 p.m. Lung Cancer (EL5) 1:00 p.m. 2:30 p.m. Head and Neck Cancer (EL2) 3:30 p.m. 5:00 p.m. Head and Neck Cancer (EL8) 8:00 a.m. 9:30 a.m. Gynecologic Cancer (EL7) 10:30 a.m. 12:00 p.m. Gastrointestinal Cancer (EL4) 1:00 p.m. 2:30 p.m. Prostate Cancer (EL3) 3:30 p.m. 5:00 p.m. CARDHOLDER S NAME (as it appears on card) SIGNATURE BILLING ADDRESS STREET Calculate your total amount for the econtouring Learning Lab: # of sessions selected X $ session amount. Total econtouring Learning Lab Amount: STEP 15. LIVE SAMS CITY STATE COUNTRY ZIP CODE Pancreatic Cancer: Current Treatment Approaches and Controversies (SE1) Integration of Systemic Treatment with Radiation Therapy for Head and Neck Cancer (SE2) Brachytherapy Fundamentals and Evolving Paradigms (SE3) Low/High Grade Gliomas An Update (SE4) d Treatment of Non-small Cell Lung Cancer: Using All the Tools (Imaging, Motion Correction, and IMRT) Promises and Pitfalls- A Case Based Approach (SE5) Total Live SAM Amount: $ STEP 16. CALCULATE PAYMENT STEP 18. SUBMIT ALL THREE PAGES OF THIS FORM TO: Please review the cancellation policy before submitting this form. MAIL: ASTRO P.O. Box Boston, MA FAX: QUESTIONS? Phone: or astroregistration@jspargo.com Registration Amount: Ticketed Event Amount : Member-in-Training Event Amount : econtouring Learning Lab Amount: Live SAM Amount: Mail/Fax Processing Fee: Please note that all mailed and faxed registration forms will be charged a $10 processing fee. To avoid being charged this processing fee, you may register online at TOTAL AMOUNT DUE: $ 10 CANCELLATION POLICY Refunds will be given only if written notification is received on or before September 21, No refunds will be given for cancellations received after September 21, All refunds are subject to a $100 processing fee. All registration refunds will be processed 60 days after the conclusion of the meeting. Telephone cancellations will NOT be accepted. econtouring Learning Lab and Live SAM session changes can be made until September 21, 2012., 2012, session changes may NOT be made. Due to high popularity of the econtouring Learning Lab and Live SAM sessions, these registration fees are nonrefundable. Cancellation of registration INCLUDES canceling access to the Virtual Meeting. Registration fees are not transferable to another attendee or meeting.