Adult Day Health Care April 16-17, 2015 Courtyard by Marriott Saratoga Springs

Similar documents
Adult Day Health Care: Adapting to Change

BE THE VOICE for Charting New Directions

8:00 4:00 PM General Registration

American Collectors Association of Texas

Vicki Kitchen, Clerk-Treasurer, North Liberty. Lisa Mullaney, Clerk-Treasurer, Argos. April 3, 2018

National Association of Women Highway Safety Leaders

2016 Registration Brochure LIFE IN THE BALANCE. March 10-12, 2016 JW Marriott Houston Houston, Texas

CLERK LIKE A CHAMPION. ILMCT 82nd ANNUAL CONFERENCE & STATE BOARD OF ACCOUNTS SCHOOL JUNE 10-14, 2018 SOUTH BEND, INDIANA

NAMEPA Region A 2010 Fall Conference The National Association of Multicultural Engineering Program Advocates, Inc.

THE MICHIGAN GUARDIANSHIP ASSOCIATION proudly presents

Make the commitment to attend the 2017 WVBA Annual Convention and register today.

Sailing into the Future

REGISTRATION BROCHURE

Early Bird Registration Offering WVBA Annual Convention

Proposal prepared for. APA Colorado. September 27-20, 2017

You Won t Want to Miss the MML Fall Conference, October 10-12, 2018 The Westin Annapolis, MD

Why should you attend?

[Type text] [Type text]

GOLDEN NUGGET OCTOBER 22-23, MANAGEMENT & TECHNICAL CONFERENCE AT T E N D E E I N F O R M AT I O N

A Great Conference Awaits You At The End Of The Road. 35 th Emerald Anniversary Regional Conference of Mortgage Bankers Associations

JUNE 12-15, 2018 IN DENVER, COLORADO ATTENDEE PROSPECTUS

NABE Tech Economics Conference Career & Expo November 15-16, 2017 Seattle Marriott Waterfront Seattle, WA

Principals of Volunteer Resource Management Presenter - Mary McCormick, CAVS

43rd Annual Conference & Exposition Sheraton/Overland Park Convention Center Overland Park/Johnson County October 15-17, 2018

JUNE 20-22, JEKYLL ISLAND CLUB HOTEL 371 Riverview Drive Jekyll Island, Georgia

The Annual Conference is also a time to learn, share ideas, establish a communications network, and renew friendships.

giving care taking care

2018 ANNUAL CONVENTION

Illinois Lake Management Association

Click here to Register

D-TRAIN. Cruise into 9ER District Training. March 17-20, 2016 Clarion Hotel Marina & Conference Center Dunkirk, New York Spring D-Train 1

Making a difference. with leadership with vision with awareness with competence. 43rd Annual Conference & Exposition

109th SCOPA Annual Meeting

30TH ANNUAL ARKANSAS. Workers Compensation Commission Educational Conference. Sponsored By The Arkansas Workers Compensation Commission AWCC

NAPA MIDYEAR MEETING CHICAGO, IL JULY 16-19, 2017 PRELIMINARY PROGRAM AND REGISTRATION. THE WESTIN MICHIGAN AVENUE

BY: Robert J. Avery, Adjutant Christopher Burtch, Assistant Adjutant Raymond Jarvis, Assistant Adjutant Mark D. Kearsing, Assistant Adjutant

NASWGA Chapter 30 th Annual State Conference - October 18-21, 2018 Sponsor Application

Celebrating the Past, Envisioning the Future

2017 IHCA Convention & Trade Show INVITATION TO PARTICIPATE. Sponsorship Information. Trade Show. Advertising Information.

FLGISA ANNUAL CONFERENCE. Attendee Information. July 30-August 2, 2018 Boca Raton Resort & Club GENERAL MEETING INFORMATION WHY YOU NEED TO ATTEND THE

the Inaugural CISCA Ceiling Product Showcase at the

RuralWaterCon 2018 Fort Worth, texas. April 4-6 at the Omni Hotel

May 28th & 29th, 2015, Hyatt Regency Century Plaza, Los Angeles, CA

37 th ANNUAL EDUCATIONAL CONFERENCE

2018 LEADERSHIP SUMMIT

PENNSYLVANIA BAR ASSOCIATION ANNUAL MEETING May 4 6, 2011 Sheraton Philadelphia City Center Hotel Philadelphia, Pennsylvania

2017 VAECE Annual Conference

MCMCFC. Believe & Succeed! In order to succeed, we must first believe that we can. - Nikos Kazantzakis

FAQ (Frequently Asked Questions)

NJOTA Annual Conference sponsored by

2015 ALP Convention Meeting Registration. April 16-19, 2015

Sponsorship & Marketing Opportunities

2017 OKLAHOMA CHAMBER OF COMMERCE EXECUTIVES ANNUAL CONFERENCE & AWARDS

8 th Annual Western New York Fall State Association of Municipal Purchasing Officials Conference Niagara Falls, New York October 17-18, 2012

TH ANNUAL SAMA CONFERENCE. June 1 st - 3 rd, The Lodge at Torrey Pines SPECIAL ASSETS MANAGEMENT ASSOCIATION (SAMA)

2019 Venue RFP. the EVENT Venue RFP Page 1 of 6

Multifaceted COSHRM OUT OF THE ORDINARY INTO THE EXTRAORDINARY. State Conference EXHIBITOR PROSPECTUS. September 27 29, 2017 Keystone CO PRESENTED BY

Welcome To the Veterans of Foreign Wars & Auxiliary Eastern States Conference October 27 29, 2017

Omni Corpus Christi Hotel 900 North Shoreline Boulevard Corpus Christi, Texas

Sponsorship and Exhibition Opportunities Package

37 Annual Winter CME Conference

Request for Proposals to Host the 24 th Annual Conference of the National Association for Civilian Oversight of Law Enforcement FALL 2018

Sponsorship Opportunities

2017 Florida Citrus Industry Annual Conference

May 4 th 6 th, 2016 Peoria Civic Center

LEGISLATIVE CONFERENCE

2014 PTG Convention Registration Form Atlanta July 16-20, 2014

ACWA s 2011 Fall Conference & Exhibition FINANCING OUR FUTURE. August November 29- December 2, 2011 Anaheim Marriott

DO GOOD FOR YOUR BUSINESS.

The 34th Annual New England. Regional Symposium April 29th - May 1st, At The Westin Hotel Providence, RI

Partner Agreement

Conference Event Schedule

Be Part of APC s Jubilee Celebration! Important Deadlines. Early Application (Discount) Deadline Application Approved by December 31, 2016

Maurice Rosenbaum. March 25, Dear Southeast Centricity Users:

ANNUAL CONFERENCE SPONSORSHIP OPPORTUNITIES Building for the Future September 12-14, 2018

EXHIBITOR & SPONSORSHIP AGREEMENT

Join us as a Sponsor of the 6th Annual 2017 Gateway Conference

2017 FS-ISAC Annual Summit April 30 - May 3 Lake Buena Vista, FL

Ecclesiology and Spiritual Renewal Program for Health Care Leaders A P R I L ,

ALL CLASSES ARE 12 HOURS IN LENGTH

NORFOLK VIRGINIA 2009 EXHIBITOR PROSPECTUS REGIONAL CONFERENCE

You re Invited... All the Right Moves. Positioning your practice for success. San Francisco, CA June 9 12

Marketing & Sponsorship Opportunities

National Meeting and Training Conference Baltimore Hilton Baltimore, Maryland

AGENDA-AT-A-GLANCE. Northeast Home Health Leadership Summit January 21 23, 2014 Colonnade Hotel, Boston, MA. Resilient Leadership

FS-ISAC Annual Summit 2016 May 1-4 Miami Beach, FL

INDIANA TOWNSHIP ASSOCIATION ANNUAL EDUCATION CONFERENCE REGISTRATION PACKET

Sponsorship Package CNSA National Conference. Hosted by McMaster University

2018 Partnership Digital Marketing Events

University of Shopping Centers 2014 on the campus of The Wharton School of the University of Pennsylvania, Philadelphia, PA

THE COLORADO STATE AIR FORCE ASSOCIATION

2016 Great Lakes Union Leadership Institute

MDtranslation.com helping you make the language and cultural connection with your audience

ESICA 2017 SPRING CONFERENCE MAY 3-5, 2017 ANNAPOLIS WATERFRONT HOTEL 80 COMPROMISE STREET, ANNAPOLIS, MD. Painting by Guido Borelli

WE RE NUMBER 1. WELCOME TO THE VIRGINIA ASSOCIATION of FAIRS 2015 CONFERENCE. THURSDAY, JANUARY 8th

Invitation to Exhibit

OHIO TRUCKING ASSOCIATION 2017 TECHNICIAN COMPETITION

FUNDRAISING FOR PRESIDENTS: INSTITUTE

2018 Florida Literacy Conference Exhibitor Information Kit

NPA. Exhibitor and Sponsor Prospectus. for the 2017 NPA Annual Conference

Transcription:

BE THE VOICE Adult Day Health Care April 16-17, 15 Courtyard by Marriott Saratoga Springs SPONSORED BY ANNUAL CONFERENCE

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Registration fees Full conference Thursday, April 16 only Friday, April 17 only ADHCC Member ADHCC Non-member $423 $473 $239 $279 $229 $269 Registration Information Full conference registration rate includes: Attendance at all sessions and access to online session materials, time with exhibitors, Thursday continental breakfast and awards luncheon, Friday full breakfast and buffet luncheon, all refreshment breaks, as well as networking with your peers. Daily conference rate for Thursday, April 16 includes: Attendance at all sessions on Thursday and access to online session materials, time with exhibitors, continental breakfast, two refreshment breaks, awards luncheon, as well as networking opportunities with your peers. Daily conference rate for Friday, April 17 includes: Attendance at all sessions on Friday and access to online session materials, a full breakfast, refreshment break, buffet luncheon, as well as networking opportunities with your peers. Cancellations received by April 6 are refundable, less a 25 percent administrative fee. Cancellations must be sent in writing to Kathy Burke at kburke@leadingageny.org or fax: 518.867.8386/518.867.8389. Those who are registered, and do not comply with the cancellation policy will be billed. Substitutions are permitted. Exhibits: Thursday, April 16 This is an incredible opportunity for you to view the newest products and services available to you as adult day health care professionals...an additional conference value! Accreditation An application has been submitted to the New York State Recreation and Park Society (NYSRPS) for therapeutic recreation professional certification credit. A certificate of completion will be sent to all attendees upon verification of hours attended. Dress Casual dress is encouraged throughout the conference, including the awards luncheon. Many thanks to the Conference Advisory Committee: Kathy Cocciole, program director, Seneca Hill Manor Adult Day Health Services, Oswego Candice Duffy, director, Schofield ADHC, Buffalo Patricia H. Granados, vice president, JGB Health Facilities Corporation; director, GuildCare Network, Albany Betsy Hochhauser, program director, Hebrew Hospital Home ADS of Westchester, Valhalla Jeannine Palazza, program director, GuildCare, Buffalo Jackie Tier, program director, Cortland Regional Nursing & Rehabilitation Center ADHC, Cortland Josephine Tramontana, program director, Sunrise Adult Day Health Care Center, Brooklyn Kim Vogt, program director, Meadowbrook ADHC at the Highlands, Pittsford p 2

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 7:30 a.m. 5 p.m. Registration 7:30 8:30 a.m. Continental breakfast/visit exhibitors Thursday, April 16, 15 8:30 10 a.m. Opening remarks & Keynote presentation: Effective Communication Techniques That Work! Our lives are based upon relationships with other people and businesses we deal with every day, and these relationships depend upon communication. Interpersonal communication is the most important process in our lives, yet little time and attention is given to the personal development of this ability. We no longer live simply as a result of the products of our own hands, but through our dealings with others. Just how well can you convey your thoughts to registrants and MLTCs? Does your staff understand your guidance and direction? Are you persuasive? Do people listen to what you have to say? Do you feel as if no one really listens to you? Attend this session to learn the techniques of effective communication and persuasive speaking. Catherine R. Selman, president/co-founder, The Healthcare Communicators, Inc., Vonore, TN 10 10:30 a.m. Visit exhibitors/refreshment break 10:30 a.m. noon Concurrent sessions: 1) Activity Interventions for Challenging Behavior This session will focus on interventions for behavioral challenges and dementia care, as well as utilization of non-pharmacologic interventions for the reduction of antipsychotics. Alleviating the symptoms of behavioral problems in registrants often becomes a challenge for the ADHC professional, especially as the percentage of registrants with dementia steadily increases. This session will identify causal factors and provide valid activity interventions for a variety of behaviors. Catherine R. Selman, president/co-founder, The Healthcare Communicators, Inc., Vonore, TN 2) Supervision and Management It Only LOOKS Easy! Dressing for success is easy. Supervising and managing health care staff, particularly during times of great change, can be a genuine challenge no matter how long you have been in charge. This session, presented by a multi-program manager with more than thirty-five years of supervisory experience with direct care staff, will explore why some supervisors have more success than others. In addition, it will help attendees develop and/or modify and adjust their management style for a successful outcome. Also included will be discussions on communication, how to get what you need from your staff, progressive discipline and performance appraisals. This session is geared toward new supervisors; but can be applied to anyone finding management a challenge. Patricia H. Granados, vice president, JGB Health Facilities Corporation; director, GuildCare Network, Albany (Continued on page 4) p 3

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Thursday, April 16, 15 Noon 1:30 p.m. Awards luncheon The Adult Day Health Care Council will honor our own at the th ADHCC Annual Awards Ceremony. Awards will be given in the following categories: Outstanding Member of the Year Innovations of the Year A banquet luncheon will be served. Please refer to the luncheon choices on the conference registration form. 1:30 3 p.m. Concurrent sessions: 1) Corporate Compliance A Clear View The implementation of a corporate compliance program can be overwhelming and confusing. During this informative and engaging session, Ms. Rich will provide an overview of the basics necessary to meet corporate compliance regulations and standards. She will also provide the outline, based on practical solutions, on how to operationalize and successfully implement a corporate compliance program in an ADHC setting. Caroline Rich, LNHA, CHC, chief operating officer/chief compliance officer, Four Seasons Nursing & Rehabilitation Center, Brooklyn 2) The Art of the Interview The Common Sense Approach to Interviewing Registrants With the implementation of the UAS-NY, interviewing has taken on a more significant role in the registrant assessment process. This session will review practical, common-sense communication techniques that can be utilized effectively when interviewing elders. Catherine R. Selman, president/co-founder, The Healthcare Communicators, Inc., Vonore, TN 3 3:30 p.m. Visit exhibitors/refreshment break 3:30 5 p.m. Concurrent sessions: 1) How to Submit Clean and Payable Claims in a Managed Care Environment Reduce your rate of claim rejections and denials by learning about the completion of the claim forms that must be submitted by ADHC programs. Our presenter will discuss such items as mandatory, situational and optional fields on the forms, common errors in claim submission and contractspecific billing issues. Michael Lewensohn, director of medical reimbursement services, O Connor Davies, LLP, Harrison Christopher McCarthy, partner, O Connor Davies, LLP, Harrison 2) Quality Assurance Defined and Delivered ADHC programs are required by regulation to have an ongoing quality assurance program, and the QA/QI program is always discussed and reviewed on survey. During this session, the speaker will discuss what the regulations require as well as the process and components of an effective QA system in ADHC. Caroline Rich, LNHA, CHC, chief operating officer/chief compliance officer, Four Seasons Nursing & Rehabilitation Center, Brooklyn (Continued on page 5) p 4

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Thursday, April 16 5:30 7:30 p.m. Cocktail Party in Honor of Christine M. Fitzpatrick After a career of loyal work and service, Christine M. Fitzpatrick, executive director of the ADHCC, has retired. Come celebrate and honor Christine, and enjoy a reception with open bar and light fare. Invitation to follow. Friday, April 17, 15 7 a.m. 2:45 p.m. Registration 7:30 8 a.m. Full breakfast buffet 8 8:45 a.m. Presentations by the Innovations of the Year award recipients 8:45 9:30 a.m. ADHCC Business Meeting/Legislative Update Susan Holodak Robertshaw, MS, vice president for day care services, Jewish Home Lifecare, Mamaroneck Brian Lucey, partner, Whiteman, Osterman & Hanna LLP, Albany 9:30 9:45 a.m. Stretch break/hotel check-out p 5

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Friday, April 17, 15 9:45 11:15 a.m. Concurrent sessions: 1) Marketing Adult Day Services to Managed Care Plans An Inside-Out Provider Approach With mandatory enrollment in managed long term care in full swing throughout New York State, we have all had experience with managed care plans marketing to our registrants and to ADHC programs. This session will explore marketing to managed care from the provider side with an experienced representative of an organization that has been successful in its marketing efforts. During this session the presenter will discuss the evolving managed care landscape and the impact of this evolution on day services. She will also provide guidance on developing a marketing strategy that works, and how to highlight your program through your marketing materials. Finally, this session will explore how a program can gain a competitive edge that will set it apart from the competition. Susan Holodak Robertshaw, MS, vice president for day care services, Jewish Home Lifecare, Mamaroneck 2 Defensive Documentation Documentation is important, not only to validate the care that is being provided, but in today s sue-happy world, it is essential that each member of the interdisciplinary team knows how to document defensively. This session will emphasize the challenges, pitfalls and concerns of documentation to ensure that care and services are captured, ethical issues are considered and potential legal action is prevented. Gail Weinstein, MS, CTRS, LNHA, consultant, ProCare, LeadingAge New York, Latham 11:30 a.m. 1 p.m. Concurrent sessions: 1) Managing Problem Behaviors in Mental Health Populations Adult day health care programs can provide needed support, health care monitoring and socialization for persons with mental health problems. The early recognition and management of problem behaviors can help registrants use day treatment services appropriately and productively so that problematic behaviors are not acted out but instead are managed for the safety of all registrants and the smooth operation of the day program. This session will describe the early symptoms of problem behaviors and possible interventions, the management of specific behavioral health problems and how to develop problem solving strategies and facilitate collaboration and improved communication between providers. Goldie Dersh, LCSW, Ph.D., vice president behavioral health services, JGB, Mental Health and Mental Retardation Services Inc., LighthouseGuild International, New York City 2) UAS-NY Help Desk Comes to Saratoga! In this session, Department of Health Uniform Assessment System NY (UAS-NY) project staff will provide the latest updates on the UAS-NY. During this session, attendees will learn: New or upcoming features of the assessment tool; Concerns the Department of Health might have; How to implement error-free assessments; and ADHC regulations. This session will be helpful for the new UAS-NY user who is still getting accustomed to the tool, as well as seasoned users looking for the latest news from the State. Come prepared to share your concerns and ask questions. Scott Jill, project director, UAS-NY Project Team, Albany (Continued on page 7) p 6

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 1 1:45 p.m. Networking luncheon buffet Friday, April 17, 15 1:45 2:45 p.m. The Bless in This Mess This fast-paced humorous presentation is peppered with personal anecdotes and real life experience. Yvonne Conte provides insights into the trials and triumphs we face at home and in the workplace. She has met personal challenges - major career changes, death, illness, divorce and single parenthood with unshakable optimism, deep faith and a sense of humor. She brings laughter and encouragement, delighting her audiences as she offers life-changing material. A seasoned motivational humorist, Yvonne takes good clean real-life experiences and adds a delightful serving of laughter helping her audience to discover how thoughts, feelings and behavior can affect work performance, relationships and personal success. This is a common-sense, no-nonsense and hysterical look at life. Yvonne Conte, motivational humorist, Syracuse 2:45 p.m. Conference concludes A look back at our 10 th anniversary in 1995 Telly Award 1995 p 7

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Hotel Accommodations Rates at the Courtyard by Marriott Saratoga Springs are based on a single or double occupancy, per night: Standard room: $129 Suite: $159 Taxes are not included in the above rates. Please add an additional 13 percent tax (6 percent room occupancy tax and 7 percent sales tax). Check-in: 3 p.m. Check-out: Noon If rooms are available earlier than 3 p.m., you may check-in. For early arrivals, arrangements have been made with the hotel s front desk to hold your luggage. Hotel Reservation Deadline: In order to qualify for the special room rate, reservations must be received by the hotel on or before March 13, 15. How to Make Your Reservation at the Courtyard by Marriott Saratoga Springs: Call toll-free at 866-210-9325 or call the hotel directly at 518-226-0538 and identify yourself as being with the Adult Day Health Care Council s Annual Conference. Our block of rooms is being held for Wednesday, April 15 through Friday, April 17. A major credit card (MC, Visa, Amex or Discover) is required to guarantee your room at the time of reservation. The hotel s cancellation policy requires notice 48 hours before arrival date to avoid a lost deposit of one night s accommodation, plus applicable taxes. To qualify as tax-exempt, a tax-exempt form must be presented and payment must be made by company check or corporate credit card with the company name printed on it. About the Courtyard by Marriott Saratoga Springs: With a stay at Courtyard by Marriott Saratoga Springs, you ll be just a short walk from beautiful downtown Saratoga Springs, with its many charming and unique shops and restaurants. You ll find a great variety of shopping from upscale and elegant to unique and eclectic. Rooms Make yourself at home in one of the 146 guest rooms. Complimentary wired and wireless Internet access keeps you connected, and cable programming provides entertainment. Conveniences include safes and complimentary weekday newspapers, as well as phones with free local calls. Rec, Spa, Premium Amenities Take advantage of recreational opportunities offered, including an indoor pool, spa tub, and a 24-hour fitness center. Dining Enjoy a meal at a restaurant, or stay in and take advantage of The Bistro, a casual dining atmosphere serving Starbucks coffee, breakfast, lunch, and dinner. Quench your thirst with your favorite drink at the bar and lounge. Business, Other Amenities Featured amenities include complimentary high-speed (wired) Internet access, a 24-hour business center, and express check-out. Free self-parking is available onsite. Traveling to Saratoga The Courtyard by Marriott Saratoga Springs is 30 minutes from the Albany International Airport and has direct Amtrak transportation into Saratoga Springs. New York City and New Jersey attendees may catch the train at Penn station that comes directly into Saratoga. p 8

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Registration Please print or type and use one registration form per attendee. Be sure to complete both pages of this form. Name: Title: Organization: Address: City/State/Zip: Phone: ( ) Email Address (required): Please check here if you require specific aids or services pursuant to the Americans with Disabilities Act. Our staff will contact you to make further arrangements. Registration fees: Please select the appropriate fee. Full conference: April 16-17 Member: $423 Non-member: $473 Thursday, April 16 only Member: $239 Non-member: $279 Friday, April 17 only Member: $229 Non-member: $269 Cancellations received by April 6 are refundable, less a 25 percent administrative fee. After that, the fee will not be refunded. Cancellations must be sent in writing to Kathy Burke at kburke@leadingageny.org or fax: 518.867.8386/518.867.8389. Those who are registered, and do not comply with the cancellation policy will be billed. Substitutions are permitted. Concurrent session choices: Please select one session per time slot. Thursday, April 16 10:30 a.m. noon Activity Interventions for Challenging Behavior Supervision and Management 1:30 3 p.m. Corporate Compliance The Art of the Interview 3:30 5 p.m. How to Submit Clean and Payable Claims Quality Assurance Friday, April 17 9:45 11:15 a.m. Marketing to Managed Care Plans Defensive Documentation 11:30 a.m. 1 p.m. Managing Problem Behaviors UAS-NY Help Desk Meal tickets: Meals for one person are included in the registration fee. Additional meal tickets must be purchased for guests. Meal tickets are non-refundable. Please make meal selection for Thursday s awards luncheon below. Extra meal tickets for guest(s): # Thursday awards luncheon @ $35 ea. = $ (Please make meal selection below.) For the awards luncheon on Thursday, I prefer: Grilled swordfish, poached garlic puree, confit tomato, herbed lemon butter Slow-braised, bone-out beef short rib, classic mirepoix and fresh thyme jus Eggplant, pan-fried with basil, filled with Italian cheeses with fresh pomodoro (vegetarian option) * Gluten-free option * Frozen Kosher meal * If your guest requires gluten-free or Kosher meals, please indicate his/her name: Summary of Charges: Please enter the applicable fees. Conference fee: Extra meal ticket(s): $ $ Total $ (continued on p 10) p 9

BE THE VOICE Adult Day Health Care Annual Conference April 16-17, 15 Registration (continued from p 9) Name: Organization: Payment Method: Please check: Check MasterCard Visa Discover Amex Card number: Exp.: Security code: Cardholder s name (exactly as on card): Authorized signature: Please make your check payable to ADHCC Complete both pages of the form and return with payment to: ADHCC, Attn: Kathy Burke Mail: 13 British American Blvd., Suite 2, Latham, N.Y. 12110-1431 Email: kburke@leadingageny.org Phone: 518.867.8385, ext. 117 Fax: 518.867.8386 or 518.867.8389 If you have any questions or a problem that keeps you from attending this conference, please let us know. Perhaps we can help. Contact Tedi DeMartino at 518.867.8385, ext. 117, or email tdemartino@leadingageny.org. Logistical arrangements for the ADHCC Annual Conference have been provided by the Foundation for Long Term Care (FLTC). p 10