Fall 2015 CME Conference

Registration Brochure Fall 2015 CME Conference Friday through Sunday, October 9-11, 2015 DoubleTree by Hilton Hotel Tarrytown Tarrytown, New York

2015/2016 Board of Directors Jennifer E. Kelly, MPAS, PA-C President Mary Springston, PA-C, MS, Ed President Elect John Hallowell, MBA, PA-C Vice President/Chief Delegate Virginia Kaufman, PA-C, WCC Secretary Ariana Zaza, MPAS, PA-C Treasurer Daniel Forsberg, PA-C, MPH, CPH Past President Jonathan Uitto Executive Director District Directors Area A - Brian Glick, PA-C Area B - Thomas J. Antonini, MPA-C Area C - Sheri Orr, MBA, PA-C Area D - Donna Hall, PA-C Area E - Lauren Morasse, MS, PA-C Student Directors Adam Paul Fenton, PA-S; NYIT Mike Sacks, PA-S; Hofstra University Jennifer Marie Griffith, PA-S; Pace 2015 Fall CME Conference Committee Shannan Maxey-Ricoy, MS, PA-C (Co-Chair) Christine Zammit, MS, PA-C (Co-Chair) Mary Banahan, MS, PA-C (Co-Chair) Jennifer Kelly, MPAS, PA-C Christine Amendola, PA-C Erika Bramlette, MBA, PA-C Susan Cappelmann, MS, MT, PA-C Carlo Gwardschaladse, MBA, PA-C Tracy Jackson, PA-C Monica Losquadro, PA-C JoAnn Montecalvo, PA-C Sheri Orr, MBA, PA-C Kelly Porta, MS, PA-C Maureen Regan, MBA, PA-C Erica Reid, PA-S Mike Sacks, PA-S Travis Sherer, PA-C, AAHIVS Brittni Silvestri, PA Ariana Zaza, MPAS, PA-C Dear Colleague, The NYSSPA Executive Board and I welcome you to Tarrytown! We hope that you find the 2015 Fall CME conference informative, applicable and fun! We hope you rekindle old friendships and make some new ones. During your time here, see some of what the Hudson Valley has to offer and enjoy dinner at one of the many area restaurants. Minutes to NYC and all that has to offer, we hope you find the conference convenient to all you might enjoy! We have again arranged the program in tracks to allow for little conflict with areas of common interest. Please be sure to attend the Membership Luncheon and meet with your District Director and other members in your region. Please make sure to stop by the Fifth Annual Poster Session and see and discuss the research your future colleagues have been producing. Finally, keep in mind that NYSSPA is a Twenty-Four hour Seven day a week organization, entirely devoted to ensuring professional advancement for you. We provide a resource to assist you in doing your job and advancing your career. Take a moment to talk with board members about your concerns, learn more about utilization, regulation, reimbursement, contracting, or any issues you may have in your practice setting. Get involved, there are many opportunities to lend your talents to the organization or to develop new skills. Thank you for being a part of the 2015 conference and your continued support of NYSSPA! Best Regards, Jennifer Kelly, MPAS, PA-C President Images ThinkStock istockphoto/comstock 2

SCHEDULE OF EVENTS Friday, October 9, 2015 7:00 AM 7:00 PM Registration Open 8:00 AM 9:00 AM Breakfast with Exhibitors & Posters 8:00 AM 5:00 PM Exhibits Open 8:00 AM 5:00 PM Poster Session 10:00 AM 10:30 AM Coffee Break with Exhibitors & Posters Women s Health Track 8:00 AM 9:00 AM Concomitant Management of Pelvic Organ Prolapse and Stress Urinary Incontinence Bogdan Grigorescu, MD 9:00 AM 10:00 AM Screening for Perinatal Mood and Anxiety Disorders in Pediatric Primary Care Jack Levine, MD 10:30 AM 11:30 AM 2015 Current Pap Guideline Karen Crowley, MS, PA-C Behavioral Medicine/Psychiatry Track 9:00 AM 10:00 AM Behavioral Emergencies Shinu Kuriahose, MPAS, PA-C 10:30 AM 11:30 AM Advances in the Treatment of Depression Jerry Chang, MD 11:30 AM 12:30 PM Screening and Intervention for Substance Use Disorders in the Primary Care Setting Frank G. Dowling, MD Allison Maloney, PhD 12:30 PM 2:00 PM Legislative Luncheon 3:00 PM 3:30 PM Refreshment Break with Exhibitors & Posters Professionalism Track 11:30 AM 12:30 PM Issues Affecting Pimary Care Practice in 2015 Jean Covino, DHSc, MPA, PA-C 2:00 PM 3:00 PM Is Race a Factor When Prescribing Medication? Harry Pomeranz, MS, PA-C Reynold Jaglal, MBA, PA-C 3:30 PM 4:30 PM Like a Sandwich Without the Bread: Examining the Four Dimensions of Health Disparities James Anderson, MPAS, PA-C, ATC, DFAAPA 4:30 PM 5:30 PM Navigating the Affordable Care Act in Primary Care Michelle Melchiorre, MS, PA-C Emergency/Trauma Track 2:00 PM 3:00 PM Oncologic Emergencies Katherine L. Kunstel, MMSc, PA-C 3:30 PM 4:30 PM Post-operative and Post-trauma Respiratory Failure and Pneumonia Brian Van Ness, MS, PA-C 4:30 PM 5:30 PM Gender Based Violence in the Emergency Department Christine Lazaros Amendola, MS, PA-C, NY-SAFE CT Surgery/Cardiology Track 2:00 PM 3:00 PM PFO s: Considerations for Catheter Based Closure & Atrial Fibrillation: What You Need to Know Sean Levchuck, MD Nicole Cornachio, PA-C 3:30 PM 4:30 PM Aortic Stenosis: What is TAVR? & Transcatheter Therapies for Mitral Reguritation Kristen Pascarello, PA-C Tiffany Wong, PA-C 4:30 PM 5:30 PM The Role of Hemodynamic Support Devices in the Cath Lab & A Look into the Future: Imaging Modalities in the Cath Lab Bridget McGarry, PA-C Monica Losquadro, MS, PA-C Receptions 7:15 PM 8:00 PM Student Reception Students Only 8:00 PM 12:00 AM NYSSPA Reception & Party Saturday, October 10, 2015 7:00 AM 6:30 PM Registration Open 7:00 AM 8:00 AM Breakfast Showcase 8:00 AM 12:30 PM Exhibits Open 10:00 AM 10:30 AM Coffee Break with Exhibitors Pediatrics Track 8:00 AM 9:00 AM Early Relationships Matter: The Catalyst for the New York Association for Infant Mental Health and a New System of Standards and Competencies Marcy Safyer, PhD, LCSW-R 9:00 AM 10:00 AM Are You Smarter than a Pediatric Intensivist: Audience Response Session Edward E. Conway, Jr., MS, MD Orthopedics Track 10:30 AM 11:30 AM Management Options of Degenerative Joint Disease of the Hip and Knee Jeffrey Wagner, PA-C 11:30 AM 12:30 PM To Have or Not to Have Arthroscopy? That is the Question Donna Romano, MPAS, PA-C FALL 2015 CME CONFERENCE / OCTOBER 9-11, 2015 3

SCHEDULE OF EVENTS Saturday, October 10, 2015 Educators Track 8:00 AM 9:00 AM PAEA Examinations in the PA Curriculum: Are They Worth It? Christine Zammit, MS, PA-C Shannan Maxey-Ricoy, MS, PA-C 9:00 AM 10:00 AM Remediation Techniques Kelly Porta MS, PA-C Mark L Eplattenier, MPAS, PA-C 10:30 AM 11:30 AM Incorporating Interprofessional Education into PA Curriculum Mary Banahan, MS, PA-C Pamela Gregory-Fernandez, MS, PA-C 11:30 AM 12:30 PM Faculty Forum: Challenges in PA Education Susan O. Cappelmann, MS, PA-C, MT(ASCP) Carina Loscalzo, MS, PA-C Surgery Track 8:00 AM 9:00 AM Injury Prevention Larry M. Gentilello, MD 9:00 AM 10:00 AM Trauma and Pregnancy Aparna Kolli, MD 10:30 AM 11:30 AM Breast Cancer and Breast Reconstruction Jennifer Oliver, PA-C 11:30 AM 12:30 PM The Role of the PA in Robotic Surgery Suzannah Sorin, MPAS, PA-C Student Track 9:00 AM 10:00 AM EKGs as Easy as ABC s in 60 Minutes Stacey Singer-Leshinsky, PA-C 10:30 AM 11:30 AM Understanding Acute Leukemia and its Common Complications John Katsetos, PA-C 11:30 AM 12:30 PM The Approach to the Pediatric Patient Christopher Kelly, MD 12:30 PM 2:00 PM Membership Luncheon Workshops (additional fee applies) 2:00 PM 5:00 PM Clinical Informatics Patti Cuartas, PA, MBA, PMP Alison Connelly-Flores, PA 2:00 PM 5:00 PM Mini-Skills 2:00 PM 4:00 PM AANPA - Kidneys in a Box Kim Zuber, PA-C NYSSPA is pleased to offer a workshop that will assist PAs needing to complete their Performance Improvement CME (PI-CME) for their NCCPA certification. Participants attending the workshop on chronic kidney disease will earn Category 1 CME credits. After completion of the workshop, there will be an opportunity to earn an additional 20 AAPA Category 1 PI-CME credits by completing the optional Kidneys in a Box post program. Completion will satisfy the NCCPA PI-CME requirement. 4:00 PM 5:00 PM AANPA - The Good, the Bad and the Latrogenic Kim Zuber, PA-C **Session is complimentary for all attendees, NYSSPA will apply for approval through AAPA for Category 1 Self Assessment CME (SA-CME) credit. Internal Medicine Track 2:00 PM 3:00 PM Utilization of Abdominal and Renal Ultrasound in Primary Care Ronald Thompson, MD 3:00 PM 4:00 PM IBD & Nutrition Joanna Esterow, PA-C 4:00 PM 5:00 PM The Role of Naturopathic Physicians in Primary Care Geovanni Espinosa, ND, LAc Critical Care/ICU Track 2:00 PM 3:00 PM Traumatic Brain Injury - A Critical Care Perspective Joseph Lindner, MPAS, PA-C 3:00 PM 4:00 PM Oxygen Delivery Michael Grossman, MD 4:00 PM 5:00 PM Sepsis Update 2015 Frank A. Acevedo, MS, PA-C, DFAAPA Receptions & Dinner 5:45 PM 6:30 PM President s Reception 6:30 PM 7:30 PM Alumni Receptions 7:30 PM 8:00 PM Gala Reception 8:00 PM 12:00 AM Clara Vanderbilt Gala Dinner Sunday, October 11, 2015 8:00 AM 1:00 PM Registration Open/ CME Certificate Distribution 8:00 AM 10:00 AM Pre-PA Fair & Professional Workshop Kevin Bolan, PA-C Maureen C. Regan, PA-C Peter D. Kuemmel, MS, PA-C Susan Cappelmann, MS, PA-C, MT(ASCP) Carina Loscalzo, MS, PA-C 9:00 AM 10:00 AM Breakfast Showcase 10:00 AM 1:00 PM Medical Jeopardy Hematology/Oncology Track 10:00 AM 11:00 AM Clinical Ethics for the Physician Assistant Sharyn Kurtz, MA, MPAS, PA-C 11:00 AM 12:00 PM Radiation Oncology Majorie A. Nagle, PA-C Note: Lectures and speakers may be added or changed after the printing of this brochure. For updated conference information, please visit the NYSSPA website at. FALL 2015 CME CONFERENCE / OCTOBER 9-11, 2015 4

Frank A. Acevedo, MS, PA-C, DFAAPA New York Institute of Technology/Winthrop University Hospital Department of Surgical Critical Care Mineola, NY Christine Lazaros Amendola, MS, PA-C, NY-SAFE North Central Bronx/Jacobi Hospital Department of Emergency Valhalla, NY James Anderson, PA-C, MPAS, ATC, DFAAPA Evergeen Treatment Services Seattle, WA Mary Banahan, MS, PA-C Hofstra University Farmingdale, NY Kevin Bolan, PA-C Newcomb Health Center Newcomb,NY Susan O. Cappelmann, MS, PA-C, MT(ASCP) Pace University College of Health Professions Jerry Chang, MD Zucker Hillside Hospital - North Shore-LIJ Health System Department of Psychiatry Glen Oaks, NY Alison Connelly-Flores, PA Urban Health Plan, Inc Department of IT/Medicine Bronx, NY Edward E. Conway, Jr., MS, MD Mount Sinai Beth Israel Medical Center Department of Pediatrics Nicole Cornachio, PA-C Island Cardiac Specialists Department of Cardiology/Electrophysiology Garden City, NY Faculty Listing Jean Covino, DHSc, MPA, PA-C Pace University-Lenox Hill Hospital Karen Crowley, MS, PA-C North Shore University Hospital Department of Obstetrics/Gynecology Manhasset, NY Patti Cuartas, PA, MBA, PMP Montefiore Medical Center Clinical Informatics Bronx, NY Frank G. Dowling, MD Stony Brook University Stony Brook, NY Geovanni Espinosa, ND, LAc NYU Integrative & Functional Urology Center Joanna Esterow, PA-C Weill Cornell Medical College Larry M. Gentilello, MD Southside Hospital - North Shore-LIJ Health System Department of Surgery Bay Shore, NY Pamela Gregory-Fernandez, MS, PA-C St. John s University College of Pharmacy and Health Sciences Physician Assistant Program Fresh Meadows, NY Bogdan Grigorescu, MD Winthrop University Hospital Department of Obstetrics and Gynecology Mineola, NY Michael Grossman, MD Southside Hospital - North Shore-LIJ Health System Department of Acute Care Surgery Bay Shore, NY John Katsetos, PA-C New York Presbyterian: Weill Cornell Medical Center Department of Hematology-Oncology Christopher Kelly, MD New York Methodist Hospital Department of Pediatric Emergency Medicine Brooklyn, NY Aparna Kolli, MD Southside Hospital - North Shore-LIJ Health System Department of Acute Care Surgery Bay Shore, NY Peter D. Kuemmel, MS, PA-C Stony Brook University Department of Physician Assistant Education Stony Brook, NY Katherine L. Kunstel, MMSc, PA-C Pace University - Lenox Hill Hospital Shinu Kuriakose, MPAS, PA-C Stony Brook Physician Assistant Program Stony Brook, NY Sharyn Kurtz, MA, MPAS, PA-C Memorial Sloan Kettering Cancer Center Department of Medicine Mark L Eplattenier, MPAS, PA-C Hofstra University Hemsptead, NY Sean Levchuck, MD Saint Francis Hospital Department of Cath Lab/Cardiology Roslyn, NY Jack Levine, MD Nassau University Medical Center Department of Pediatrics East Meadow, NY 5

Joseph Lindner, MPAS, PA-C Jacobi Medical Center Department of Trauma/Surgical Critical Care Bronx, NY Carina Loscalzo, MS, PA-C Hofstra University Hemsptead, NY Monica Losquadro, MS, PA-C Saint Francis Hospital Department of Cath Lab Roslyn, NY Allison Maloney, PhD Long Island Mind Body Medicine Group Garden City, NY Bridget McGarry, PA-C Saint Francis Hospital Department of Cath Lab Roslyn, NY Michelle Melchiorre, MS, PA-C Boriken Neighborhood Health Center Department of Family Medicine Springfield, NJ Marjorie A. Nagle, PA-C Memorial Sloan Kettering Cancer Center Department of Radiation Oncology Jennifer Oliver, PA-C Memorial Sloan Kettering Cancer Center Department of Surgery Faculty Listing Kristen Pascarello, PA-C Saint Francis Hospital Heart Valve Center Roslyn, NY Harry Pomeranz, MS, PA-C Sacred Heart University College of Health Professions Physician Assistant Program Fairfield, CT Kelly Porta, MS, PA-C Hofstra University Hemsptead, NY Shannan Maxey-Ricoy, MS, PA-C Hofstra University Hempstead, NY Maureen C. Regan, MBA, PA-C Winthrop University Hospital Mineola, NY Donna Romano, MPAS, PA-C Premier Orthopedic Surgery and Sport Medicine, PLLC Melville, NY Marcy Safyer, PhD, LCSW-R Adelphi University Institute for Parenting Garden City, NY Stacey Singer-Leshinsky, PA-C St. John s University Department of Clinical Health Professions Suzannah Sorin, MPAS, PA-C NYU Langone Medical Center Department of Surgery-Robotics Ronald Thompson, MD Radiology Enterprises, LTD Radiology Conyers, GA Brian Van Ness, MS, PA-C Hackensack University Medical Center Department of Surgical- Trauma ICU Hackensack, NJ Jeffrey Wagner, PA-C Southside Hospital - North Shore-LIJ Health System Department of Orthopedics Bay Shore, NY Tiffany Wong, PA-C Columbia University Medical Center Heart Valve Center Christine Zammit, MS, PA-C Hofstra University Hemsptead, NY Kim Zuber, PA-C American Academy of Nephrology Physician Assistants (AANPA) Alexandria, VA 6

ANNUAL NYSSPA FALL CME CONFERENCE WEEKEND Since our annual Fall NYSSPA CME Conference is scheduled for Columbus Day weekend this year (October 9-11), why not bring the whole family and enjoy some of the fabulous fall activities that Tarrytown and its surrounding communities have to offer. The Hudson Valley region is jammed packed with activities that will entertain young and old alike. Below gives a sampling of some of the events going on that weekend. Horseman s Hollow Taking the tale of The Legend of Sleepy Hollow to its darkest extremes, Horseman s Hollow takes visitors through an 18thcentury town driven mad by the Headless Horseman. Creatures, human and otherwise, lurk in the shadows. Heads will roll...maybe even your own! $20 Friday night $25 Saturday night The event organizers advise: This event is NOT suitable for adults who are claustrophobic, have heart or respiratory conditions, are prone to seizures, or have other chronic health conditions. Enter at your own risk! Great Jack O Lantern Blaze Over 5,000 hand-carved, illuminated pumpkins set against the mysterious backdrop of Van Cortland Manor s 18th-century buildings and riverside landscape. $20 Friday night ($16 ages 3-17) $25 Saturday night ($20 ages 3-17) Recommended for all ages Irving s Legend Master storyteller Jonathan Kruk offers a dramatic performance of Washington Irving s classic tale, The Legend of Sleepy Hollow. Featuring the Headless Horseman, Ichabod Crane, Brom Bones, and Katrina Van Tassel. Flavored with live spooky organ music by Jim Keyes, Kruk s spellbinding storytelling captivates all audiences. $20 both nights (children < 18, $16) Recommended for ages 10+ Sleepy Hollow Cemetery Tours A trip to Sleepy Hollow isn t complete without a visit to Sleepy Hollow Cemetery and its famous residents, including Elizabeth Arden, Brooke Astor, Andrew Carnegie, Walter Chrysler, Samuel Gompers, Washington Irving, and William Rockefeller. $19.99 for Guided Walking Tours Recommended for all ages For more information on these and other events in the area, please visit http://www.hudsonvalley.org or http://visitsleepyhollow.com/ Photos courtesy of www.hudsonvalley.org. 7

General Information Continuing Medical Education (CME) Credits - Category 1 The New York State Society of Physician Assistants utilizes the ACCME standards for programs of the AAPA (American Academy of Physician Assistants) in order to provide CME to participants. NYSSPA takes responsibility for the content, quality and scientific integrity of the CME Activity. This program is not yet approved for CME Credit. NYSSPA plans to request at least 30 hours of AAPA Category I CME credit from the Physician Assistant Review Panel. Total number of approved credits is yet to be determined. Each PA should claim only those hours of credit that he/she actually spent in the educational activity. This program is planned in accordance with AAPA s CME Standards for Live Programs and for commercial support of Live Programs FOR ASSISTANCE OR ADDITIONAL INFORMATION The NYSSPA Registration team is happy to assist with any questions or concerns you may have. Please do not hesitate to contact us at (877) 769-7722, or you can send an e-mail to nysspareg@nysspa.org NOT A NYSSPA MEMBER? Discounted registration fees are one of the many benefits of becoming a member of the New York State Society of Physician Assistants. If you are not a NYSSPA member, and you submit a completed membership form on or before the deadline, you will receive the NYSSPA member registration rate. For your convenience, a membership application is included in this brochure, available on the website () or call NYSSPA Headquarters at (877) 769-7722, for more information. SCHOLARSHIP COMMITTEE ACTIVITIES The Scholarship Committee is planning a fund-raising activity during the Fall Conference to benefit the Scholarship Fund. HOTEL INFORMATION DoubleTree by Hilton Hotel Tarrytown 455 S Broadway Tarrytown, NY 10591 914-631-5700 ACCOMMODATIONS The Fall CME Conference will be held at the DoubleTree by Hilton Hotel, Tarrytown, New York. You can reserve a room at the negotiated rate of $165 (single/double occupancy) plus tax (Thursday Sunday). Rooms will be available at this rate until September 15, 2015 or until the block is full, whichever comes first. You can call the hotel directly at 914-631-5700 and be sure to mention that you are a NYSSPA conference attendee. You can also reserve a room online by clicking here and to the left of the page when entering your dates, click on the link Add special rate codes. Under group code enter NSP. Checkin time is 3:00 pm and check-out time is 12:00 pm. It is recommended that you make your hotel reservation as early as possible to insure availability. Parking is complementary. FALL 2015 CME CONFERENCE / OCTOBER 9-11, 2015 8

General Information EXHIBITS Educational and informational exhibits will be available for viewing during the Conference and representatives will be available to answer questions. Please visit the exhibits as they are an integral part of the meeting. SPECIAL NEEDS The Hilton Tarrytown Doubletree is accessible to persons with disabilities. Specially equipped sleeping rooms are available by request in advance of arrival. Registrants with questions regarding special housing, equipment, transportation and auxiliary requirements should indicate this on the registration form or contact NYSSPA Meetings, 877-769-7722. Please give prior notification so that we can make arrangements in advance of the meeting. ATTIRE Attire for the Conference is business casual with the exception of the Gala Dinner where business attire is requested. CELL PHONE USAGE NYSSPA acknowledges that cell phones are very important in our lives; however, during the lectures, it is requested that all cell phones should be turned off or on the silent/vibrate mode. CONFERENCE CONTACTS NYSSPA Conference HQ 100 North 20th Street, Suite 400 Philadelphia, PA 19103 FOR MEETING MANAGEMENT AND CORPORATE SUPPORT: Telephone: 877-769-7722 E-Mail: meetings@nysspa.org FOR EXHIBIT MANAGEMENT AND SPONSORSHIP: Telephone: 877-769-7722 E-Mail: tdiggs@nysspa.org REGISTRATION QUESTIONS Telephone: 877-769-7722 E-Mail: nysspareg@nysspa.org NYSSPA MISSION To improve the quality of healthcare and promote the Physician Assistant profession in the State of New York. FALL 2015 CME CONFERENCE / OCTOBER 9-11, 2015 9

Fall 2015 CME Conference Registration DoubleTree by Hilton Hotel Tarrytown, Tarrytown, NY October 9-11, 2015 ONLINE: (Preferred) at BY MAIL: Send completed form with check payment to NYSSPA 2015 Fall CME Conference, 100 North 20 th Street, Suite 400, Philadelphia, PA 19103 REGISTRATION INFORMATION (Please print or type) o Please check if assistance is needed Name (Name on Badge) Degree/PA-C (list clearly) Affiliation PA Program Attended (ing) Address City State Zip Business Telephone E-Mail Address Fax Number Spouse/Guest Name: (Name on Badge) REGISTRATION FEE Early Bird Advanced On-Site Please check one: Through 8/14/15 8/14/15-9/25/15 After 9/25/15 o NYSSPA Member $325.00 $ $350.00 $ $425.00 $ o Constituent Chapter Member $325.00 $ $350.00 $ $425.00 $ o NYSSPA PA Student Member $150.00 $ $150.00 $ $200.00 $ o One Day Only Member: $175.00 $ $205.00 $ $275.00 $ o Friday o Saturday o Sunday o Join & Register $500.00 $ $525.00 $ $600.00 $ o Non-Member $525.00 $ $575.00 $ $650.00 $ o PA Student Non-Member $250.00 $ $250.00 $ $300.00 $ o One Day Only Non-Member: $350.00 $ $375.00 $ $450.00 $ o Friday o Saturday o Sunday o Spouse/Guest $140.00 $ $140.00 $ $175.00 $ Optional Information: o PA Faculty o PA Preceptor o Interested in PA Education contact cappelmann@nysspa.org o Vegetarian Meal Requested o Special Needs Assistance Requested Registration fees include: CME Lectures, AM/PM Breaks, Legislative Luncheon, Exhibit Hall access, the Past President s Reception and Gala Dinner. The Spouse/Guest registration fee includes continental breakfast, exhibit hall refreshments, lunches and receptions (Student s & NYSSPA) and the Gala Dinner. Spouse/Guest registration does not include admittance to any presentations. Due to the professional nature of the conference, children under the age of 18 are restricted from the educational sessions. TRACK OF STUDY (please check one box for each track time-frame): Friday, October 9: AM Tracks: o Women s Health o Behavioral Medicine/Psychiatry PM Tracks: o Professionalism o Emergency/Trauma o CT Surgery/Cardiology Saturday, October 10: AM Tracks: o Pediatrics o Orthopedics o Educators o Surgery o Student PM Tracks: o Internal Medicine o Critical Care/ICU Sunday, October 11: AM Tracks: o Hematology/Oncology

Fall 2015 CME Conference Registration DoubleTree by Hilton Hotel Tarrytown, Tarrytown, NY October 9-11, 2015 Conference Workshops & Events Member Non-Member Time Saturday, October 10 o Clinical Informatics $ 60.00 $ $100.00 $ 2:00 pm 5:00 pm o Clinical Informatics (Stand Alone) $160.00 $ $160.00 $ 2:00 pm 5:00 pm o Mini Skills $ 50.00 $ $ 75.00 $ 2:00 pm 5:00 pm o PI-CME Workshop $ 15.00 $ $ 15.00 $ 2:00 pm 5:00 pm Sunday, October 11 o Pre-PA Fair & Professional Workshop $ 75.00 $ $ 75.00 $ 8:00 am 10:00 am Membership Fee o Renewal $175.00 $ o New Member $175.00 $ o Student Membership $ 75.00 $ (Valid for duration of student enrollment) Total Registration Fees $ $ Membership Information: A membership application is included in the registration brochure or is available on the web site:. Or call NYSSPA Headquarters: 877-769-7722 for more information. PAYMENT METHOD REGISTRATIONS RECEIVED WITHOUT PAYMENT WILL NOT BE PROCESSED o Enclosed is a check payable to NYSSPA. Checks must be payable in U.S. dollars. A $75.00 processing fee will be charged for returned checks. ACCEPTABLE FORMS OF PAYMENT Checks: are acceptable when registration is submitted by mail or completed online or onsite at the conference. Checks must be payable (in US Dollars) to NYSSPA and issued by a US Correspondent bank. The registrant is responsible for any and all bank charges. Check with your bank before processing payment. Credit cards: may be used for online registration or completed on site at the conference. NYSSPA accepts Visa, MasterCard and American Express. NYSSPA reserves the right to charge the correct amount if different from your calculated total. Cash: is acceptable (US dollars only) when registration is done in person at the conference. Only US Dollars will be accepted for on-site registration (foreign currency will not be accepted). Please do not send cash through the mail! CONFIRMATIONS Your registration will be acknowledged with an electronic confirmation within one week of receipt. If confirmation is not received by that time, please call (877) 769-7722 or e-mail nysspareg@nysspa.org. Please be sure to provide a valid e-mail address so that we may send your confirmation electronically. CANCELLATION POLICY Requests must be submitted in writing to NYSSPA Registration, 100 North 20th Street, Suite 400, Philadelphia, PA 19103 and postmarked no later than October 5, 2015. All fees paid will be refunded minus a $75 processing fee. THERE WILL BE NO REFUNDS AFTER THE OCTOBER 5, 2015 DEADLINE.

Membership Categories Full Member Affiliate Member Associate Member You re Invited to Join NYSSPA Today! NYSSPA s Membership Year is from July 1 - June 30. 18-Month Membership is for those individuals who are joining mid-year between the months of October-April. $175 Annually $225 18-Month $300 2-Year Membership $175 Annually $225 18-Month $300 2-Year Membership $175 Annually $225 18-Month $300 2-Year Membership Any person who is registered in New York State as a PA and is a fellow member of the American Academy of Physician Assistants Any person who is registered in New York State as a Physician Assistant and is eligible for fellow membership in the AAPA but who chooses not to become such Physician Assistants from other states, or PAs in New York State who are not employed; Non-Physician Assistants who support the goals of NYSSPA Sustaining Members $75 Annually Physician Assistants eligible for Full or Affiliate membership who have chosen not to practice in a PA-oriented career or who have retired from the PA profession Student Member $75 Any person enrolled in a PA program or interested in pursuing a career in the Physician Assistant profession Student membership is valid for the duration of your student enrollment NYSSPA s Significant Accomplishments Successful lobbying for and passage of the Re-statement of Physician Assistant Practice Act Successfully lobbied for the legislative removal of the 24-hour Countersignature Requirement for PAs Secured DEA Licensure for the PA privilege to prescribe Schedule II-V Medications Protected Physician Assistants rights to First Assist in surgery Obtained Licensure for Physician Assistants from the Department of Education Awarded over $60,000 in PA student scholarships over the past decade Supported appointment of a PA Representative on the board of the OPMC These initiatives take time, money and personnel; they could not have been achieved without a strong NYSSPA Membership. NYSSPA needs you now and the best way to support the Society and the PA profession in New York is to join as a member. NYSSPA also has a membership program specifically for physicians interested in joining, which is called the Physician Partnership Program. Join NYSSPA today! 12

r New r Renewal/Former NYSSPA Membership Application First/Middle/Last Name Credentials Home Address/Street City State Zip County/District Home Phone Home E-mail Cell # Preferred Mailing Address: r Home r Work Place of Employment Referred by Practice/Department/Specialty Employment Address City/State/Zip Work Phone Work Fax Work E-mail AAPA# (if applicable) NCCPA Registration # NYS License # PA Program graduated from or currently attending Graduation Date (Required for Student Membership) r Please do not list me in the membership directory. r I am interested in being a Mentor Please indicate your interest in serving on a Committee(s) r Business Development r Finance r Membership r Reimbursement r Surgical Caucus r Committee on Diversity r Government Affairs r Newsletter r Scholarship r Website r Conference Planning r Judicial Affairs r Professional Relations r Social Media r Elections r Leadership r Public Education r Student Affairs Annual Dues Payment Please note that a portion of your dues will be used to support legislative lobbying efforts on behalf of NYSSPA and all New York State Physician Assistants. Dues Amount: Membership Length: r 1 Year r 18 months r 2 Years Membership Type: r Full r Affiliate r Associate r Sustaining r Student (valid through enrollment) $ Voluntary Scholarship Contribution: Help NYSSPA give annual scholarships annually to deserving students the voices of our future. ($50 suggested) $ Support NYSSPA s lobbying efforts with a PAC contribution. ($50 suggested) $ Total: $ If paying by check, please make check payable to NYSSPA and mail to NYSSPA, 100 North 20th Street, Suite 400, Philadelphia, PA 19103 Credit card payments can be faxed to NYSSPA at (215) 564-2175. r Visa r MasterCard r Amex Card # Exp Date Security Code Signature Automatic Renewal No more renewal notices. If paying by credit card you may authorize NYSSPA to automatically deduct your dues on an annual basis. r Yes, I want my membership to be automatically renewed each year and authorize NYSSPA to charge my credit card. Join NYSSPA today! 13

Save The Date! Fall 2016 CME Conference October 7-9, 2016 DoubleTree by Hilton Hotel Tarrytown Tarrytown, New York