TWELFTH INTERNATIONAL SYMPOSIUM

Transcription

1 TWELFTH INTERNATIONAL SYMPOSIUM Fort Worth October 26-28, 2012 Sheraton Fort Worth Hotel Presented by the GBS/CIDP Foundation International Celebrating 32 Years of Support, Education, Research & Advocacy Platinum sponsors: CSL Behring Grifols

2 Twelfth International Symposium CME Added feature for the medical community CME Course will be offered on Saturday, October 27th CMESolutions designates this live meeting for a maximum of 6 AMA PRA Category 1 Credit(s) TM. This symposium provides a unique and exciting opportunity for patients and physicians to interact. The program consists of general sessions and workshops which offer practical information and teach valuable skills to help providers, patients and caregivers. Attendees will learn about every phase of GBS/CIDP and variants from diagnosis, treatment and care to rehabilitation, coping skills, emotional issues and the latest in research. We hope you will join us in Fort Worth, Texas and participate in this exciting event. Hotel Information The Sheraton Fort Worth Hotel and Spa, opened July 2008, reflects each of the facets in a multi-million dollar property transformation. With 430 spacious guest rooms, 20,000 square feet of meeting and exhibit space, and an 8,000 square foot Spa Beaubelle, Sheraton Fort Worth Hotel and Spa is ideally located for out-of-town visitors within walking distance of plentiful restaurants and world-class entertainment and convenient to Dallas/Fort Worth International, Dallas Love Field and other regional airports. The conference rate is $ per night plus tax and includes a full hot breakfast buffet in the hotel restaurant each morning. To make your reservation, call toll-free (888) and identify yourself as an attendee with the GBS/CIDP Foundation International conference. After the cutoff date of September 24, 2012, reservations will be made at a higher rate and will be based upon availability. Airport/Travel Information Located less than 20 miles West of Dallas/Fort Worth International Airport, with convenient flights throughout each day. Airport Transportation Yellow Checker Transportation Services is recommended. Their current rate is $17.00 per person, one-way, to and from Dallas/Fort Worth International Airport and Sheraton Fort Worth Hotel and Spa. For more information, go online at Sheraton Forth Worth Hotel and Spa does not provide airport shuttle service. Local Area Transportation The city provides a complimentary trolley (Molly the Trolley) for all registered guests that travel throughout Downtown and Sundance Square. The hotel also offers a courtesy shuttle that may take guests anywhere within a three-mile radius. The hotel shuttle is BASED UPON AVAILABILITY between the hours of 7am to 10:30pm.

3 Conference at a Glance A Hospitality Room will be open throughout the symposium a chance to meet and chat with others. Thursday, October 25, :00 pm 6:00 pm Registration 6:00 pm 8:00 pm Welcome Reception Friday, October 26, :30 am 8:45 am Breakfast 7:00 am 8:45 am Registration 8:45 am 9:00 am Welcome (For all attendees) 9:00 am 9:30 am Key Note Speaker (For all attendees) 9:30 am 10:00 am Plenary Session (For all attendees) 10:00 am 10:15 am Beverage Break 10:15 am 10:45 am Workshops 10:45 am 11:15 am Workshops 11:15 am 11:45 am Workshops 11:45 am 12:15 pm Workshops 12:30 pm 1:30 pm Boxed lunch 1:30 pm 2:00 pm Workshops 2:00 pm 2:45 pm Workshops 2:45 pm 3:00 pm Beverage Break 3:00 pm 4:30 pm Current Research New Findings (For all attendees) 6:30 pm 10:00 pm State Night Dinner Special evening of entertainment (casual dress) Good Fun, Good Food (authentic Texas barbeque) Saturday, October 27, :30 am 9:00 am Breakfast 8:00 am 9:00 am Registration 9:30 am 10:30 am Worshops 10:30 am 11:15 am Workshops (For all attendees) 11:15 am 12:15 pm Workshops 12:30 pm 1:45 pm Boxed Lunch 2:00 pm 2:45 pm Workshops 2:45 pm 3:00 pm Beverage Break 3:00 pm 4:30 pm Ask the Experts (For all attendees) 4:30 pm 5:30 pm Special Interest Groups Saturday Evening On Your Own Sunday, October 28, :00 am 9:00 am Symposium Walk-a-thon 6:30 am 9:00 am Breakfast 9:15 am 10:00 am Workshops 10:15 am 11:00 am Workshops 11:00 am 11:45 am Workshops 12:00 pm 12:15 pm Wrap-up and Plans for 2014

4 Walk-a-thon-form Join Us for the GBS/CIDP Foundation WAlk-a-Thon Fort Worth Water Gardens Sunday, October 28, 2012 Participant s Name (please print) Phone Home Address City / State / Zip I will be walking: 1/4 mile 1/2 mile 1 mile 2 miles Please have sponsors pre-pay with checks made payable to GBS/CIDP Foundation International. All funds raised, including cash donations, must be brought to the Walk-a-Thon Sunday morning, October 28. All monies raised will go to support our goals and mission. Donations given via check in amounts under $25 your cancelled check will be your receipt for tax purposes. Sponsorship Form Sponsor s Name Address, State, Zip Phone Sponsorship Amount 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) Place additional sponsors names on separate sheet and attach. Total Paid Sponsorship $

5 Registration Side one Friday, OCTOBER 26, 2012 Please fill out both sides of this form. 8:45 am 9:00 am n Welcome and Opening Remarks Ken Singleton, Executive Director, Philip Kinnicutt, President 9:00 am 9:30 am n Keynote Speaker Title: TBD Presenter: Stephen C. Groft, Pharm D, Director of Rare Disease at NIH 9:30 am 10:00 am n An Introduction to Peripheral Neuropathy presenter: David R. Cornblath, MD 10:15 am 10:45 am n GBS Clinical Presentation: Diagnosis & Tests presenter: Gareth J. Parry, MD n CIDP Clinical Presentation: Diagnosis & Tests presenter: Kenneth C. Gorson, MD 10:45 am 11:15 am n GBS Pathogenesis Presenter: Kazim Sheikh, MD n CIDP Pathogenesis Presenter: Angelika F. Hahn, MD 11:15 am 11:45 am n GBS Current / Future Therapies Presenter: Carol Lee Koski, MD n CIDP Current / Future Therapies Presenter: TBA 11:45 am 12:15 pm n GBS Long-term Outcome Presenter: Richard A. Lewis, MD n CIDP Long-term Outcome Presenter: David R. Cornblath, MD 1:30 pm 2:00 pm n Neural Repair (TBD) Presenter: Douglas Zochodne, MD 2:00 pm 2:45 pm n Fatigue and Pain Presenter: Pieter A. van Doorn, MD n Children and Young Adults with GBS/CIDP Presenter: Susan T. Iannaccone, MD 3:00 pm 4:30 pm n Current Research Moderator: Carol Lee Koski, MD panel: Angelika F. Hahn, MD (MMN) Kazim Sheikh, MD (Axonal Recovery in EAN) pieter A. van Doorn, MD (SDGBS) Bart C. Jacobs, MD (IGOS) SATURDAY, OCTOBER 27, :30 am 10:30 am n Emotional Issues (Patients only) presenter: Thomas V. McGovern, PhD n Emotional Issues (Caregivers/Families only) presenter: Lynn Kuttnauer, PhD 10:30 am 11:15 am n Emotional Issues (Combined Group) 11:15 am 12:15 pm n Physical and Occupational Therapies for Inflammatory Neuropathy Patients presenter: Santo Garcia, MOT/l; PT TBA 2:00 pm 2:45 pm n Vaccinations and Immunizations Presenters: Peter D. Donofrio, MD, Jonathan Katz, MD 3:00 pm 4:30 pm n Ask the Experts Moderator: Carol Lee Koski, MD SUNDAY, OCTOBER 28, :15 am 10:00 am n The Process of IVIG and Plasma Exchange n The GBS/CIDP Patient Limited to Wheelchair 10:15 am 11:00 am n Patient Advocacy and Health Insurance Issues presenter: Ed Gdula 11:00 am 11:45 am n Holistic Medicine 12:00 pm 12:15 pm n WRAP UP AND PLANS FOR 2014 STOP Turn over and fill out side two

6 Registration Side TWO (Fill out both sides of this form) Please type or print all information. Be sure to check your workshop choices on reverse side of this form. Use a separate form for each person registering. Name (First, M.I., Last) Company and Title (if applicable) Address City State Zip Code Phone (H) (W) (Cell) Affiliation with GBS /CIDP (check all that apply): n First Time Attending n GBS Patient n Spouse/Family n CIDP Patient n Sponsor n Liaison n Friend n Medical Professional n Miller Fisher n Child Registration Fees Note: A $25 Fee will be charged for on-site registration. Fees cover: All sessions, workshops, conference materials, box lunches, coffee breaks, Thursday night Welcome Reception and Friday State Night Dinner. n $150 per person OR n $250 for family of two (please complete the second person registration form) State Night Dinner Guests: There will be a charge of $50 for each additional guest for State Night Dinner I will bring guests. At $50 for each additional guest = Total: $ Day Only Attendees: $50 per day includes all sessions and boxed lunch. Please check one: n Friday only n Saturday only n Sunday only PAYMENT Please make all checks payable to: GBS/CIDP Foundation International OR Use your credit card: n Visa n MC n Discover n AmEx Total amount enclosed $ Name on Card Signature Card # Security Code Exp. Date Total amount charged $ Return forms and payment by October 1, 2012 to: Questions: GBS/CIDP Foundation Symposium The Holly Building /2 Forrest Avenue Toll Free for US & Canada Only Narberth, PA To access this form online go to our website: Cancellations: 50% refund up to October 1, 2012 for workshops. After October 1st no refunds. For your information: An individual may deduct expenses paid for admission and transportation to a medical conference relating to the chronic disease of the taxpayer s dependent. These expenses must be primarily for and essential to the medical care of the dependent. Note, however, that meals and lodging while attending the conference are not deductible. Please consult your tax advisor for further details.

7 2nd Registration Side one Friday, OCTOBER 26, 2012 Please fill out both sides of this form. 8:45 am 9:00 am n Welcome and Opening Remarks Ken Singleton, Executive Director, Philip Kinnicutt, President 9:00 am 9:30 am n Keynote Speaker Title: TBD Presenter: Stephen C. Groft, Pharm D, Director of Rare Disease at NIH 9:30 am 10:00 am n An Introduction to Peripheral Neuropathy presenter: David R. Cornblath, MD 10:15 am 10:45 am n GBS Clinical Presentation: Diagnosis & Tests presenter: Gareth J. Parry, MD n CIDP Clinical Presentation: Diagnosis & Tests presenter: Kenneth C. Gorson, MD 10:45 am 11:15 am n GBS Pathogenesis Presenter: Kazim Sheikh, MD n CIDP Pathogenesis Presenter: Angelika F. Hahn, MD 11:15 am 11:45 am n GBS Current / Future Therapies Presenter: Carol Lee Koski, MD n CIDP Current / Future Therapies Presenter: TBA 11:45 am 12:15 pm n GBS Long-term Outcome Presenter: Richard A. Lewis, MD n CIDP Long-term Outcome Presenter: David R. Cornblath, MD 1:30 pm 2:00 pm n Neural Repair (TBD) Presenter: Douglas Zochodne, MD 2:00 pm 2:45 pm n Fatigue and Pain Presenter: Pieter A. van Doorn, MD n Children and Young Adults with GBS/CIDP Presenter: Susan T. Iannaccone, MD 3:00 pm 4:30 pm n Current Research Moderator: Carol Lee Koski, MD panel: Angelika F. Hahn, MD (MMN) Kazim Sheikh, MD (Axonal Recovery in EAN) pieter A. van Doorn, MD (SDGBS) Bart C. Jacobs, MD (IGOS) SATURDAY, OCTOBER 27, :30 am 10:30 am n Emotional Issues (Patients only) presenter: Thomas V. McGovern, PhD n Emotional Issues (Caregivers/Families only) presenter: Lynn Kuttnauer, PhD 10:30 am 11:15 am n Emotional Issues (Combined Group) 11:15 am 12:15 pm n Physical and Occupational Therapies for Inflammatory Neuropathy Patients presenter: Santo Garcia, MOT/l; PT TBA 2:00 pm 2:45 pm n Vaccinations and Immunizations Presenters: Peter D. Donofrio, MD, Jonathan Katz, MD 3:00 pm 4:30 pm n Ask the Experts Moderator: Carol Lee Koski, MD SUNDAY, OCTOBER 28, :15 am 10:00 am n The Process of IVIG and Plasma Exchange n The GBS/CIDP Patient Limited to Wheelchair 10:15 am 11:00 am n Patient Advocacy and Health Insurance Issues presenter: Ed Gdula 11:00 am 11:45 am n Holistic Medicine 12:00 pm 12:15 pm n WRAP UP AND PLANS FOR 2014 STOP Turn over and fill out side two

8 2nd Registration Side TWO (Fill out both sides of this form) Please type or print all information. Be sure to check your workshop choices on reverse side of this form. Use a separate form for each person registering. Name (First, M.I., Last) Company and Title (if applicable) Address City State Zip Code Phone (H) (W) (Cell) Affiliation with GBS /CIDP (check all that apply): n First Time Attending n GBS Patient n Spouse/Family n CIDP Patient n Sponsor n Liaison n Friend n Medical Professional n Miller Fisher n Child Registration Fees Note: A $25 Fee will be charged for on-site registration. Fees cover: All sessions, workshops, conference materials, box lunches, coffee breaks, Thursday night Welcome Reception and Friday State Night Dinner. n $150 per person OR n $250 for family of two (please complete the second person registration form) State Night Dinner Guests: There will be a charge of $50 for each additional guest for State Night Dinner I will bring guests. At $50 for each additional guest = Total: $ Day Only Attendees: $50 per day includes all sessions and boxed lunch. Please check one: n Friday only n Saturday only n Sunday only PAYMENT Please make all checks payable to: GBS/CIDP Foundation International OR Use your credit card: n Visa n MC n Discover n AmEx Total amount enclosed $ Name on Card Signature Card # Security Code Exp. Date Total amount charged $ Return forms and payment by October 1, 2012 to: Questions: GBS/CIDP Foundation Symposium The Holly Building /2 Forrest Avenue Toll Free for US & Canada Only Narberth, PA To access this form online go to our website: Cancellations: 50% refund up to October 1, 2012 for workshops. After October 1st no refunds. For your information: An individual may deduct expenses paid for admission and transportation to a medical conference relating to the chronic disease of the taxpayer s dependent. These expenses must be primarily for and essential to the medical care of the dependent. Note, however, that meals and lodging while attending the conference are not deductible. Please consult your tax advisor for further details.

9 3rd Registration Side one Friday, OCTOBER 26, 2012 Please fill out both sides of this form. 8:45 am 9:00 am n Welcome and Opening Remarks Ken Singleton, Executive Director, Philip Kinnicutt, President 9:00 am 9:30 am n Keynote Speaker Title: TBD Presenter: Stephen C. Groft, Pharm D, Director of Rare Disease at NIH 9:30 am 10:00 am n An Introduction to Peripheral Neuropathy presenter: David R. Cornblath, MD 10:15 am 10:45 am n GBS Clinical Presentation: Diagnosis & Tests presenter: Gareth J. Parry, MD n CIDP Clinical Presentation: Diagnosis & Tests presenter: Kenneth C. Gorson, MD 10:45 am 11:15 am n GBS Pathogenesis Presenter: Kazim Sheikh, MD n CIDP Pathogenesis Presenter: Angelika F. Hahn, MD 11:15 am 11:45 am n GBS Current / Future Therapies Presenter: Carol Lee Koski, MD n CIDP Current / Future Therapies Presenter: TBA 11:45 am 12:15 pm n GBS Long-term Outcome Presenter: Richard A. Lewis, MD n CIDP Long-term Outcome Presenter: David R. Cornblath, MD 1:30 pm 2:00 pm n Neural Repair (TBD) Presenter: Douglas Zochodne, MD 2:00 pm 2:45 pm n Fatigue and Pain Presenter: Pieter A. van Doorn, MD n Children and Young Adults with GBS/CIDP Presenter: Susan T. Iannaccone, MD 3:00 pm 4:30 pm n Current Research Moderator: Carol Lee Koski, MD panel: Angelika F. Hahn, MD (MMN) Kazim Sheikh, MD (Axonal Recovery in EAN) pieter A. van Doorn, MD (SDGBS) Bart C. Jacobs, MD (IGOS) SATURDAY, OCTOBER 27, :30 am 10:30 am n Emotional Issues (Patients only) presenter: Thomas V. McGovern, PhD n Emotional Issues (Caregivers/Families only) presenter: Lynn Kuttnauer, PhD 10:30 am 11:15 am n Emotional Issues (Combined Group) 11:15 am 12:15 pm n Physical and Occupational Therapies for Inflammatory Neuropathy Patients presenter: Santo Garcia, MOT/l; PT TBA 2:00 pm 2:45 pm n Vaccinations and Immunizations Presenters: Peter D. Donofrio, MD, Jonathan Katz, MD 3:00 pm 4:30 pm n Ask the Experts Moderator: Carol Lee Koski, MD SUNDAY, OCTOBER 28, :15 am 10:00 am n The Process of IVIG and Plasma Exchange n The GBS/CIDP Patient Limited to Wheelchair 10:15 am 11:00 am n Patient Advocacy and Health Insurance Issues presenter: Ed Gdula 11:00 am 11:45 am n Holistic Medicine 12:00 pm 12:15 pm n WRAP UP AND PLANS FOR 2014 STOP Turn over and fill out side two

10 3rd Registration Side TWO (Fill out both sides of this form) Please type or print all information. Be sure to check your workshop choices on reverse side of this form. Use a separate form for each person registering. Name (First, M.I., Last) Company and Title (if applicable) Address City State Zip Code Phone (H) (W) (Cell) Affiliation with GBS /CIDP (check all that apply): n First Time Attending n GBS Patient n Spouse/Family n CIDP Patient n Sponsor n Liaison n Friend n Medical Professional n Miller Fisher n Child Registration Fees Note: A $25 Fee will be charged for on-site registration. Fees cover: All sessions, workshops, conference materials, box lunches, coffee breaks, Thursday night Welcome Reception and Friday State Night Dinner. n $150 per person OR n $250 for family of two (please complete the second person registration form) State Night Dinner Guests: There will be a charge of $50 for each additional guest for State Night Dinner I will bring guests. At $50 for each additional guest = Total: $ Day Only Attendees: $50 per day includes all sessions and boxed lunch. Please check one: n Friday only n Saturday only n Sunday only PAYMENT Please make all checks payable to: GBS/CIDP Foundation International OR Use your credit card: n Visa n MC n Discover n AmEx Total amount enclosed $ Name on Card Signature Card # Security Code Exp. Date Total amount charged $ Return forms and payment by October 1, 2012 to: Questions: GBS/CIDP Foundation Symposium The Holly Building /2 Forrest Avenue Toll Free for US & Canada Only Narberth, PA To access this form online go to our website: Cancellations: 50% refund up to October 1, 2012 for workshops. After October 1st no refunds. For your information: An individual may deduct expenses paid for admission and transportation to a medical conference relating to the chronic disease of the taxpayer s dependent. These expenses must be primarily for and essential to the medical care of the dependent. Note, however, that meals and lodging while attending the conference are not deductible. Please consult your tax advisor for further details.

11 2012 Program journal A comprehensive publication featuring the Symposium Program, a description of Symposium workshops, information about GBS/CIDP, and biographies of Symposium faculty and GBS/CIDP medical advisory board members. You can reach a broad audience including the more than 400 Symposium participants by purchasing an ad 2012 Program Journal SUBMIT YOUR AD TO: info@gbs-cidp.org no later than September 1, 2012 Digital file/print-ready PDF format Return this form with your enclosed check for $ (Contributions are tax deductible to the extent allowed by law.) Make check payable to: GBS/CIDP Foundation International Send to: Place your ad now and help suppport the Symposium GBS/CIDP Foundation International The Holly Building, / 2 Forrest Avenue, Narberth, PA $2,500 $1,500 $500 $250 $125 $75 $25 Back Cover Inside front or inside back cover Full Page Half Page Quarter Page Eighth of a Page Your name will appear on the Greeting Page n Yes, my ad was ed to info@gbs-cidp.org Name Title Company/Organization Address City State Zip Code Phone Fax

12 International Office The Holly Building / 2 Forrest Avenue Narberth, PA Non-Profit U.S. Postage PAID Permit No. 726 Wayne, PA Register NOW 12th International Symposium Join us in Fort Worth Who should attend: Patients, Families, Neurologists, Physiatrists, ER Doctors, Physical Therapists, Internists, Occupational Therapists, Social Workers, Psychiatrists, Nurses, Family Practitioners, Psychologists, Speech Therapists, Researchers... Added feature for the Medical Community A CME Course will be offered on Saturday, October 27th Register Now