2017 CNS ANNUAL MEETING Advance Registration and Housing Form OCTOBER 7 11, 2017 BOSTON, MASSACHUSETTS

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1 1 Advance Registration Deadline: September 7, 2017 All meeting confirmations will be sent via . REGISTRANT INFORMATION (Please type or print legibly using one form per person.) The name and address entered below will be used for CME Certificate. 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 COUNTRY ZIP/POSTAL CODE TELEPHONE (If international please include country code) FAX Exhibitor /Phone Opt-out: m Check here if you do not want your phone number encoded. m Check here if you do not want your address encoded. Americans with Disabilities Act: m Check here if you may require special accommodations or services in order to attend. You will be contacted by a CNS representative. Special Dietary Restrictions: m Vegetarian m Kosher (Please Specify) m None DEMOGRAPHIC INFORMATION Please help us collect accurate attendee demographics by answering the following questions. This information is required in order to process your registration. Please indicate your practice setting: (check one only) m Private m Full-time Academic m Private (Academic Affiliate or Appointment) REGISTRATION CNS MEMBER MEDICAL REGISTRANT Please indicate your subspecialty: (check all that apply) m Cerebrovascular m Peripheral Nerves m Endovascular m Skull Base Lesions m Epilepsy m Spine m Movement Disorders m Trauma m Pain m Tumor m Pediatric BEFORE m Active (Domestic & Int l.) $ 750 $ 950 m International Vista $ 750 $ 950 m Associate $ 750 $ 950 m Active Duty Military $ 0 $ 0 m Armed Forces (Guard/Reserve/Retiree) $ 475 $ 675 m Transitional $ 750 $ 950 m Resident (Domestic & Int l.) $ 150 $ 250 m Fellow (Domestic & Int l.) $ 200 $ 300 m Senior $ 650 m Medical Student $ 0 $ 200 m Affiliate $ 350 $ 550 Please indicate your professional level: (check one only) m Director/Department Head Senior Management m Staff m Resident m Nurse/Nurse Practitioner/PA NON-MEMBER MEDICAL REGISTRANT BEFORE Gender: (optional) m Male m Female Age: (optional) m Under 35 m m m m 66+ m Neurosurgeon $ 1000 $ 1200 m Physician (MD, DO, etc.) $ 1000 $ 1200 m Non-Physician $ 1000 $ 1200 (Clinical Researcher/Scientist)* m Neurosurgeon (Faculty) $ 850 $ 1050 m Resident** $ 400 $ 500 m Fellow*** $ 550 m Medical Student $ 250 m PA/Physician Extender $ 600 $ 800 m Nurse $ 600 $ 800 m Nurse Practitioner $ 600 $ 800 m Corporate Representative $ 1250 $ 1450 Non-Member categories are open to domestic and international registrants. *Non-member/Non-physician category is limited to scientists, engineers, etc., involved in neurosurgical research, and/or product development not affiliated with an exhibiting company. **All non-member residents must have their Program Director sign registration form. If registering online, a letter from your Program Director certifying that you are a resident in a neurosurgical training program must be faxed to , or ed to cns@wyndhamjade.com within one week of completing registration. PROGRAM DIRECTOR (PRINT OR TYPE NAME) PROGRAM DIRECTOR SIGNATURE ***All non-member fellows must attach a letter from their Chief of Service verifying fellow status. If registering online, your letter must be faxed to , or ed to cns@wyndhamjade.com within one week of completing registration. m YES! I am interested in volunteering for the CNS Sergeant-at-Arms Committee. NON-MEDICAL REGISTRATION BEFORE m Spouse/Guest/Child 13 & Over $ 150 $ 250 m Spouse/Guest/Child 13 & Over $ 75 $ 150 (Resident/Fellow) m Child (12 & Under) $ 0 $ 0 SPOUSE/GUEST FULL NAME SPOUSE/GUEST FULL NAME SUBTOTAL REGISTRATION $

2 2 HOTEL ROOM RATES Single/Double Room Rate Only m Westin Boston Waterfront HEADQUARTER HOTEL SOLD OUT! m $ 349 $ m Aloft Boston Seaport, a Starwood property m $ 319 $ m Courtyard Boston Downtown m $ 289 $ m DoubleTree Hotel Boston Downtown m $ 299 $ m Element Boston Seaport, a Starwood property m $ 319 $ m Four Seasons Hotel Boston m $ 495 $ m Hilton Boston Downtown/Faneuil Hall m $ 339 $ m Hyatt Regency Boston m $ 299 $ m InterContinental Boston m $ 389 $ m Omni Parker House m $ 329 $ m Renaissance Boston Waterfront m $ 359 $ m Seaport Hotel m $ 360 $ ** *Tax rates subject to change. **An additional $3.00 service/hotel fee will be charged per room per night. The fee will be included in the one night room and tax deposit. Room Rate with local/state tax and fees* HOTEL RESERVATIONS Special Requests m Two (2) Beds m Crib (additional fee may apply) OCTOBER 2017 m Rollaway bed (additional fee may apply) S M T W T F S ARRIVAL DATE DEPARTURE DATE 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 confirmed into the next available hotel. m 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 meantime, a standard room will be assigned.) HOTEL CHANGE/CANCELLATION POLICY Please Note: Each hotel has its own cancellation policy and some may charge an early departure fee. The individual hotel s policies will be listed in your confirmation. Any cancellations not made within the hotel s cancellation policy will result in forfeiture of your one night s room and tax deposit. The deadline date for new reservations based on availability is September 26, The hotel requires a deposit of one night s room and tax to reserve your room. Please continue to make any requests/changes by ing cns@wyndhamjade.com or calling through September 26, Beginning September 27, 2017, changes and cancellations must be made with your assigned hotel. SUBTOTAL HOTEL DEPOSIT $ If not registering for optional courses, skip to page 5 for payment.

3 3 CNS Annual Meeting registration is required in order to purchase optional course tickets Register early to receive your preferred choice All meeting confirmations will be sent via COURSE DIRECTORS/FACULTY/MODERATORS: No one-day speaker badges will be issued. Full meeting registration fees apply from 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. 1 REGISTRANT INFORMATION (Please type or print neatly in black ink.) FIRST NAME LAST NAME 2 SYMPOSIA Saturday, October 7, 2017 Sunday, October 8, 2017 ALL DAY 8:00 AM 4:00 PM (Includes Lunch) ALL DAY 8:00 AM 4:00 PM (Includes Lunch) m SYM2 Neurovascular Update: Evidence-based Guidelines in $ 300 Ischemic and Hemorrhagic Stroke for the Practicing Neurosurgeon m SYM1 Functional Neurosurgery Update* $ 300 m SYM3 Neurocritical Care and Neurosurgical Emergencies Update $ 300 SUBTOTAL SYMPOSIA $ 3 PRACTICAL COURSES Saturday, October 7, 2017 ALL DAY 8:00 AM 4:00 PM (Includes Lunch) PC01 Comprehensive Endoscopic Skull Base Surgery: Hands-On Cadaver Course Part 1 m Part 1: Didactic and Lab $ 1600 m Parts 1 & 2: Didactic and Lab $ 3000 m Part 1: Didactic Only $ 550 m Parts 1 & 2: Didactic Only $ 1000 MORNING 8:00 AM 11:30 AM m PC02 Advanced Cerebrovascular Surgery: 2D and 3D Operative Video-based Surgical and Anatomical Pearls m PC03 Thrombectomy Tips and Tricks m PC04 Minimally Invasive Spine Surgery Case-based Complications and Future Directions m PC05 Surgical Management of Eloquent Area Tumors: Functional Mapping and/or Navigation m PC06 Contemporary Management of Meningiomas AFTERNOON 12:30 PM 4:00 PM m PC07 Spinal Deformity: Thoraco-lumbar and Cervical Case-based Presentations m PC08 Management of Pituitary Adenomas and other Sellar Pathology m PC09 New Devices and Technology in Cerebrovascular Neurosurgery (includes Aneurysm treatment, ICH, Stroke) m PC10 Complications in Cerebrovascular Neurosurgery m PC11 Peripheral Nerve Surgery: Techniques and Exposure m PC12 Cervical Spine Case Management: A Casebased Approach to Treating Degenerative and Traumatic Cervical Pathology m PC13 Sports Concussions: Acute Management, Return to Activity and Possible Short and Long Term Sequelae Sunday, October 8, 2017 ALL DAY 8:00 AM 4:00 PM (Includes Lunch) m PC14 Comprehensive Endoscopic Skull Base Surgery: Hands-On Cadaver Course Part 2 m Part 2: Didactic and Lab $ 1600 m Part 2: Didactic Only $ 550 m PC15 ANSPA Annual Fall CME Meeting: Presented in Collaboration with the CNS Complimentary m PC16 SANS MOC Course MORNING 8:00 AM 11:30 AM m PC17 Innovation in Spine Surgery: From Artificial Discs to Biologics, Robots and Advanced Navigation m PC18 Brain Tumor Update Part 1: Malignant Brain Tumors* m PC19 3D Surgical Neuroanatomy (Supratentorial) m PC20 Neurosurgeons Hospital Relationships: Options, Negotiations, and Achieving What you are Worth AFTERNOON 12:30 PM 4:00 PM m PC21 Spinal Trauma: Case-based Presentations and Guidelines Update* m PC22 Economics of Neurosurgery: Navigating MACRA/MIPS, Bundled Payments, and Future of Healthcare Across Practice Settings m PC23 What You Need to Know When Looking for Your First (or Maybe Second) Job m PC24 Spinal Biomechanics in Modern Clinical Practice m PC25 Thoracolumbar: Trauma, Tumor and Degenerative Case-based Presentations m PC26 3D Surgical Neuroanatomy (Infratentorial) m PC27 Brain Tumor Update Part 2: Benign Brain Tumors m PC28 Integrating New Technology Into Your Work Flow: LITT, RNS, Stereo EEG, and Surgical Robots m PC29 Neurosurgical Treatment of Chronic Headache m PC30 Clinical Trials 101: What Neurosurgeons Should Know m PC31 Management of Challenging Brain Tumors m PC32 Clinical Guidelines Development: A Primer on the Development and Review of Evidence-Based Clinical Guidelines m PC33 Laser Ablation Surgery: Opportunities, Indications, Technique and Outcome m PC34 The FDA: Investigational Device Exemptions, Regulatory Process, and Moving Medical Devices to Patients SUBTOTAL PRACTICAL COURSES $ See page 5 for complete payment information

4 CNS ANNUAL MEETING 4 LUNCHEON SEMINARS Cost per Luncheon Seminar: $95. Discounted pricing of $75 offered for residents/fellows/medical students/advance practice providers. Ticket price will be applied based on your membership/registration status. MONDAY, OCTOBER 9, :15 1:45 PM m M01 m M02 m M03 m M04 m M05 m M06 m M07 m M08 m M09 m M10 m M11 m M12 m M13 m M14 Honored Guest Luncheon (Complimentary to CNS Resident members) 7 Aneurysms* Hematology and Coagulation for Neurosurgeons Starting a Fetal Surgery Program at Your Institution Peripheral Nerve Entrapment Syndromes: Diagnosis and Management* Spinal Column Metastases Management Navigation in Spine Surgery: Robotics The Future is Now Minimally Invasive Epilepsy Surgery Clinical Trials Review of Key Stereotactic and Functional Studies: Update on the Clinical Translation Diagnosis and Management of Concussion and Athletic Clearance Update on Diagnosis and Management of Low Grade Gliomas Immunotherapy Based Therapies for Gliomas and Brain Metastasis Making Sense of MACRA Educating Neurosurgeons: The Science and Art of Teaching Surgery TUESDAY, OCTOBER 10, :15 1:45 PM m T15 m T16 m T17 m T18 m T19 m T20 m T21 m T22 m T23 m T24 m T25 m T26 m T27 Dural AV Fistula Diagnosis and Management ICH Trial Update Retreating Trigeminal Neuralgia Tethered Cord: Practice Variations and Evidence Update Controversies in Spinal Deformity Surgery Cervical Radiculopathy: Anterior Versus Posterior Approaches* Spinal Surgery Controversies: Case-based Interactive Discussion Building a Functional Neurosurgery Practice Malignant Gliomas: Advances in Surgery and Adjuvant Therapy Managing ICP in the Trauma Patient* Meningioma: Management Strategies Laser Interstitial Thermal Therapy for Brain Tumors Using Outcome Data to Work with Hospital Administration on Appropriate Quality Metrics WEDNESDAY, OCTOBER 11, 2017 m W28 m W29 m W30 m W31 m W32 m W33 m W34 m W35 m W36 m W37 m W38 m W39 How to Onboard New Partners Flow Diversion and Intra-Saccular Devices: An Update Venous Stenting for Pseudotumor 12:15 1:45 PM Intra-arterial Therapies for Tumors SCS-Evidence and Expertise Pediatric Head Trauma Complication Management in Spine Surgery Non-functioning Pituitary Adenomas: Operative Nuances and Management Cutting Edge Management of Brain Metastasis Acoustic Neuromas: Current Management Strategies* From Residency to Practice and beyond: Getting the Job that is Right for You Surgery, Research, and Innovation: Lessons Learned from my Mentor *SANS Supplemental Exam is available for purchase with the course for an additional $15. SANS Supplemental Exams may also be purchased separately without having to attend the live course (see page 5). SUBTOTAL LUNCHEON SEMINARS $ 5 DINNER SEMINARS Cost per Dinner Seminar: $190 SATURDAY, OCTOBER 7, :30 8:30 PM MONDAY, OCTOBER 9, :30 9:30 PM TUESDAY, OCTOBER 10, :30 9:30 PM m DIN1 The World is Changing Around Us New CPT Codes, ICD-10, MIPS, and Bundling: Does This Affect My Bottom Line? m DIN2 m DIN3 Guidelines for Lumbar Spine Degenerative Disease Skull Base Tumors: Contemporary Management m DIN4 Global Neurosurgery SUBTOTAL DINNERS SEMINARS $

5 CNS ANNUAL MEETING Continue your education after the Annual Meeting and earn one hour of additional CME credit with SANS Supplemental Exams! The supplemental exams for each of the following courses are available for only $15 each. Any Annual Meeting attendee can purchase these exams, regardless of attendance at the live courses. 6 SANS SUPPLEMENTAL EXAMS m SYM1 SANS Functional Neurosurgery Update $ 15 m PC16 SANS Spinal Trauma: Case-based Presentations and Guidelines Update $ 15 m PC18 SANS Brain Tumor Update Part 1: Malignant Brain Tumors $ 15 m M02 SANS 7 Aneurysms $ 15 m M05 SANS Peripheral Nerve Entrapment Syndromes: Diagnosis and Management $ 15 m T20 SANS Cervical Radiculopathy: Anterior Versus Posterior Approaches $ 15 m T24 SANS Managing ICP in the Trauma Patient $ 15 m W37 SANS Acoustic Neuromas: Current Management Strategies $ 15 SUBTOTAL SANS EXAMS $ 7 PAYMENT Subtotal Registration $ Subtotal Hotel Deposit $ Subtotal Symposia $ Subtotal Practical Courses $ Subtotal Luncheon Seminars $ Subtotal Dinner Seminars $ Subtotal SANS Exams $ TOTAL $ m Check: Full payment must accompany your registration form. 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 from an overseas bank will be returned. Any checks returned for insufficient funds are subject to additional charges.) m Credit Card Authorization: Credit card will be charged immediately for registration fees. (US dollars drawn on a US bank) m Visa m American Express m MasterCard CREDIT CARD NUMBER NAME OF CARDHOLDER (PRINT) BILLING ADDRESS (IF DIFFERENT THAN REGISTRANT) SIGNATURE EXPIRATION DATE (MONTH/YEAR) By signing this form: I authorize the CNS Registration and Housing Center to charge my credit card for the total payment 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 me in promotional materials for future meetings. 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 pm CT on September 14, Course, seminar, and event tickets will be refunded in full until September 14, 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 September 14, 2017, are assessed a $50 processing fee. Written requests may be ed to cns@wyndhamjade.com, faxed to , or mailed 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 may 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