2018 CNS ANNUAL MEETING Advance Registration and Housing Form OCTOBER 6 10, 2018 HOUSTON, TEXAS

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1 1 Advance Registration and Housing For Advance Registration Deadline: Septeber 6, 2018 All eeting confirations will be sent via e-ail. REGISTRANT INFORMATION (Please type or print legibly using one for per person.) FIRST/GIVEN NAME LAST NAME CREDENTIALS BADGE NAME (as you would like it to appear on your badge) INSTITUTION/HOSPITAL/OFFICE/COMPANY NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER MAILING ADDRESS CITY STATE/PROVINCE TELEPHONE (If international please include country code) FAX COUNTRY ZIP/POSTAL CODE Exhibitor E-ail/Phone Opt-out: Check here if you do not want your phone nuber encoded. Check here if you do not want your e-ail address encoded. Aericans with Disabilities Act: Check here if you require special accoodations or services in order to attend. You will be contacted by a CNS representative. Special Dietary Restrictions: Vegetarian Kosher Other (Please Specify) None DEMOGRAPHIC INFORMATION Please help us collect accurate attendee deographics by answering the following questions. This inforation is required in order to process your registration. Please indicate your practice setting: (check one only) Private Full-tie Acadeic Private (Acadeic Affiliate or Appointent) Other Please indicate your subspecialty: (check all that apply) Cerebrovascular Peripheral Nerves Endovascular Skull Base Lesions Epilepsy Spine Moveent Disorders Traua Pain Tuor Pediatric Other REGISTRATION CNS MEMBER MEDICAL REGISTRANT Active (Doestic) International Associate Active Duty Military Ared Forces (Guard/Reserve/Retiree) Transitional Resident (Doestic) International Vista Resident Fellow (Doestic & Int l.) Senior Medical Student Affiliate Please indicate your professional level: (check one only) Director/Departent Head Other Senior Manageent Staff Resident Nurse/Nurse Practitioner/PA Other Gender: (optional) Feale Male Age: (optional) Under Neurosurgeon Physician (MD, DO, etc.) Non-Physician (Clinical Researcher/Scientist)* Neurosurgeon (Faculty) Resident** Fellow*** Medical Student PA/Physician Extender Nurse Nurse Practitioner Corporate Representative ANSPA Meber NON-MEMBER MEDICAL REGISTRANT Non-Meber categories ore open to doestic and international registrants. * Non-eber/Non-physician category is liited to scientists, engineers, etc. involved in neurological research, and/or product developent not affiliated with an exhibiting copany. **All non-eber Residents ust have their Progra Director sign registration for. If registering online, a letter fro your Progra Director certifying that you are a Resident in a neurosurgical training progra ust be faxed to , or e-ailed to cns@cievents.co within one week of copleting registration. ***All non-eber Fellows ust provide a letter fro their Chief of Service verifying Fellow status within one week of copleting registration, it ay be faxed to , or e-ailed to cns@cievents.co. Corporate representatives attend for education only. They ust not conduct sales activities in the eeting space, nor influence content in any way. Solicitation of edical attendees is strictly prohibited. lncludes one year of CNS Affiliate ebership in 2019 (for ANSPA ebers only). PROGRAM DIRECTOR (PRINT OR TYPE NAME) PROGRAM DIRECTOR SIGNATURE YES! I a interested in volunteering for the CNS Sergeant-at-Ars Coittee. (Valid for residents and fellows only.) NON-MEDICAL REGISTRATION Spouse/Guest/Child 13 & Over Spouse/Guest/Child 13 & Over (Resident/Fellow) Child (12 & Under) SPOUSE/GUEST FULL NAME SPOUSE/GUEST FULL NAME SUBTOTAL REGISTRATION

2 2 Advance Registration and Housing For HOTEL ROOM RATES Single/Double Roo Rate Only Roo Rate with local/state tax and fees* Marriott Marquis Houston Headquarters Hotel (connected to GRB Convention Center) Ebassy Suites by Hilton Houston Downtown Four Seasons Hotel Houston ** Hapton Inn Houston Downtown Hilton Aericas Houston (connected to GRB Convention Center) Hoewood Suites by Hilton Houston Downtown Westin Houston Downtown *Tax rates subject to change. **An additional State Cost-Recovery Fee of 2.25 will be charged per roo per night. The fee will not be included in the one night roo and tax deposit. HOTEL RESERVATIONS Special Requests SEPTEMBER/OCTOBER 2018 S M T W T F ARRIVAL DATE S Two (2) Beds Crib (additional fee ay apply) Rollaway bed (additional fee ay apply) Please note, CNS cannot guarantee bed type or special requests as this is subject to availability upon arrival at the hotel. If your preferred hotel choice is not available, you will be contacted and confired into the next available hotel. DEPARTURE DATE Please check this box if you are interested in reserving a suite. (A CNS housing center representative will contact you regarding suite availability and rates. In the eantie, a standard roo will be assigned.) HOTEL CHANGE/CANCELLATION POLICY Please Note: Each hotel has its own cancellation policy and soe ay charge an early departure fee. The individual hotel s policies will be listed in your e-ail confiration. Any cancellations not ade within the hotel s cancellation policy will result in forfeiture of your one night s roo and tax deposit. The deadline date for new reservations based on availability is Septeber 25, The hotel requires a deposit of one night s roo and tax to reserve your roo. Please continue to ake any requests/changes by e-ailing cns@cievents.co or calling through Septeber 25, Beginning Septeber 26, 2018, changes and cancellations ust be ade with your assigned hotel. SUBTOTAL HOTEL DEPOSIT If not registering for optional courses, skip to page 5 for payent.

3 3 Advance Registration and Housing For CNS Annual Meeting registration is required in order to purchase optional course tickets Register early to receive your preferred choice All eeting confirations will be sent via e-ail COURSE DIRECTORS/FACULTY/MODERATORS: No one-day speaker badges will be issued. Full eeting registration fees apply fro page 1. However, there will be no fee assessed for the course(s) in which you are participating. Please check the faculty box next to your course selection below. Please check one: 1 REGISTRANT INFORMATION (Please type or print neatly in black ink.) FIRST NAME Physician Nurse/NP/PA Resident/Med Student LAST NAME 2 SYMPOSIA Saturday, October 6, 2018 Sunday, October 7, 2018 FEE: 300 Physician 200 Nurse/NP/PA 100 Resident/Med Student SYM1 Neurovascular Update: Evidence-based Guidelines in Ischeic and Heorrhagic Stroke for the Practicing Neurosurgeon FACULTY FEE: 300 Physician 200 Nurse/NP/PA 100 Resident/Med Student SYM2 Surgical Robotics: Engineering to Bedside FACULTY SUBTOTAL SYMPOSIA 3 PRACTICAL COURSES Saturday, October 6, 2018 Sunday, October 7, 2018 FEE: 650 Physician 425 Nurse/NP/PA 175 Resident/Med Student PC01 Severe TBI update: Trends and Tools* FACULTY MORNING 8:00 AM 11:30 AM FEE: 450 Physician 300 Nurse/NP/PA 125 Resident/Med Student Association of Neurosurgical Physician Assistants (ANSPA) Fall 2018 CME Meeting Presented in Collaboration with Congress of Neurological Surgeons (CNS) FACULTY MORNING 8:00 AM 11:30 AM PC02 Minially Invasive Spine Surgery Case-based Coplications and Future Directions PC03 Cervical Spine Case Manageent: Techniques and Technology Update PC04 Bypass Techniques in Cerebrovascular Neurosurgery PC05 Endoscopic Craniosynostosis Repair: Hands on Course PC06 Update on Moveent Disorders: Case Based Review of Approaches and Controversies PC07 Modern Applications of Radiosurgery PC08 WINS Practical Course on Leadership and Education PC09 3D Surgical Neuroanatoy (Supratentorial) FACULTY FEE: Coplientary PC16 AFTERNOON 12:30 PM 4:00 PM FEE: 450 Physician 300 Nurse/NP/PA 125 Resident/Med Student PC10 PC11 PC12 PC13 PC14 Innovation, Quality and Safety A Balance Along the Continuu of Care for Neurosurgical Patients Spinal Traua and Spinal Cord Injury: Case-based Presentations and Future Directions* My Worst Spinal Coplication: What I Learned Peripheral Nerve Surgery: Techniques and Exposure 3D Surgical Neuroanatoy (Infratentorial) Neurosurgeon-hospital Relationships: Options, Negotiations, and Achieving What You Are Worth FACULTY FEE: 450 Physician 300 Nurse/NP/PA 125 Resident/Med Student PC17 PC18 PC19 PC20 PC21 PC22 PC23 New Era in Stenting CPT Update Spinal Bioechanics in Modern Clinical Practice Thoracolubar Spinal Defority for the Non-Defority Spine Surgeon Neurosurgical Treatent of Chronic Headache Review of Functional Neurosurgery for the Non-Specialist* Surgical Manageent of Eloquent Area Tuors: Functional Mapping and/or Navigation Brain Tuor Update Part 1: Malignant Brain Tuors PC24 PC25 Concussion: Advances in Mild Traua Brain Injury Science FACULTY AFTERNOON 12:30 PM 4:00 PM FEE: 450 Physician 300 Nurse/NP/PA 125 Resident/Med Student PC26 Big Data Core Principles of Data Science for Neurosurgeons PC27 Brain Tuor Update Part 2: Benign Brain Tuors FACULTY PC SUBTOTAL PRACTICAL COURSES See page 5 for coplete payent inforation

4 4 Advance Registration and Housing For 4 LUNCHEON SEMINARS Cost per Luncheon Seinar: 95. Discounted pricing of 75 offered for residents/fellows/edical students/advance practice providers. Ticket price will be applied based on your ebership/registration status. MONDAY, OCTOBER 8, : 1:45 PM TUESDAY, OCTOBER 9, : 1:45 PM WEDNESDAY, OCTOBER 10, : 1:45 PM M01 M02 M03 M04 M05 M06 M07 M08 M09 M10 M11 FACULTY Honored Guest Lunch: The Business of Medicine in the 21st Century: Pearls and Pitfalls (Coplientary to CNS Resident & IVR ebers) Navigating MACRA/MIPS and Bundled Payents Is Intracerebral Heorrhage a Surgical Disease? Venous Stenting for Pseudotuor Controversies in Spinal Defority Surgery Cervical Spondylotic Myelopathy: Anterior Versus Posterior Approaches* Manageent of Chronic Subdural Heatoa Manageent of Brachial Plexus Injuries: fro Birth to Adult Key Clinical Trials in Epilepsy Surgery Update on Diagnosis and Manageent of Low Grade Glioas Acoustic Neuroas: Current Manageent Strategies* T12 Medical Malpractice Update 2018 T13 T14 T T16 T17 T18 T19 T20 T21 T22 FACULTY Dural AV Fistula: Diagnosis, Classification, and Manageent Update on the Manageent of Anticoagulation and Anti-platelet Therapies in Neurosurgical Patients Spinal Tuor Surgery: Case-based Manageent Peak Perforance: Optiizing the Spine Surgical Patient fro Pre-op to Post-op Cobat and Mass Casualties: Neurosurgery Under Fire SCS: Evidence and Applications Pediatric Dystonia: Advanceents with DBS and Manageent Updates Malignant Glioas: Advances in Surgery and Adjuvant Therapy* Manageent of Pituitary Adenoas and other Sellar Pathology Diversity in Learning: New Initiatives in Mentorship W23 W24 W25 Spinal Arteriovenous Fistulae and Malforations: Manageent Strategies in 2018 Conteporary and Practical Manageent of an Enigatic Process: Cerebral Vasospas (Delayed Cerebral Ischeia) Novel Techniques for Manageent of Lubar Spondylolisthesis W26 Peripheral Nerve Entrapent Syndroes: Diagnosis and Manageent* W27 Sports-related Injuries W28 Pediatric Head Traua W29 Cutting-edge Manageent of Brain Metastasis W30 W31 FACULTY Advanced Iaging of Brain Tuors Enhancing Counication Skills to Lead Your Practice *SANS Suppleental Exa is available for purchase with the course for an additional. SANS Suppleental Exas ay also be purchased separately without having to attend the live course (see page 5). SUBTOTAL LUNCHEON SEMINARS 5 DINNER SEMINARS Cost per Dinner Seinar: 190 SATURDAY, OCTOBER 6, :30 8:30 PM MONDAY, OCTOBER 8, :30 9:30 PM TUESDAY, OCTOBER 9, :30 9:30 PM DIN1 The Botto Line in a Changing World Updates about CPT, ICD-10, MIPS and Bundling FACULTY DIN2 DIN3 Advances and Controversies in Intracranial AVM Manageent Robotics and Spinal Surgery: The Future is Now DIN4 FACULTY Eerging Indications for Functional Neurosurgery: Tourette, OCD, Depression and Pain FACULTY SUBTOTAL DINNERS SEMINARS

5 5 Advance Registration and Housing For Continue your education after the Annual Meeting and earn one hour of additional CME credit with SANS Suppleental Exas! The suppleental exas for each of the following courses are available for only each. Any Annual Meeting attendee can purchase these exas, regardless of attendance at the live courses. 6 SANS SUPPLEMENTAL EXAMS PC01 SANS Severe TBI update: Trends and Tools PC11 SANS Spinal Traua and Spinal Cord Injury: Case-based Presentations and Future Directions PC22 SANS Review of Functional Neurosurgery for the Non-Specialist M06 SANS Cervical Spondylotic Myelopathy: Anterior Versus Posterior Approaches M11 SANS Acoustic Neuroas: Current Manageent Strategies T20 SANS Malignant Glioas: Advances in Surgery and Adjuvant Therapy W26 SANS Peripheral Nerve Entrapent Syndroes: Diagnosis and Manageent SUBTOTAL SANS EXAMS 7 PAYMENT Subtotal Registration Subtotal Hotel Deposit Subtotal Syposia Subtotal Practical Courses Subtotal Luncheon Seinars Subtotal Dinner Seinars Subtotal SANS Exas TOTAL Check: Full payent ust accopany your registration for. Make check (US Dollars drawn on a US Bank) payable to: CNS Annual Meeting Registration and Housing Center, 6100 W. Plano Pkwy, Suite 3500, Plano, TX (Any checks received fro an overseas bank will be returned. Any checks returned for insufficient funds are subject to additional charges.) Credit Card Authorization: Credit card will be charged iediately for registration fees. (US dollars drawn on a US bank) Visa Aerican Express CREDIT CARD NUMBER MasterCard EXPIRATION DATE (MONTH/YEAR) NAME OF CARDHOLDER (PRINT) BILLING ADDRESS (IF DIFFERENT THAN REGISTRANT) SIGNATURE By signing this for: I authorize the CNS Registration and Housing Center to charge y credit card for the total payent due, acknowledge that the CNS registration cancellation policies are in effect, and grant the CNS the right to use photos taken at the CNS Annual Meeting which include e in prootional aterials for future eetings. These fees are subject to audit and in case of error, the CNS Registration and Housing Center reserves the right to correct the error and charge the appropriate fees. Registration Cancellation Policy: Full registration refunds, less a 100 processing fee, will be granted if written requests for cancellation are received by 5:00 p CT on Septeber 13, Course, seinar, and event tickets will be refunded in full until Septeber 13, No refunds of any kind will be given after this date, regardless of cause. Refunds will not be given for no-shows. Any changes to existing badges after the published cut-off date of Septeber 13, 2018, are assessed a 50 processing fee. Written requests ay be eailed to cns@cievents.co, faxed to , or ailed to the CNS Annual Meeting Registration and Housing Center, 6100 W. Plano Pkwy, Suite 3500, Plano, TX RETURN TO CNS REGISTRATION AND HOUSING CENTER You ay also register online at Fax: (credit card only) Mail: CNS Annual Meeting CNS Registration and Housing Center 6100 W. Plano Pkwy, Suite 3500 Plano, TX 75093