INNOVATIONS & REVELATIONS

Transcription

1 INNOVATIONS & REVELATIONS ONTARIO THORACIC SOCIETY PRELIMINARY PROGRAM Welcome to The Lung Association s Better Breathing Conference 2016, Ontario s premier respiratory conference. The Ontario Thoracic Society (OTS) is the medical section of The Lung Association. We promote respiratory health through medical research and education. At the Better Breathing Conference you will be among healthcare professionals from many disciplines including respirologists, family physicians, nurses, respiratory therapists, physiotherapists and pharmacists. The Lung Association is a registered charity that focuses on the prevention and control of asthma, chronic lung disease, smoking cessation and prevention, as well as air quality and its effect on lung health. The Ontario Thoracic Society (OTS) Our mission is to promote respiratory health through medical research and education. TABLE OF CONTENTS Planning Committee OTS Membership Summary Conference program Presenters & Chairs Better Breathing Registration STUDY CREDITS Application has been made to the Canadian Thoracic Society Professional Development Committee for an Accredited Group Activity (section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. 1. Facilitate, encourage, and adjudicate clinical, epidemiological, and basic scientific research in the prevention, diagnosis and treatment of respiratory disease and the promotion of respiratory health. 2. Support and facilitate continuing medical education into all aspects of respiratory health and disease throughout the province of Ontario. 3. Provide scientific and educational advice to the Ontario Lung Association (OLA). 4. Assist the OLA in furthering its goals of supporting medical research and conducting community health programs. 5. Liaise with the Canadian Thoracic Society and other provincial thoracic societies in the achievement of common goals. Register at Early bird ends December 31, 2015

2 ONTARIO THORACIC SOCIETY BETTER BREATHING 2016 PLANNING COMMITTEE 2 CHAIR Jane Batt, MD, PhD, FRCPC OTS Better Breathing Conference Chair; Assistant Professor, Faculty of Medicine, University of Toronto; Respirologist and Medical Director, TB Program, St Michael s Hospital; Scientist, Keenan Research Centre for Biomedical Science, St Michael s Hospital, University of Toronto MEMBERS George Chandy, MD, MSc, FRCPC OTS Chair Elect; Assistant Professor University of Ottawa; Respirologist, Ottawa Hospital and Ottawa Heart Institute, Ottawa Hedy Ginzberg, MDCM, FRCPC, PhD Medical Director, Ontario Thoracic Society, Toronto John Granton, MD, FRCPC OTS Past Chair; OLA Chair; Professor, Faculty of Medicine, University of Toronto; Head, Division of Respirology, University Health Network, Mount Sinai Hospital and Women s College Hospital, Toronto Lawrence Jackson, BSc, Phm Clinical Coordinator, Veterans Centre, Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto Sherri Katz, MDCM, FRCPC, MSc Associate Professor, Department of Pediatrics, University of Ottawa; Pediatric Respirologist and Director, Sleep Laboratory, Children s Hospital of Eastern Ontario, Ottawa Michael Keim, RRT, MA Chair, ORCS Education Committee; Lead Educator, Ornge Critical Care Transport, London Thomas Kovesi, MD, FRCPC Chair, Ontario Thoracic Society; Professor of Pediatrics, The University of Ottawa; Pediatric Respirologist, Children s Hospital of Eastern Ontario, Ottawa Dilshad Moosa, BSc, RRT, CRE, MASc(c) Manager, Quality Improvement and Health System Integration, Ontario Lung Association, Toronto Onofre Morán, MD, MSc, PhD, FRCPC Associate Professor, Department of Medicine, Queens University; Respirologist, Division of Respiratory and Critical Care Medicine, Kingston Mitra Niroumand, MD, FRCP(C), D. ABSM Assistant Professor, Division of Respirology, University of Toronto; Staff Physician, Mount Sinai Hospital, Toronto Christopher M. Parker, MD, MSc, FRCPC, FCCP Associate Professor, Departments of Medicine and Biomedical & Molecular Sciences, Division of Respiratory and Critical Care Medicine, Queen s University; Program Director, Respirology Training Program, Queen s University; Attending Respirologist and Co-Director, Intensive Care Unit, Kingston General Hospital, Kingston Mithu Sen, MD, FRCPC, FCCP, FCCM, FAASM, D.ABSM Associate Professor of Medicine, Divisions of Respirology & Critical Care and Sleep Medicine; Assistant Dean, Faculty Equity and Wellness, and Program Director, Critical Care (Adult) Schulich School of Medicine and Dentistry, University of Western Ontario, London Marcel Tunks, MD, FRCPC Assistant Professor, Department of Medicine, McMaster University; Medical Director, Pulmonary Function Laboratory, St. Joseph s Healthcare Hamilton Better Breathing is a smoke and fragrance free conference

3 3 THE ONTARIO THORACIC SOCIETY (OTS) Membership in the OTS provides the following benefits: Receipt of the Ontario Thoracic Reviews. This official publication features updates on current clinical and scientific topics in respiratory medicine. Reduced registration fee at the annual scientific conference, Better Breathing. This is the largest respiratory conference in Ontario and features topics of relevance to practitioners, an annual controversies in respiratory medicine forum and state-of-the-art discussions on the application of current respiratory research to clinical respiratory medicine. The opportunity to participate in the development of Better Breathing. Advance notice of registration for OTS-sponsored continuing medical education events. Receipt of published position papers, standards and statements from both the OTS and the Canadian Thoracic Society. Updates on OTS and OLA activities. Active: This category is open to individuals with a medical degree, PhD or equivalent degree or training. Active members pay annual dues of $95.00, are entitled to one vote at the annual meeting of the Society, and are eligible to hold office. Associate: Associate membership is open to residents, fellows or graduate students undertaking studies in the medical or allied health sciences, or fellows during their period of training. Associate members are not required to pay dues, and may not vote or be elected to office, but otherwise enjoy all the privileges of membership in the Society. Honourary: Individuals who have made distinguished contributions to respiratory health in Ontario may be nominated for an Honourary Life Membership in the Society. Contributions may have come through patient care, exemplary teaching, innovative research or distinguished service to the Ontario Lung Association, the Ontario Thoracic Society, or the community. Honourary Life Members are not required to pay dues, but otherwise enjoy all the privileges of membership in the Society. Better Breathing is a smoke and fragrance free conference

4 4 OTS CONFERENCE PROGRAM FRIDAY, JANUARY 29, :30 a.m. Registration PLENARY SESSION: Innovations & Revelations At the end of this session, participants will be able to: 1. Explain how biomass fuel exposure affects individual lung health. 2. Identify new treatment options for lung cancer and understand the role of personalized medicine. This session addresses the following CanMEDS competencies: Communicator, Collaborator, Health Advocate, Manager, Medical Expert, Professional and Scholar 8:00 a.m. Welcome Address Dr. John Granton, Chair, Ontario Lung Association 8:30 a.m. THEME: Innovations & Revelations Dr. Jane Batt, OTS Better Breathing Chair :35 a.m. Where There s Smoke, There s Lung Disease: Health risks of biomass fuels Dr. Matthew Stanbrook 9:15 a.m. Canada s Silent Cancer - A tidal wave of progress Dr. Natasha Leighl 10:00 a.m. Refreshment break with exhibitors ORCS/OTS JOINT SCIENTIFIC PROGRAM - What s new in lung health Session Co-Chairs: Dr. Tom Kovesi, OTS Chair, and Shelley Prevost, ORCS Chair At the end of this session participants will be able to: 1. Explain the role of electronic monitoring and education in patient self-management of asthma. 2. Analyze new ways to manage sleep disordered breathing using home ventilation 3. Identify morbidities associated with hookah and marijuana use. This session addresses the following CanMEDS competencies: Communicator, Collaborator, Medical Expert, Professional and Scholar 10:45 a.m. The Electronic Asthma Management System (eams): A point-of-care knowledge translation tool for asthma Dr. Samir Gupta 11:15 a.m. CPAP & BIPAP: Home Ventilation New modes, new names Dr. Douglas McKim 11:45 a.m. Vaping, Hookahs, and Pot: Redefining smoking Dr. Marcel Tunks GENERAL LUNCH or LUNCH WITH A PROFESSOR 12:15 p.m. 1. General Lunch 12:15 p.m. 2. Inhalers and Devices for Asthma and COPD: A hands on session Dr. Mirna Dolovich and Dr. Diane Lougheed Learning Objective: At the end of this session participants will be able to know how to correctly use Inhalers and Devices as it relates to their pharmacologic and clinical action in Asthma/COPD This session addresses the following CanMEDS competencies: Professional & Manager, Medical Expert, and Professional & Scholar 12:15 p.m. 3. BBC 2016 Team Challenge Dr. Onofre Morán and Dr. Christopher Parker Learning Objective: At the end of this session, participants will be able to identify key concepts in the diagnosis and management of respiratory diseases as per current guidelines recommendations in the new BBC Team Challenge This session addresses the following CanMEDS competencies: Communicator, Medical Expert, and Professional & Scholar Better OntarioLungassociation Breathing is a smoke and fragrance free conference

5 OTS CONFERENCE PROGRAM FRIDAY, JANUARY 29, GENERAL LUNCH or LUNCH WITH A PROFESSOR (continued) 12:15 p.m. 4. Dr. André Péloquin Clinical Case Series Chair: Dr. Raymond Gottschalk Speakers: Dr. David Schneiderman, Dr. Robert Chernish, Dr. Zoe Nugent Learning Objective: At the end of this session participants will be able to diagnose and manage challenging respiratory cases in community practice. This session addresses the following CanMEDS competencies: Communicator, Medical Expert & Scholar CONCURRENT AFTERNOON SESSIONS 1:45 p.m. OTS AFTERNOON SESSION - THEME: STATE OF THE ART IN RESPIRATORY MEDICINE Dr. Jane Batt, OTS Better Breathing Chair :45 - Pulmonary Toxicity in the Era of Biologics Dr. Shikha Mittoo 2:10 - Treating Pulmonary Embolism at Home: Radical/economic driven practice or the obvious choice Dr. Philip Wells At the end of this session participants will be able to: 1. Identify safety and toxicity associated with the use of biologics for treatment of severe lung diseases. 2. Explain when it is in the patients best interest to be treated at home vs in the hospital following pulmonary embolism. This session addresses the following CanMEDS competencies: Communicator, Collaborator, Health Advocate, Medical Expert, Professional and Scholar OR 1:45 p.m. OTS PEDIATRIC SESSION: DON T FORGET THE KIDS! THINGS WORTH KNOWING IF YOU TREAT KIDS, OR PEOPLE WHO USED TO BE KIDS Chair: Dr. Sherri Katz 1:45 - New Tools to Measure Old Diseases in Young Patients Dr. Grace Parraga 2:15 - Pediatric Pulmonary Hypertension in 2016 Dr. Tilman Humpl At the end of this session participants will be able to: 1. Assess how to use new methods to manage pediatric lung disease 2. Explain new developments in understanding and treating pediatric pulmonary hypertension. This session addresses the following CanMEDS competencies: Communicator, Collaborator, Medical Expert, Professional & Scholar 2:40 p.m. OTS Award Presentations 2:45 p.m. Refreshment break with exhibitors RESIDENT CASE PRESENTATIONS Learning Objective: At the end of this session, participants will be able to identify and evaluate difficult clinical diagnoses based on presentations of cases by Respiratory Residents from the major Ontario academic centers. This session addresses the following CanMEDS competencies: Communicator, Medical Expert, Scholar 3:15 p.m. Resident Case Presentations CHAIR: Dr. Rebecca Amer; JUDGES: Dr. David Schneiderman (Ottawa), Dr. Robert Chernish (Kitchener), Dr. Zoe Nugent; SPEAKERS: TBA (one resident from each of six centers) 4:45 p.m. OTS Annual General Meeting 5:15 p.m. OMA Section Meeting Better Breathing is a smoke and fragrance free conference

6 OTS CONFERENCE PROGRAM SATURDAY, JANUARY 30, :00 a.m. Registration OTS Debates: Controversies in pulmonary medicine Chair: Dr. Shawn Aaron At the end of this session participants will be able to: 1. Explain fiscal challenges in providing medications for rare diseases. 2. Identify where further research is needed in breathing & sleep and explain how to better disseminate new developments. 3. Assess the role of fluoroquinones in the treatment of TB 4. Explain the scientific contribution of birth cohorts and association studies to understand asthma This session addresses the following CanMEDS competencies: Collaborator, Communicator, Health Advocate, Medical Expert, Professional & Scholar 8:30 a.m. Be it resolved that there should be public reimbursement for very expensive medications for rare diseases Pro: Dr. Gerard Cox Con: Dr. Gerald Evans OLA/OTS RESEARCH UPDATE 9:15 a.m. Understanding the Science of Breathing and Sleep: Critical Importance of Research Funding and Discovery Dissemination Dr. Richard Horner 10:00 a.m. Refreshment Break with Exhibitors OTS DEBATES: Controversies in pulmonary medicine Chair: Dr. Shawn Aaron 10:30 a.m. Be it resolved that Fluoroquinolones are 1st line treatment for TB Pro: Dr. Sarah Brode Con: Dr. Harvey Wong 11:15 a.m. Be it resolved that birth cohort and other association studies in Asthma are a waste of time Pro: Dr. Thomas Kovesi Con: Dr. Joe Reisman 12:00 p.m. Conclusion of the 2016 Better Breathing Conference Better Breathing is a smoke and fragrance free conference

7 PRESENTERS AND SESSION CHAIRS 7 Shawn Aaron, MD, MSc, FRCPC Senior Scientist, Clinical Epidemiology, Ottawa Hospital Research Institute; Professor of Medicine, Faculty of Medicine, University of Ottawa; Division Head, Division of Respiratory Medicine, The Ottawa Hospital, Ottawa Rebecca Amer, MD, FRCPC Associate Professor, Department of Medicine, St Joseph s Healthcare Hamilton; Director, Adult Respirology Training Program, McMaster University, Hamilton Jane Batt, MD, PhD, FRCPC Chair, Better Breathing Conference 2016; Assistant Professor, Faculty of Medicine, University of Toronto; Respirologist and Medical Director, TB Program, St Michael s Hospital; Scientist, Keenan Research Centre for Biomedical Science, St Michaels Hospital, University of Toronto Sarah Brode, MD, FRCPC Clinical Associate; University Health Network and West Park Healthcare Centre, Toronto Rob Chernish, MD, FRCPC Respirology and Critical Care, St. Mary s General Hospital, Kitchener Gerard Cox, MB, BCh, BAO, FRCP(C), FRCP(I) Professor of Medicine, Division of Respirology, McMaster University, Hamilton Mirna Dolovich B. Eng., P. Eng. Professor, Medicine, Faculty of Health Sciences, McMaster University; Member, Research institute, St Joseph s Healthcare; Research Scientist, Firestone Institute for Respiratory Health, St Joseph s Healthcare, Hamilton Natasha B. Leighl, MD, MMSc, FRCPC Associate Professor, Department of Medicine, University of Toronto, Lung Medical Oncology Site Group Lead, Division of Medical Oncology, Princess Margaret Cancer Centre; OSI Pharmaceuticals Foundation Chair in Cancer New Drug Development; Co-Chair, NCIC Clinical Trials Group Committee on Economic Analysis President, Lung Cancer Canada, Toronto M. Diane Lougheed, MD, M.Sc., FRCP(C) Professor, Departments of Medicine (Respirology), Biomedical and Molecular Sciences (Physiology), and Public Health Sciences (Epidemiology) Queen s University, Kingston Douglas McKim MD, FRCPC, DABSM Professor of Medicine, University of Ottawa; Medical Director, Ottawa Hospital Sleep Centre and CANVent Respiratory Rehabilitation Services, Ottawa Shikha Mittoo, MD, MHS, FRCPC (Internal Medicine, Rheumatology) Assistant Professor Medicine, University of Toronto; Staff Rheumatologist, co-research director, ILD Program, Mount Sinai Hospital/University Health Network, Toronto Onofre Morán, MD, MSc, PhD, FRCPC Associate Professor, Department of Medicine, Queens University; Respirologist, Division of Respiratory and Critical Care Medicine, Kingston Zoe Nugent, MBBS, FRCPC Associate Professor, Department of Family Medicine, Queen s University; Paediatric Respirologist, Peterborough Regional Health Centre, Peterborough Grace Parraga, PhD Professor and Graduate Chair, Departments of Medical Biophysics, Oncology, Medical Imaging, and Graduate Program in Biomedical Engineering, The University of Western Ontario; Scientist, Robarts Research Institute, London Gerald A. Evans, MD, FRCPC Professor of Medicine, Biomedical & Molecular Sciences and Pathology & Molecular Medicine; Chair, Division of Infectious Diseases, Queen s University; Medical Director, Infection Prevention & Control, Kingston General Hospital/Hôpital Hotel Dieu Hospital, Kingston Christopher M. Parker, MD, MSc, FRCPC, FCCP Associate Professor, Departments of Medicine and Biomedical & Molecular Sciences, Division of Respiratory and Critical Care Medicine, Queen s University; Program Director, Respirology Training Program, Queen s University; Attending Respirologist and Co-Director, Intensive Care Unit, Kingston General Hospital, Kingston Raymond Gottschalk, MBChB(UCT), FRCPC, FCCP, D ABSM, FAASM, D ABIM Clinical Assistant Professor of Medicine, McMaster University.; Director of the Sleep Laboratory and the Asthma and Respiratory Health Centre Hamilton; Quality Assurance Director, Sleep Disorders Clinic, Hamilton John Granton, MD, FRCPC OTS Past Chair; OLA Chair; Professor, Faculty of Medicine, University of Toronto; Head, Division of Respirology, University Health Network, Mount Sinai Hospital and Women s College Hospital, Toronto Samir Gupta, MD, FRCPC, MSc Assistant Professor, University Of Toronto, Department Of Medicine, Division of Respirology, St. Michael s Hospital; Adjunct Scientist, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael s Hospital, Toronto Richard L. Horner, PhD Professor of Medicine and Physiology, University of Toronto; Canada Research Chair, Toronto Tilman Humpl, MD, PhD Associate Professor of Pediatrics, University of Toronto; Director, Pulmonary Hypertension Service and Staff Physician, Cardiac Critical Care Unit, Hospital for Sick Children, Toronto Sherri Katz, MDCM, FRCPC, MSc Associate Professor, Department of Pediatrics, University of Ottawa; Pediatric Respirologist and Director, Sleep Laboratory, Children s Hospital of Eastern Ontario, Ottawa Thomas Kovesi, MD, FRCPC Chair, Ontario Thoracic Society; Professor of Pediatrics, The University of Ottawa; Pediatric Respirologist, Children s Hospital of Eastern Ontario, Ottawa Shelley Prevost, RRT, MASc(Resp) Chair, Ontario Respiratory Care Society; COPD and Asthma Educator, Pulmonary Rehabilitation & Ventilation Programs, St. Joseph s Care Group, St. Joseph s Hospital, Thunder Bay John (Joe) Reisman, MD, FRCPC, MBA Professor, Department of Pediatrics, Faculty of Medicine, University of Ottawa, specializing in Respirology; Past Chair & Chief, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children s Hospital of Eastern Ontario, Ottawa David Schneiderman, MD, FRCPC Staff Respirologist, Montfort Hospital, Ottawa Matthew B. Stanbrook, MD, PhD, FRCPC Associate Professor, Department of Medicine and Institute of Health Policy, Management and Evaluation University of Toronto; Staff Respirologist, Asthma & Airway Centre, University Health Network; Deputy Editor, CMAJ, Toronto Marcel Tunks, MD, FRCPC Assistant Professor, Department of Medicine, McMaster University; Medical Director, Pulmonary Function Laboratory, St. Joseph s Healthcare, Hamilton Philip Wells, MD, FRCPC, MSc Professor, Chair and Chief, Department of Medicine; The University of Ottawa, Faculty of Medicine and The Ottawa Hospital; Senior Scientist, Ottawa Hospital Research Institute, Ottawa Harvey Wong, MD, FRCP(C), MScCH Assistant Professor, Division of Respirology, Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, St. Michael s Hospital, Toronto Better OntarioLungassociation Breathing is a smoke and fragrance free conference Ontariolung #BBconf14

8 Registration for Better Breathing Conference 2016 Name Organizaton Credentials Department Position/Title Address City Postal Code Telephone Fax EARLY BIRD REGISTRATION discount applies until December 31, All applications must be accompanied by cheque, money order or credit card information. Registration is required prior to January 22, After this date, registration can only be processed on-site. There is a cancellation fee of $50.00 and after January 22, 2016, no refunds will be issued. YOUR RECEIPT WILL BE INCLUDED IN THE REGISTRATION PACKAGE AT THE CONFERENCE. INTERNATIONAL DELEGATES: International delegates wishing to attend the Better Breathing Conference (BBC) 2016, note that the BBC does not provide letters of invitation. BBC will provide receipts upon payment of fees as confirmation of registration to assist with securing travel visas. International delegates wishing to attend the conference must register online and pay by credit card. PHOTOGRAPHS: Photos taken at Better Breathing will be utilized in future BB and OLA promotional material that may include print, electronic or other media including the BB and OLA websites. By participating in BB 2016, you grant Better Breathing and OLA the right to use your profile captured photographically for such purpose. CONSENT: A list of conference delegates including their contact information will be distributed to conference attendees. Please indicate your agreement for publishing. YES, please include my name and contact information on the delegate list. NO, please do not include my name and contact information on the delegate list. REGISTRATION FEES PLEASE INDICATE YOUR CHOICES FOR FRIDAY LUNCH GENERAL LUNCH or LUNCH WITH A PROFESSOR SERIES Seating is limited to 33 participants for each Lunch with a Professor session. Please indicate first, second and third choice. If all sessions are full at the time of receipt of registration, General Lunch is available. Inhalers and Devices for Asthma and COPD: A hands on session BBC 2016 Team Challenge The Dr. André Péloquin Clinical Case Series If you have any special dietary requirements, please specify: FIRST CHOICE: SECOND CHOICE: THIRD CHOICE: FIRST CHOICE: SECOND CHOICE: THIRD CHOICE: FIRST CHOICE: SECOND CHOICE: THIRD CHOICE: PLEASE INDICATE YOUR CHOICE FOR FRIDAY AFTERNOON SESSION (1:45 p.m. TO 2:45 p.m.) OTS AFTERNOON SESSION THEME: STATE OF THE ART IN RESPIRATORY MEDICINE 1:45 p.m. Pulmonary Toxicity of New Age Biologics 2:10 p.m. Treating Pulmonary Embolism at Home: Radical/Economic Driven Practice or The Obvious Choice OTS PEDIATRIC SESSION Seating is limited to 30 participants for this session. THEME: DON T FORGET THE KIDS! THINGS WORTH KNOWING IF YOU TREAT KIDS, OR PEOPLE WHO USED TO BE KIDS 1:45 p.m New Tools to Measure Old Diseases in Young Patients 2:15 p.m. Pediatric Pulmonary Hypertension in 2016 REGISTRATION Friday only or Friday and Saturday morning (includes Friday Lunch): EARLY BIRD REGISTRATION BEFORE DECEMBER 31, 2015 Registration AFTER December 31, 2015 Breathe! Benefit event An evening of inspiration to benefit Lung Health Research $350 - OTS member $400 - OTS member $250 BBC Registrants $95 - OTS Membership renewal $95 - OTS Membership renewal $350 Individual tickets $445 - Non-Member (includes OTS membership to March 31, 2017) $495 - Non-Member (includes OTS membership to March 31, 2017) For more details on this event, please visit $95 - Resident Staff $95 - Resident Staff TO REGISTER FOR BETTER BREATHING 1. ONLINE: visit 2. FAX: complete your registration and satellite session registration forms with payment and fax to (416) MAIL: complete your registration and satellite session registration forms with payment and send to: Ontario Thoracic Society, Ontario Lung Association 18 Wynford Drive, Suite 401 Toronto, ON M3C 0K8 IMPORTANT: If you are registering for the Better Breathing Conference by mail or fax, please include a registration form for the satellite sessions with your BBC registration. To download and print the Satellite Sessions Registration form, visit the BBC website at and click on Ontario Thoracic Society. On the form you will need to fill in your name, and your selection of sessions. If you do not plan on attending any please also include this on your form. Return the completed satellite sessions registration form with your BBC registration. All satellite symposia are included with your registration. Meals will be served with all satellite sessions. (Does not apply to those registering online for the conference, registration for satellite symposia is automatic for those registering online). For more information: Tel: (416) ext [email protected] PAYMENT DETAILS Please ensure to include sufficient amount if after December 31, REGISTRATION FEE $ + MEMBERSHIP FEE $ (OTS) + BREATHE! $250 (BB REGISTRANT) $350 (ADDITIONAL TICKETS) CHEQUE ENCLOSED PAYABLE TO THE LUNG ASSOCIATION CHARGE MY: VISA / MASTERCARD / AMEX Name of Cardholder Signature TOTAL: $ Credit Card No. Expiry Date