ADVANCED CRITICAL CARE & EMERGENCY NURSING

ADVANCED CRITICAL CARE & EMERGENCY NURSING LAS VEGAS, NV NOVEMBER 1-4, 2017 REGISTER EARLY & SAVE $80 EARN UP TO 24.75 CE HOURS REGISTER ONLINE AT CONTEMPORARYFORUMS.COM OR CALL 800-377-7707

CONTEMPORARYFORUMS.COM ADVANCED CRITICAL CARE & EMERGENCY NURSING LAS VEGAS, NV NOVEMBER 1-4, 2107 #ACCEN17 YOU ARE INVITED! Education Interaction Relaxation! We invite you to join us at the 2017 Advanced Critical Care & Emergency Nursing Conference in Las Vegas to experience all three. ICU and ED nurses are a unique group of high energy, confident, quick-thinking individuals with an ever-present need for more knowledge in order to provide the best possible care and outcomes for their patients. We look forward to helping you achieve this goal through presentations provided by nationally-known experts, interaction with your colleagues and the faculty, shared problem-solving and in-depth case study discussions. HIGHLIGHTS AND BENEFITS A full-day Preconference dedicated to 12 Lead ECG Interpretation: Journey from Basic to Complex, where your understanding and interpretation of 12 Lead ECGs will improve through tips, tools and case studies provided by the faculty. Main Conference General Sessions, in which speakers will address issues and challenges relevant to both ICU and ED staff. Concurrent Sessions allowing attendees to participate in 5 classes from a choice of 20, offering specialty-specific options as well as broad-based sessions that apply to caring for all critically ill patients. Conference speakers who will empower you to think critically and act appropriately and safely when confronted with urgent and emergent clinical situations. Opportunities for networking and lively conversations with friends and colleagues. Conference Co-Chairs Helen F. Brown, MS, BC-ACNP, BC-FNP Kathryn T. Von Rueden, MS, RN, ACNS-BC, FCCM Contemporary Forums Jeannine Strunk, BSN, RN Senior Program Manager CONFERENCE OBJECTIVES THIS PROGRAM WILL ENABLE EXPERIENCED ICU AND ED CLINICIANS TO: Better assess critically ill and injured patients, provide timely, appropriate evidence-based care, and evaluate patient response through collaboration with the ICU and/or ED team. Explore pharmacologic challenges surrounding anesthesia, Cytochrome P450, antimicrobial use and abuse, street drugs, overdoses, anticoagulation and ED medications. Utilize information from new STEMI and Sepsis Guidelines when assessing ICU and ED patients. Describe the utilization of diagnostic and monitoring tools including 12-lead ECG, PA catheters and imaging. Examine the pathophysiology associated with toxidromes, acute CHF, cardiomyopathy, pulmonary arterial hypertension, AKI, brain death and endocrine emergencies. WHO SHOULD ATTEND? Experienced clinicians involved in the care of critically ill and injured adults. IF YOU ARE A Staff Nurse Clinical Nurse Specialist Nurse Practitioner Nurse Manager Physician Assistant Educator/Instructor Clinical Coordinator Transport Nurse Case Manager THEN THIS IS A MUST ATTEND CONFERENCE FOR YOU! WORKING IN ANY ADULT... Intensive Care Unit Trauma Unit Emergency Department Step-Down Unit OPTION #1 OPTION #2 ATTEND THE LIVE CONFERENCE! Register by September 20, 2017 to receive the Early Registration discount. See Conference Information for tuition pricing and additional registration information. ACCESS THE RECORDED CONFERENCE CONTENT ONLINE! Register by October 31 to receive the $330 pre-order discount price! See additional Recorded Conference information at the bottom of the Preconference Schedule page.

ACCREDITATION In support of improving patient care, Contemporary Forums is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. PRECONFERENCE MAIN CONFERENCE 1 NURSES AND NURSE PRACTITIONERS ANCC CERTIFIED NPs AND CNSs 2 PHARMACOLOGY CREDIT FOR PRESCRIPTIVE AUTHORITY PHYSICIAN ASSISTANTS 7 ANCC/8.4 CA BRN contact hours 17.75 ANCC/21.3 CA BRN contact hours This course provides a maximum of 8.25 pharmacotherapeutic hours toward the required 25 hours needed for ANCC recertification. No Credit 8.25 hours available This program is not yet approved for CME credit. Conference organizers plan to request 24.75 hours of AAPA Category I CME credit from the Physician Assistant Review Panel. Total number of approved credits yet to be determined. Application has been made for continuing education credit CASE MANAGERS from the Commission for Case Manager Certification. 1 Contemporary Forums is approved by the California Board of Registered Nursing, 2 Rx indicates pharmacology content. Because states requirements vary, contact Provider #04516. (CA BRN contact hour = 50 minutes) your Board of Nursing for more information. Joint accreditation is the leading model of interprofessional collaboration that helps improve healthcare through continuing education for the team by the team. Contemporary Forums is one of 42 continuing education organizations to receive Joint Accreditation. CONFERENCE FACULTY Helen F. Brown, MS, BC-ACNP, BC-FNP Conference Co-Chair Nurse Practitioner, Emergency Department Doctors Emergency Services Anne Arundel Medical Center Annapolis, Maryland Adjunct Faculty, Adult Gerontology Acute Care Nurse Practitioner Program Georgetown University School of Nursing and Health Studies Washington, DC Zlatan Coralic, PharmD, BCPS Emergency Medicine Clinical Pharmacist Associate Clinical Professor Departments of Pharmacy and Emergency Medicine University of California San Francisco San Francisco, California Detective Brian Grammas Major Violators/Narcotics Bureau Las Vegas Metropolitan Police Department Las Vegas, Nevada William D. Hampton, DO, FACOEP Emergency Physician and Assistant Medical Director Holy Family Memorial Hospital Manitowoc, Wisconsin Assistant Clinical Professor of Emergency Medicine Downers Grove, Illinois Jan M. Headley, BS, RN Principal Consultants in Acute and Critical Care Yankee Hill, California Christine A. Kessler, MN, CNS, ANP, BC-ADM, CDTC, FAANP Founder, Nurse Practitioner Metabolic Medicine Associates King George, Virginia Deborah Klein, MSN, RN, ACNS-BC, CCRN, CHFN, FAHA Clinical Nurse Specialist Coronary ICU, Heart Failure ICU, Cardiac Short Stay/ PACU/CARU Cleveland Clinic Cleveland, Ohio Ann Lystrup, BSN, RN, CFRN, CEN, CCRN, CSPI Manager, Integrated Case Management Veridicus Health/Magellan Rx Management Salt Lake City, Utah Karen Marzlin, DNP, CCNS, ACNP-AG, CCRN-CMC, CHFN APRN Medical Cardiology/Heart Failure Aultman Hospital/Cardiovascular Consultants Partner, Key Choice and Cardiovascular Nursing Education Associates Canton, Ohio Karen A. McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN Lead Clinical Nurse Specialist R Adams Cowley Shock Trauma Center University of Maryland Medical Center Baltimore, Maryland Nancy Munro, MN, RN, CCRN, ACNP-BC, FAANP Senior Acute Care Nurse Practitioner Critical Care Medicine Department National Institutes of Health Bethesda, Maryland Detective Joe Pannullo Training Coordinator Major Violators/Narcotics Bureau Las Vegas Metropolitan Police Department Las Vegas, Nevada Lynelle N. B. Pierce, MS, RN, CCRN, CCNS Clinical Nurse Specialist, Critical Care The University of Kansas Health System Kansas City, Kansas Daria C. Ruffolo, DNP, RN, CCRN, ACNP-BC Acute Care Nurse Practitioner Department of Anesthesia Loyola University Medical Center Maywood, Illinois Maureen A. Seckel, MSN, APRN, ACNS-BC, CCNS, CCRN, FCCM Clinical Nurse Specialist Medical Pulmonary Critical Care & Sepsis Leader Christiana Care Health System Newark, Delaware Jeff Solheim, MSN, RN, CEN, TCRN, CFRN, FAEN Founder/Emeritus Executive Director of Project Helping Hands President of Solheim Enterprises West Linn, Oregon Jeannine Strunk, BSN, RN Senior Program Manager Contemporary Forums Kathryn T. Von Rueden, MS, RN, ACNS-BC, FCCM Conference Co-Chair Critical Care Consultant Baltimore, Maryland Cynthia L. Webner, DNP, ACNPC-AG, CCNS, CCRN-CMC, CHFN APRN Medical Cardiology/Heart Failure Aultman Hospital/Cardiovascular Consultants Partner, Key Choice Consulting and Cardiovascular Nursing Education Associates Canton, Ohio HOTEL ACCOMMODATIONS At the newly renovated Tropicana, you ll find luxury rooms offering comfort, style and sophistication, with open floor plans, premium amenities, plush new mattresses, and modern technology such as 42 LCD TVs and ihome clock radios with universal docking stations. An enticing casino awaits, offering all the best Las Vegas games, including your favorite slots and table games, a state-of-the-art race and sports book, and an award-winning rewards program. HOTEL SPECIAL GROUP RATES/DATES ROOM BLOCK DATES RESERVATIONS TROPICANA LAS VEGAS, A DOUBLETREE BY HILTON 3801 Las Vegas Blvd. South Las Vegas, NV 89109 (702) 739-2222 Single/Double * $139 Book by October 9, 2017 to take advantage of Group Rates. October 30 - November 4 (888) 381-8767 * Room reservations are subject to a daily resort fee of $10. Resort fee includes daily in-room high speed internet access on one device, fitness center access, and 2 bottles of water upon check-in.. EXHIBITS We are inviting a group of companies and organizations with professionally relevant products, services or career opportunities to exhibit at this conference. The schedule provides time for you to address your particular areas of interest at each exhibit. FOR EXHIBIT SPACE AVAILABILITY OR ADDITIONAL INFORMATION: PHONE EMAIL VISIT (925) 361-4807 exhibits@cforums.com ContemporaryForums.com/exhibitors

PRECONFERENCE SCHEDULE PRECONFERENCE The 12 Lead ECG Interpretation: Journey from Basic to Complex Karen Marzlin, DNP, CCNS, ACNP-AG, CCRN-CMC, CHFN Cynthia L. Webner, DNP, ACNPC-AG, CCNS, CCRN-CMC, CHFN The 12 lead ECG is a commonly-used procedure for diagnosing a wide variety of cardiac conditions including acute coronary syndrome (ACS), wide complex tachycardia, conduction disturbances, hypertrophy, and high risk features for sudden cardiac death. Timely and accurate ECG interpretation can lead to rapid intervention and improved patient outcomes. Although the ECG is a commonly performed diagnostic test, many clinicians lack confidence in their interpretation skills. In this rapidly changing, complex healthcare system, more and more non-physicians are finding themselves in a situation with a fresh ECG in hand and a decision to be made. Be it the nurse at the point of care, a member of a Rapid Response Team, or a non-physician provider, accurate ECG interpretation requires a skilled eye to look beyond the computer-generated interpretation, recognizing important findings that will lead to appropriate action benefiting the patient. Join us as we take you on a journey from the basic to the complex in 12 lead ECG interpretation. The day will nurture the novice and challenge the experienced ECG readers. Your confidence will grow throughout the day as we provide many tips, tools and case studies to help you improve your understanding and skill in 12 lead ECG interpretation. THIS PRECONFERENCE WILL ENABLE YOU TO: Accurately identify criteria for normal and abnormal patterns on the ECG. Identify subtle and early signs of injury and ischemia. Investigate ECG changes associated with myocardial mimics including normal variants, chamber enlargement, electrolytes, and other disease entities. Examine ECG signs and QRS morphology that allow for the accurate interpretation of wide complex tachyarrhythmias. WEDNESDAY, NOVEMBER 1, 2017 7:00 A.M. Preconference Registration/Continental Breakfast 8:00 Identifying Normal on the ECG: Contiguous Leads, Normal Morphology, Axis, Bundle Branch Blocks 10:00 Refreshment Break 10:15 Injury and Ischemia 11:45 Questions & Discussion 12:15 P.M. Lunch on Your Own 1:45 Atrial and Ventricular Hypertrophies, Myocardial Mimics, Electrolyte and Drug Effects on the ECG 3:15 Refreshment Break 3:30 Wide Complex Tachycardias: Differentiating Ectopy from Aberrance 4:30 Final Case Studies, Questions and Answers 5:00 Adjourn EARN CE CREDIT ONLINE AT YOUR CONVENIENCE RECORDED CONFERENCE You will receive access to all recorded Preconference and Main Conference sessions for 3 years and earn over 40 hours of ANCC credit. Place your order today by registering for this meeting online at ContemporaryForums.com and selecting the Online Learning option, or mail/fax the Registration Form. Register by October 31 to receive the pre-order discount. Access instructions to log into your account at ContemporaryForumsOnline.com will be emailed approximately 2-3 weeks after the end of the conference. Contemporary Forums always means you re going to a great conference with the latest topics and top quality speakers. Trez Marie Zotkewicz, RNC, MN New Orleans, LA

MAIN CONFERENCE SCHEDULE THURSDAY, NOVEMBER 2, 2017 7:00 A.M. Main Conference Registration/Displays/Continental Breakfast 8:00 Courageous Care McQuillan 9:00 STEMI Guidelines: The Most Current Evidence for Impacting Outcomes (Rx =.25 hr.) Marzlin 10:00 Refreshment Break/Displays 10:30 Drug Trends: From Pharmaceuticals to Street Drugs Grammas Pannullo 11:30 Questions and Discussion (Rx =.25 hr.) Faculty Panel 12:00 P.M. Lunch on Your Own 1:30 The Land of OZ(2): Strategies for Multisystem Assessment of Ventilation, Headley Circulation and Metabolism 2:30 Takotsubo Cardiomyopathy: Broken Heart Syndrome Webner 3:30 Refreshment Break/Displays 3:45 Body Art Gone Wrong: The Medical Implications of Body Modification Solheim 4:45 Questions and Discussion Faculty Panel 5:15 Adjourn During each Concurrent Session, 4 topics are presented simultaneously in separate rooms. Indicate your selections on the Registration Form. FRIDAY, NOVEMBER 3, 2017 7:00 A.M. Continental Breakfast/Displays 8:00 CONCURRENT SESSIONS #1 #11 Use of Advanced Radiology in Managing Emergent and Acutely Ill Brown Adults: CT, MRI, Ultrasound #12 Multi-System Effects of Traumatic Brain Injury McQuillan #13 Targeting Renal Recovery: Acute Kidney Injury Treatment and Pierce Optimized Renal Replacement Therapy (CRRT) (Rx =.25 hr.) #14 The Use and Abuse of Antimicrobials (Rx = 1.25 hrs.) Munro 9:15 Refreshment Break/Displays 9:45 CONCURRENT SESSIONS #2 #21 Fall Down Go Boom: Mechanisms of Trauma Solheim #22 Applied Individualized Hemodynamics: Continuum of Where, Why, for Headley Whom, and with What #23 Anesthesia and Your Patient: Not a Benign Event (Rx =.5 hr.) Ruffolo #24 Cytochrome P450: What Every Nurse Should Know (Rx = 1.25 hrs.) Lystrup 11:00 Session Change 11:15 CONCURRENT SESSIONS #3 #31 Breaking Down the Complex Management of Pulmonary Arterial Seckel Hypertension (Rx = 1 hr.) #32 Immunity Concepts (Rx =.5 hr.) Munro #33 APRV: What, Why and When? Pierce #34 Emergency Medicine Medications: Pearls and Pitfalls (Rx = 1.25 hrs.) Coralic 12:30 P.M. Lunch on Your Own 2:00 CONCURRENT SESSIONS #4 #41 Diagnosis and Management of Abdominal itises Brown #42 PA Catheters: Insertion and Trouble-Shooting Von Rueden #43 The Metabolic Mess of Obesity: What Critical Care Nurses SHOULD Kessler Know and Do (Rx =.25 hr.) #44 Toxidromes: Up? Down? Or In-Between? (Rx = 1.25 hrs.) Lystrup 3:15 Refreshment Break/Displays 3:30 CONCURRENT SESSIONS #5 #51 Best Ventilation Practices: From Intubation to Admission Hampton #52 Hypertensive Crisis (Rx =.5 hr.) Klein #53 Determining Brain Death: It s Not as Easy as You Think Ruffalo #54 Reversing Dangerous Bleeding: Must-Know New Medications (Rx = 1.25 hrs.) Coralic 4:45 Adjourn SATURDAY, NOVEMBER 4, 2017 7:00 A.M. Continental Breakfast 8:00 Life Threatening Non-Diabetic Endocrine Emergencies (Rx =.5 hr.) Kessler 9:00 Acute Heart Failure (Rx =.5 hr.) Klein 10:00 Refreshment Break 10:15 Know the Rules and Keep Score: Evidence-Based Decision Rules & Tools from Hampton Head to Toe 11:15 The New Sepsis Guidelines (Rx =.25 hr.) Seckel 12:15 P.M. Questions and Discussion (Rx =.25 hr.) Faculty Panel 12:45 Adjourn Rx = Pharmacology Credit for Prescriptive Authority.

ADVANCED CRITICAL CARE & EMERGENCY NURSING CONFERENCE INFORMATION Registrations must include full tuition payment to be accepted. Conference confirmation is sent via email. Take advantage of special conference pricing and discounted hotel room rates by registering early! TUITION LIVE CONFERENCE EARLY REGISTRATION* REGULAR REGISTRATION (On/before September 20) (After September 20) PRECONFERENCE $255 $285 MAIN CONFERENCE $525 $575 NEW GRADS^ $395 $395 RECORDED CONFERENCE PRECONFERENCE & MAIN CONFERENCE REGISTRATION (on/before October 31) $330 * Postmarked or phone/fax/online registration and fees received on/before September 20, 2017. ^ New Grads (graduated 2014 or after): To qualify, submit proof of graduation date with registration. Your tuition includes continental breakfasts, refreshment breaks, Certificate of Attendance and online access to posted presentation handouts before and after the conference. 4 EASY WAYS TO REGISTER ONLINE Visit us 24/7 at: ContemporaryForums.com PHONE (800) 377-7707 Monday Friday 8 am 5 pm, Pacific Time HAVE YOUR CREDIT CARD READY FAX (800) 329-9923 MAIL Contemporary Forums Attn: Registration Office 151 Innovation Drive Irvine, CA 92617 ATTENDANCE RULES Registrations may not be shared. Children of any age and spouses may not attend sessions. Audio recording, video recording and livestreaming of speakers, sessions and/or attendees is strictly prohibited. Medical information presented at this conference is intended for educational purposes only and should not be considered medical advice. GROUP DISCOUNTS Tuition discounts are given to groups of 3 or more registering for the complete conference. $25 per person discount for 3 or 4 in a group; $45 per person discount for 5 or more in a group. To qualify for the group discount, all registration information must be complete for all group members, payment included and forms sent together. If faxing, list all group members on cover sheet. Subtract the discount from the tuition fee. Groups may not be formed after individual registrations are received. CANCELLATION POLICY Cancellations must be made by phone or in writing. A $75 processing fee will apply. No refunds will be issued for cancellations received or postmarked on/after October 3, 2017. However, tuition paid, less the $75 processing fee, may be applied to a future Contemporary Forums conference of equal or greater value. No refunds for no shows. If this meeting is cancelled for any reason, including labor strikes or acts of God, liability is limited to a full refund of registration fees. ADA NEEDS & SPECIAL REQUESTS If you require special arrangements at this conference, call (800) 377-7707, at least 30 days prior to the conference. METHOD OF PAYMENT Make payment by check (payable to Contemporary Forums and enclose with Registration Form), Visa, MasterCard, Discover, American Express or Purchase Order. A $30 fee is charged for any returned check. Personal checks are NOT accepted at the conference. Purchase Orders must be received with registration by the conference date and include the P.O. number, invoice address, tuition, approval signature, contact name, email address and phone number. QUESTIONS? Contact Contemporary Forums at (800) 377-7707, M F, 8 am 5 pm (Pacfic Time) or email: info@cforums.com EMAIL UPDATES If you are not currently receiving information via email about our conferences or Contemporary Forums Online website, please go to ContemporaryForums.com to join our mailing list or to update your email address. You will then be notified of all conferences as soon as they are announced, as well as have access to all special promotions. All email addresses are for Contemporary Forums use only.

NEW! SPANISH MEDICAL TERMINOLOGY FOR HEALTH CARE PROFESSIONALS! Contemporary Forums has developed an interactive, self-paced online course to help teach the novice or native speaker Spanish medical terminology. You will earn a Certificate of Completion and Continuing Education credit when all modules are completed. Even if you are fluent in Spanish, you will learn the appropriate vocabulary for human anatomy and medical terminology. Visit ContemporaryForumsOnline.com for more information or call 925-361-4822. CONTEMPORARY FORUMS 151 INNOVATION DR. IRVINE, CA 92617 CONFERENCE LOCATION Viva Las Vegas! It s impossible to resist the excitement of the neon lights, the shrieks of delight from jackpot winners, and the glitz and glamour of the hotels on the strip. A Disneyland for adults? You bet and Las Vegas is so much more! Dine at restaurants inspired by the world s greatest collection of chefs Wolfgang Puck, Emeril Lagasse, Bobby Flay and Thomas Keller, just to name a few. Treat yourself to a world-class show, including a choice of seven Cirque du Soleil productions, the Blue Man Group or an everchanging variety of celebrity performers at Caesars Palace, Hard Rock Café and T-Moble Arena. Make sure to also consider the variety of well-known headliners from the worlds of music, comedy and magic performing during your stay. 2017 CONFERENCE CALENDAR (PARTIAL LISTING) The Park, which opened Spring 2016, is an eclectic blend of restaurants, bars and entertainment connecting New York New York, the Monte Carlo resort and the new T-Mobile Arena. The Park offers an array of common spaces for socializing, relaxing, exploring and sampling the surrounding tastes, sights and sounds. PSYCHIATRIC NURSING LAS VEGAS, NV MAY 17-20, 2017 PERINATAL DILEMMAS JACKSON HOLE, WY JUNE 25-28, 2017 PHARMACOLOGY FOR ADVANCED PRACTICE CLINICIANS SAN FRANCISCO, CA JULY 24-30, 2017 HOT TOPICS FOR PRIMARY CARE SAN DIEGO, CA JULY 26-29, 2017 PHARMACOLOGY FOR ADVANCED PRACTICE CLINICIANS NASHVILLE, TN SEPTEMBER 11-17, 2017 WOMEN S HEALTH AND OB/GYN CARE WASHINGTON, DC SEPTEMBER 20-23, 2017 NORTH AMERICAN CONGRESS OF CLINICAL TOXICOLOGY VANCOUVER, BC - CANADA OCTOBER 11-15, 2017 WOMEN S HEALTH UPDATE 2017 PRESENTED BY ESSENTIAL LOS ANGELES, CA OCTOBER 23-24, 2017 ACCESS HEALTH + CONTRACEPTIVE TECHNOLOGY PEDIATRIC CRITICAL CARE & EMERGENCY NURSING LAS VEGAS, NV OCTOBER 31-NOVEMBER 3, 2017 CONTRACEPTIVE TECHNOLOGY ATLANTA, GA NOVEMBER 1-3-2017 PHARMACOLOGY FOR ADVANCED PRACTICE CLINICIANS LAS VEGAS, NV NOVEMBER 6-12, 2017 THE FETUS & NEWBORN LAS VEGAS, NV NOVEMBER 8-11, 2017 PLEASE SHARE THIS WITH YOUR COLLEAGUES.

ADVANCED CRITICAL CARE & EMERGENCY NURSING REGISTRATION FORM FILL OUT, DETACH, AND RETURN THIS FORM WITH FULL PAYMENT TO: CONTEMPORARY FORUMS ATTN: REGISTRATION OFFICE 151 INNOVATION DRIVE IRVINE, CA 92617 REGISTER ONLINE 24/7 AT: CONTEMPORARY FORUMS.COM FAX THIS FORM TO: (800) 329-9923 CALL: (800) 377-7707 M-F 8:00 AM 5:00 PM PACIFIC TIME REGISTRATION INFORMATION (Please Print Clearly - *Name, License/Degrees, Place of Employment, City and State appear on your badge). *First Name *Last Name *License/Degrees *Place of Employment REGISTER TO ATTEND: #3G Preconference: 12 Lead ECG Interpretation (November 1) Main Conference (November 2-4) OR Recorded Conference via ContemporaryForumsOnline.com CONCURRENT SESSIONS SELECTION (Friday, November 3. See Conference Schedule.) Please indicate the numbers of your choices below. #1 (8:00 a.m.) #2 (9:45 a.m.) Address *City *State Attendee s email (Required) For confirmation, receipt, handouts prior to conference, and access to your Certificate of Attendance. Provide your best email address as some emails are filtered and blocked. Home Address City State Zip #3 (11:15 a.m.) #4 (2:00 p.m.) #5 (3:30 p.m.) PAYMENT SUMMARY (#3G) EARLY FEE POSTMARK DEADLINE: SEPTEMBER 20, 2017 Main Conference Tuition $ *Group Discount (See Registration Information) -$ Daytime Phone(s) PROFESSIONAL PROFILE Choose ONE category in each section that best applies to you. If you have multiple roles, select the one that occupies the majority of your time. Use Other only if none of the choices apply to you. 1. POSITION/JOB FUNCTION Clinical Coordinator Clinical Nurse Specialist Educator/Instructor Nurse Manager/Assistant Nurse Practitioner Physician Assistant Staff/Charge Nurse Other: 2. CLINICAL SETTING Cardiovascular Surgical ICU Combined ICU/CCU Coronary Care Unit Emergency Department Intensive Care Unit Medical/Surgical ICU Neuro/Neurosurgical ICU Progressive Care Unit Respiratory ICU Step-Down Unit Transport Trauma Unit Other: 3. HIGHEST EDUCATIONAL LEVEL Diploma Associate Degree Bachelor s Degree Master s Degree NP Certificate Doctoral Degree Other: 4. YEARS IN PRACTICE 1-2 3-5 6-10 11+ Preconference Tuition +$ OR Recorded Sessions via ContemporaryForums +$ Online.com TOTAL PAYMENT ENCLOSED $ *Registration forms must be sent in together. See Conference Information. Check/Money Order Payable to Contemporary Forums Credit Card # Exp. Date Print Cardholder s Name Payer Phone # CVC* Payer Email *(3 digit Security Code on the back of the card. Amex: 4 digit code on the front of the card.) We collect this data in order to provide you with information about Contemporary Forums and conferences. If you prefer not to receive further information, please see our privacy policy at ContemporaryForums.com. By registering for this conference, I acknowledge and agree to adhere to Contemporary Forums onsite policies, which include: Audio recording, video recording and livestreaming of speakers, sessions and/or attendees is strictly prohibited.