1 9 T H A N N U A L M E D I C A L S T A F F E D U C A T I O N A L S Y M P O S I U M

June 24-25, 2016Boyne MountainBoyne Falls, MI

K E E P I N G I T I N T H E F A M I LY

Last year, our colleagues from Botsford and

Oakwood Health System came to Boyne

Mountain for the first time. Not surprising to

Symposium veterans, the result was the same.

The academic program was outstanding and

everyone had a good time. While new friends

were made, the laughter of children and the

commitment to learning remained unchanged.

The only difference was that we added Team

Trivia to the program. This further emphasized

our similarity; everyone, regardless of institution

or background, competed vigorously! Last year

many of us were meeting for the first time. This

year we return to celebrate a successful year

together. Beaumont Health is firmly on the map

and an organizational strategy is now in place.

Yet we remain challenged by the tsunami of

change in health care. Amidst this uncertainty,

the Beaumont Health Medical Staff Symposium

remains an opportunity to enjoy a few days of

stability, unless you choose to participate in the

Family Scavenger Hunt where anything goes!

Have a great weekend.

Welcome

David Forst, M.D. Symposium Director Medical Staff President, Beaumont Hospital, Troy; Department of Cardiovascular Medicine, Beaumont Health; Professor, Department of Internal Medicine, Oakland University William Beaumont (OUWB) School of Medicine

Roderick Boyes, M.D. Chief of Staff, Beaumont Hospital, Dearborn; Department of Internal Medicine, Beaumont, Dearborn

Kassem Charara, M.D. Chief of Staff, Beaumont Hospital, Taylor; Department of Surgery, Beaumont, Taylor; Assistant Clinical Professor, Department of Surgery, Wayne State University

George Ghanem, M.D. Medical Staff President, Beaumont Hospital, Grosse Pointe; Department of Cardiovascular Medicine, Beaumont, Grosse Pointe; Assistant Professor, Department of Internal Medicine, OUWB School of Medicine

Ashok Jain, M.D. Chief of Staff, Beaumont Hospital, Wayne; Department of Radiology, Beaumont, Wayne

Alonzo Lewis, MHSA Vice President, Women & Children’s Services and Business Development, Beaumont Health

Iqbal Nasir, M.D. Chief of Staff, Beaumont Hospital, Trenton; Department of Internal Medicine, Beaumont, Trenton; Clinical Associate Professor, Michigan State University

Peggy Nowak, M.D. Medical Staff President, Beaumont Hospital, Royal Oak; Department of Otolaryngology, Beaumont, Royal Oak; Associate Professor, Department of Surgery, OUWB School of Medicine

Raimundo Pastor, D.O. Medical Staff President, Beaumont Hospital, Farmington Hills; Department of Surgery, Beaumont, Farmington Hills; Assistant Clinical Professor of Surgery, Michigan State University College of Osteopathic Medicine

Jill Schoenherr Senior Executive Administrative Assistant & Conference/Event Planner, Beaumont, Troy

Symposium Planning Committee

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Symposium/Event Overview

The Medical Staffs of Beaumont Health are hosting a weekend educational symposium at Boyne Mountain beginning Thursday evening, June 23, to promote the continuing education of the Beaumont Medical Staff. In addition to the presentation of interesting medical topics, social activities are planned.

Educational Conference

The19th Annual Symposium is your source for cutting-edge information, best practices and national guidelines that cover a wide variety of medical specialties and disease management.

Who Should Attend

Medical Staff members and leaders of Beaumont Health.

Conference Registration

See enclosed registration form for various pricing levels.

Call, fax, or mail registration:

Phone: 248-964-1063 Fax: 248-964-8842 Mail: Beaumont, Troy/Administration 44201 Dequindre Rd. Troy, MI 48085

For questions please contact Jill Schoenherr at jill.schoenherr@beaumont.org

For additional event information, please visit https://beaumont.cloud-cme.com

Lodging

A block of rooms has been reserved at Boyne Mountain. Please call, mail or fax your reservation request using the enclosed registration form. Please be sure to mention “Beaumont Health” when reserving your overnight accommodations in order to receive our negotiated rate.

Call, fax, mail or go online for your overnight accommodation requests:

Phone: 800-462-6963 Fax: 231-549-6844 Mail: Boyne Mountain Central Reservations Dept PO Box 19 Boyne Falls MI 49713 Website: boyne.com Use online code: 1063NB

CME Accreditation and Credit Designation

William Beaumont Hospital is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

William Beaumont Hospital designates this live activity for a maximum of 7.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Non-physician professionals should check with their individual credentialing bodies to confirm that participation in this CME activity will be approved for credit. CME credits can be used to meet the continuing education requirements needed for Michigan physician assistant and nursing relicensure without limitation.

This activity is eligible for meaningful participation (MP) credits. MP Questions? Contact Deirdre Pitts, 248-370-2741

Faculty Disclosure

All speakers and members of the planning committee have been asked to disclose any significant relationships they may have with commercial companies. The presence or absence of relationships will be disclosed at the time of the meeting.

Global and Educational Objectives

By attending the educational sessions, the participants should be better able to:

1. Apply a judicious approach to prescribing opiates.

2. Describe the utility, capability, and appropriateness of critical care air transport.

3. Explain how physicians can more easily transition from volume-based healthcare to value-based healthcare.

4. Identify opportunities to improve physician-patient communication/education using social media/internet.

5. Identify some of the new services/innovations that are being offered by Beaumont Health.

Evaluation Form

All participants wishing to receive CME credit for these sessions will be required to complete an online ”CME Evaluation Form”.

CME Overview

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Faculty Speakers

Patrick Pettengill, M.D., FAAEMMedical Director, Beaumont One Critical Care Transport; Department of Emergency Medicine, Beaumont, Royal Oak; Assistant Professor, Department of Emergency Medicine, OUWB School of Medicine

Paul Reitemeier, Ph.D.Corporate Director, Clinical Ethics; Department of Internal Medicine, Beaumont Health

Arthur Rosner, M.D.Department of Otolaryngology, Beaumont, Troy; Associate Professor, Department of Surgery, OUWB School of Medicine

Farnoosh Sokhandon, M.D.Medical Director of Body CT, Department of Radiology, Beaumont Health; Associate Professor, Department of Diagnostic Radiology and Molecular Imaging, OUWB School of Medicine

Karen Weaver, M.D.Director, Family Medicine Education Program and Chief, Department of Family Medicine, Beaumont, Wayne; Clinical Associate Professor, Department of Family Medicine, Wayne State University School of Medicine

Pablo Ysunza, M.D., Ph.D.Coordinator of Speech Services, Ian Jackson Craniofacial and Cleft Palate Clinic, Neuroscience Program, Beaumont, Royal Oak; Department of Physical Medicine and Rehabilitation, Beaumont, Royal Oak; Professor, Department of Physical Medicine and Rehabilitation, OUWB School of Medicine

Steven Ajluni, M.D.Department of Cardiovascular Medicine, Beaumont Health; Assistant Professor, Department of Internal Medicine, OUWB School of Medicine

Daniel Arndt, M.D.Department of Pediatric Neurology, Beaumont Health; Assistant Professor, Department of Pediatrics, OUWB School of Medicine

Bret Bielawski, D.O.Department of Internal Medicine, Beaumont, Troy; Assistant Clinical Professor, Department of Internal Medicine, Michigan State University College of Osteopathic Medicine

Lan Bui, D.O.Department of Obstetrics & Gynecology, Beaumont Health; Associate Program Director, OB/GYN Residency Program, Beaumont, Dearborn

Barry Franklin, Ph.D.Director, Department of Cardiovascular Rehabilitation, Beaumont, Royal Oak; Professor, Department of Internal Medicine, OUWB School of Medicine

Peyman Kabolizadeh, M.D., Ph.D.Department of Radiation Oncology, Beaumont Health; Assistant Professor, Department of Radiation Oncology, OUWB School of Medicine

Michael Brennan, D.O.Department of Internal Medicine, Beaumont, Grosse Pointe; Assistant Professor, Department of Internal Medicine, OUWB School of Medicine

Shant Korkigian, D.O.Department of Otolaryngology, Beaumont, Farmington Hills; Assistant Clinical Professor, Michigan State University School of Medicine

6:30 to 8 p.m. Welcome Reception

FRIDAY, June 24

6:45 to 8:30 a.m. Complimentary Buffet Breakfast

8:30 a.m. to 9:30 p.m. Optional Activities*

Core Educational Symposium7:30 to 8 a.m. Introductions

8 to 8:30 a.m. Beaumont One: Who Ya Gonna Call? Patrick Pettengill, M.D., FAEEM

8:30 to 9 a.m. Interaction of Radiology, Otolaryngology and Speech Pathology in Craniofacial Anomalies Pablo Ysunza, M.D., Ph.D.

9 to 9:30 a.m. Pediatric Epilepsy: More Than Meets the Eye Daniel Arndt, M.D.

9:30 to 9:45 a.m. BREAK

9:45 to 10:15 a.m. Proton Beam Therapy: The Force is With Us Peyman Kabolizadeh, M.D., Ph.D.

10:15 to 10:45 a.m. Thyroid and Parathyroid Neoplasms: Diagnostic Updates and New Trends Shant Korkigian, D.O.

10:45 to 11:15 a.m. Thriving in Challenging Times: Using Social Media Lan Bui, D.O.

11:15 to 11:45 a.m. Breaking News in Osteoporosis Michael Brennan, D.O.

11:45 a.m. to 12:45 p.m. Complimentary Buffet Luncheon

6 to 8 p.m. Family BBQ*

8 to 9:30 p.m. Family Scavenger Hunt*

7 to 8:30 a.m. Complimentary Buffet Breakfast

8:30 a.m. to 9:30 p.m. Optional Activities*

Core Educational Symposium7:45 to 8 a.m. Introductions

8 to 8:30 a.m. Population Health in World B Karen Weaver, M.D.

8:30 to 9 a.m. The Appropriate Use of Medical Imaging Farnoosh Sokhandon, M.D.

9 to 9:30 a.m. Beyond Acute and Palliative Care: An Ounce of Prevention is Worth a Pound of Pills and Procedures Barry Franklin, Ph.D.

9:30 to 9:45 a.m. BREAK

9:45 to 10:15 a.m. Ethical Considerations in Adding New Chemotherapeutic Agents to The Formulary Paul Reitemeier, Ph.D.

10:15 to 10:45 a.m. Our Opioid Epidemic: Primum Non Nocere Bret Bielawski, D.O.

10:45 to 11:15 a.m. Innovations in Hearing Arthur Rosner, M.D.

11:15 to 11:45 a.m. Sleep Apnea: The Heart of the Matter Steven Ajluni, M.D.

11:45 to 12:45 p.m. Complimentary Buffet Luncheon

6:15 to 9:30 p.m. Cocktails, Dinner & Team Trivia*

*Please see pages 6 and 7 for information about Beaumont Sponsored Optional Activities.

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THURSDAY, June 23 SATURDAY, June 25

For CME questions contact Jessica Rice at 248-551-0748 or cme@beaumont.edu

Agenda and amount of CME credits available are subject to change.

8:30 to 11:30 a.m. ZIPLINE ADVENTURE TOUR The Zipline Adventure Tour features a series of 10 lines that travel up to 4300 feet, 20-25 mph, up to 50 feet in the air and 780 feet in length! The adventure begins at the top of the mountain and routes you through trees across the slopes of Boyne Mountain. This activity is suitable for individuals 10+ years old. For safety reasons children must be 60+ pounds to participate. This activity can accommodate a maximum of 12 participants and will be filled on a first-come first-served basis. Due to last years overwhelming interest we are offering time slots on both Friday and Saturday mornings. $55 per person

9 to 10:15 a.m. YARD GAMES We’ve got some fun yard games planned with an obstacle course, Ker-plunk and a life-size matching game. Wear comfortable shoes and clothing as we’ll be moving around a lot in these activities! This activity is suitable for children 7+ years old. $10 per child

9:30 to 10:30 a.m. ARTS ‘N CRAFTS Arts and Crafts classes are a fun way to promote creativity in kids. Using their hands to form objects, this type of instruction allows children to bring their thoughts and ideas into reality. This activity is suitable for children 3-6 years old. $10 per child

1 to 4 p.m. RAFTING ON THE JORDAN RIVER This 1½ hour rafting trip will take you through the pristine scenery of the Jordan River and is suitable for individuals 5+ years old. Rafts can accommodate 8-10 people. Bathing suits or clothes/shoes that can get wet are suggested. Sunscreen, bug spray and towels are also recommended. Lifejackets are required and will be provided. This activity can accommodate a maximum of 40 participants and will be filled on a first-come first-served basis. Rafting will take place unless there is severe weather in the area. $20 per person (10+ years old) $10 per child (5-9 years old)

1:20 p.m. GOLF ON THE “ALPINE” Home of the “Tournament of Champions,” this course weaves down the mountainside toward spectacular Deer Lake. Stunning vistas with strategically placed water hazards and bunkers make for a thrilling round. Awards will be given for the longest drive & closest to the pin. $73 per person

6 to 8 p.m. FAMILY BBQ Bounce houses, glitter tattoos and other interactive activities are planned for the kids. Casual dress and a cash bar. $29 per person (13 years old and older) $15 per child (4-12 years old) N/C (children under 4 years old)

8 to 9:30 p.m. FAMILY SCAVENGER HUNT* Families use a series of clues, common sense, and creativity, to navigate through the resort to find pieces of a puzzle. The team that finds all the pieces first and assembles the puzzle claims the prize! Please wear your team t-shirt and comfortable shoes. Weather appropriate clothing is suggested. Please be sure to fill out the optional activities form with the name of each participant and t-shirt size. Shirts must be ordered by Friday, June 10. Shirts will be guaranteed for all registrations that are received by the close of business on Thursday, June 9. There is no charge for this activity and participants of all ages are encouraged to participate!

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(advance reservations required)

Fritz’s Adventure Camp: Open daily for children 5-12 years of age. The mission at Fritz’s Adventure Camp is to develop and promote an active lifestyle in an educationally friendly environment. Campers experience a variety of activities including at least one and a half hours of aquatic thrills at Avalanche Bay, Michigan’s largest Indoor waterpark, as well as nature hikes, games, and crafts. During summer months, activities are often based on rotating weekly themes.

Avalanche Bay Splash Camp: Open daily for children 6-12 years of age. Supervised activities include: waterpark play, arts and crafts, games & lots of fun. Full-day, half-day and night time rates available. Items to bring to camp: bathing suit, change of clothes and shoes.

Day Care Children’s Playcare: Certified and highly trained instructors will care for children ages 3 months -5 years. In-room babysitting services are also available. Full-day, half-day and hourly rates available.

For more information, visit: boyne.com

FRIDAY, June 24 • Beaumont Sponsored Optional Activities

BOYNE Additional Services

8:30 to 11:30 a.m. ZIPLINE ADVENTURE TOUR The Zipline Adventure Tour features a series of 10 lines that travel up to 4300 feet, 20-25 mph, up to 50 feet in the air and 780 feet in length! The adventure begins at the top of the mountain and routes you through trees across the slopes of Boyne Mountain. This activity is suitable for individuals 10+ years old. For safety reasons children must be 60+ pounds to participate. This activity can accommodate a maximum of 12 participants and will be filled on a first-come first-served basis. Due to last years overwhelming interest we are offering time slots on both Friday and Saturday mornings. $55 per person

8:30 to 10 a.m. SEGWAY TOUR You’ll start with a 20-minute practice session to learn how to properly maneuver the Segway and then we’ll hit the trails for a 1-hour guided tour of the mountain. Participants must be at least 14 years old. Anyone under the age of 18 must have a Release of Liability waiver signed by a parent or guardian. Participants must weigh at least 100 lbs. and under 260 lbs. This activity can accommodate a maximum of 7 participants and filled on a first-come first-served basis. $59 per person

9:30 to 10:30 a.m. YARD YAHTZEE We’ve taken the popular board game to new heights! The object of the game is to score points by rolling five dice to make certain combinations. The twist? Our dice are life size! This activity is suitable for children 6-9 years old. $10 per child

10 to 11 a.m. KIDS SCAVENGER HUNT We’ve hidden some treats, toys and other fun treasurers for the little ones to find. This activity is suitable for children 3-6 years old only. $10 per child

6 to 9:30 p.m. DINNER & A MOVIE Chicken fingers, chips & milk/juice will be served with sundae making afterwards for dessert and a kid-friendly movie. This activity is suitable for children 3-6 years old. $25 per child

6 to 9:30 p.m. AVALANCHE BAY PIZZA PARTY Pizza, chips and juice will provide some nourishment before they’re let loose in the Avalanche Bay Indoor Waterpark! This activity is suitable for children 7+ years old. $30 per child

6 to 9:30 p.m. PIZZA & PAINTBALL* This is your chance to don some camo, load up on ammo and have some fun! Boyne Mountain has joined forces with T.C. Paintball — northern Michigan’s largest, most knowledgeable paintball experts. This activity is suitable for individuals 10+ years old. A liability waiver is required to be signed by all participants or a parent/guardian signature is required for those under the age of 18. $45 per person

6:15 to 9:30 p.m. COCKTAIL RECEPTION, DINNER & TEAM TRIVIA* Join us for the always popular cash bar cocktail hour and meet your colleagues throughout Beaumont Health. Following dinner there will be a team trivia competition. Winners will receive prizes along with bragging rights. Do you know what number Joe Namath wore or who was the tallest US President? Where was hot cocoa invented? The questions and repartee will make this an evening to remember. The conference registration fee includes 2 complementary tickets. $50 per person

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Preregistered Activities It is very important to register for activities in advance as the staff at Boyne will prepare for the number of participants we provide them a few days prior to the conference. Due to space constraints and advance preparations by Boyne we cannot guarantee that on-site registration/participation will be available.

Age Restrictions If you have more than one child and want to keep them together you should register all of your children for the activity that is most suited for the youngest child. Younger children will not be able to partake in activities that are above their intended age bracket.

Miscellaneous Information

SATURDAY, June 25 • Beaumont Sponsored Optional Activities

NON-PROFITU.S. POSTAGE

P A I DROYAL OAK, MI PERMIT #404

Medical Administration 44201 Dequindre Road Troy, MI 48085-1198

248-964-1063

1 9 T H A N N U A L M E D I C A L S T A F F E D U C A T I O N A L S Y M P O S I U M

June 24-25, 2016 Boyne Mountain Boyne Falls, MI

K E E P I N G I T I N T H E F A M I LY

CONFERENCE REGISTRATION (Please remove these forms to register)

Registration Options:

MAIL: Beaumont Hospital – Troy QUESTIONS? 44201 Dequindre Road PHONE: 248-964-1063 Administration/Jill Schoenherr EMAIL: jill.schoenherr@beaumont.org Troy, MI 48085 WEBSITE: https://beaumont.cloud-cme.com

FAX: 248-964-8842 (please fax both sides of the registration forms)

Registrant Information:

First/Last Name: ____________________________________________________________________________________________

Credentials: MD DO PhD Resident/Fellow PA RN Other: _______________

First Name: (as displayed on name tag) _________________________________________________

Beaumont affiliation: Corporate Dearborn Farmington Hills Grosse Pointe Royal Oak Taylor

Trenton Troy Wayne

Preferred mailing address: ______________________________________________________________________________

________________________________________________________________________________________________________

Preferred phone: _______________________________________ Fax: _________________________________________

Preferred email address: _____________________________________________________________________________________

Family Member/Additional Guest Information:

Additional Family/Guest Names Age Diet restrictions Additional Family/Guest Names Age Diet restrictions

If you are registering more than 8 extra guests please provide the above information on a separate sheet of paper

(over)

19th Annual Medical Staff Educational Symposium ~ June 24 – 25, 2016

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CANCELLATION POLICY: Cancellations must be received by Friday, June 10. Due to commitments to the Boyne Mountain we will not be able to honor refunds for no-shows, cancellations or changes after June 10

CONFERENCE REGISTRATION

(continued)

Educational Symposium registration fee includes the following for the registrant, 1 adult guest and 2 children (under the age of 13). *Extra guest/child fees apply to any and all children 13 years of age and older.

The full 2-day Educational Symposium registration fee includes:

7.0 AMA PRA Category 1 credits

Welcome reception, Thursday

Group breakfast/lunch buffet, Friday

Family Scavenger Hunt, Friday

Group breakfast/lunch buffet, Saturday

Reception, dinner & team trivia, Saturday

Physician or Administrator: Resident or Fellow:

______$250 ______$100

______$40 Each extra guest/child* ______$25 Each extra guest/child*

Nursing or Mid-Level Provider: Medical Student:

______$100 ______$75 Medical Student

______$25 Each extra guest/child*

*Extra guest/child fees apply to any and all children 13 years of age and older

Physician or Administrator: Resident or Fellow:

______$125 Friday or Saturday ______$50 Friday or Saturday

______$25 Each extra guest/child* ______$15 Each extra guest/child*

Nursing or Mid-Level Provider: Medical Student:

______$50 Friday or Saturday ______$35 Medical Student Friday or Saturday

______$15 Each extra guest/child*

*Extra guest/child fees apply to any and all children 13 years of age and older

See the attached Optional Activities registration form for more details

Check payable to: WBH, Troy Medical Staff Fund Credit Card: AMX MC Visa

Account #: Exp. Date:

Cardholder Name: ________________________________________ Signature: __________________________________

Billing Address: ____________________________________________________________________________________________

Conference Registration Total $__________

Total from Optional Activities Form $__________

Total Paid $__________

Educational Symposium Registration Fees:

2-Day Conference Registration:

1-Day Conference Registration: (please indicate Friday or Saturday by the appropriate box)

Optional Activities:

Payment Options:

CANCELLATION POLICY: Cancellations must be received by Friday, June 10. Due to commitments to the Boyne Mountain we will not be able to honor refunds for no-shows, cancellations or changes after June 10

OPTIONAL  ACTIVITIES 

Registrant’s last name: ____________________________________________ 

THURSDAY, JUNE 23 

Time  Activity  # of participant(s)  Name of participant(s)  Cost 

6:30 to  8 p.m. 

Welcome Reception _______ # of adults (13+ yrs old) 

_______ # of kids (4 ‐ 12 yrs old) 

_______ # of kids under 4 yrs 

 

Complimentary 

FRIDAY, JUNE 24 

6:45 to 8:30 a.m. 

Breakfast Buffet _______ # of adults (13+ yrs old) 

_______ # of kids (4 ‐ 12 yrs old) 

_______ # of kids under 4 yrs

  Complimentary 

8:30 to  11:30 a.m. 

Zipline  Adventure Tour* 

(10+ yrs old) 

_______ # of participants   

 $55 per person 

$ _____________ 

9 to  10:15 a.m. 

Yard Games (7+ yrs old) 

_______ # of kids   

$10 per person 

$ _____________ 

9:30 to 10:30 a.m. 

Arts ‘N Crafts (3‐6 yrs old) 

_______ # of kids   

$10 per person 

$ _____________ 

11:45 a.m. to  12:45 p.m. 

Lunch Buffet _______ # of adults (13+ yrs old) 

_______ # of kids (4 ‐ 12 yrs old) 

_______ # of kids under 4 yrs 

 

Complimentary 

1 to 4 p.m. Rafting on the Jordan River** (5+ yrs old) 

_______ # of adults (10+ yrs old) 

_______ # of kids (5 ‐ 9 yrs old)  

 $20 per person 

$10 per child 

$ ___________ 

1:20 p.m.  Golf on the “Alpine”  _______ # of participants   $73/per person 

$ __________ 

6 to 8 p.m.  Family BBQ 

_____ # of adults (13+ yrs old) 

_____ # of kids (4 – 12 yrs old) 

_____ # of kids under 4 yrs @ N/C 

 $29 per person 

$15 per child 

$ __________ 

 

 

 

8 to 

9:30 p.m. 

 

 

 

Family Scavenger Hunt+ 

 

Participant’s first name      T‐shirt size  T‐shirt sizes 

1)_______________________________  __________  Adult: S‐2XL 

2)_______________________________  __________  Child: XS‐XL 

3)_______________________________  __________ 

4)_______________________________  __________ 

5)_______________________________  __________ 

6)_______________________________  __________ 

 

 

Complimentary 

Optional Activities Registration: 

Registrant Information: 

(over for additional activities) 

SATURDAY, JUNE 25 

Time  Activity  # of participant(s)  Name of participant(s)  Cost 

6:45 to 8:30 a.m. 

Breakfast Buffet 

_______ # of adults (13+ yrs old) 

_______ # of kids (4 ‐ 12 yrs old) 

_______ # of kids under 4 yrs

Complimentary 

8:30 to  11:30 a.m. 

Zipline  Adventure Tour* 

(10+ yrs old) 

_______ # of participants  

 $55 per person 

$ _____________ 

8:30 to  10 a.m. 

Segway Tour++ (14+ yrs old) 

_______ # of participants   

 $59 per person 

$ _____________ 

9:30 to 10:30 a.m. 

Yard Yahtzee (6‐9 yrs old) 

_______ # of participants  

 $10 per person 

$ _____________

10 to 11 a.m. Kid’s Scavenger Hunt 

(3‐6 yrs old) _______ # of participants  

 

 $10 per person 

$ _____________ 

11:45 a.m. to  12:45 p.m. 

Lunch Buffet _______ # of adults (13+ yrs old) 

_______ # of kids (4 ‐ 12 yrs old) 

_______ # of kids under 4 yrs 

 

Complimentary 

6 to  9:30 p.m. 

Dinner & a Movie (3‐6 yrs old) 

_______ # of kids  

 $25 per child 

$ _____________ 

6 to  9:30 p.m. 

Avalanche Bay Pizza Party 

(7+yrs old) 

_______ # of kids  

 $30 per child 

$ _____________ 

6 to  9:30 p.m. 

Paintball & Pizza 

Party% (9+yrs old) 

_______ # of kids 

 $35 per child 

$ _____________ 

6:15 to  9:30 p.m. 

Reception & Team Trivia 

(inc. 2 comp. guests) 

_______ # of complimentary guests 

_______ # of ea. additional guests  

 Complimentary 

$50/ per person 

$ _____________ 

Optional Activities Total $ _____________ (please insert this on the conference registration form) 

FINE PRINT: 

If you have more than 1 child and want to keep them together you must register all of your children for the activity that is most suited for the youngest child.  Younger children will not be able to partake in activities that are above their intended age bracket. 

* Zipline Adventure Tour – For safety reasons, participants under 60 pounds are not permitted on the zipline.  

** Rafting on the Jordan River ‐ This activity can only accommodate a maximum of 40 people (first‐come first served)   

+ Family Scavenger Hunt – T‐shirts will be guaranteed if your registration is received by the close of business on Thursday, June 9.  If you have more than 6 participants, please include their names/shirt size on a separate piece of paper and return with this form. 

++ Segway Tour – Children must be 14 years of age and older AND over 100 pounds to ride the Segway’s. 

% Paintball & Pizza Party – Parents will be required to complete a signed liability form.  Children must be 10 years of age and older. 

CANCELLATION POLICY:  Cancellations must be received by Friday, June 10.  Due to commitments to the Boyne Mountain we will not be able to honor refunds for no‐shows, cancellations or changes after June 10 

COMPANY:

ADDRESS:

CITY: STATE: ZIP:

American Express Visa MasterCard Discover

SIGNATURE:

$

All reservations must be guaranteed by check or credit card deposit.

CREDIT CARD #

CHECK ENCLOSED

Credit card imprint is required at check-in for all guests.

Boyne Falls, MI 49713

Security Code

Expiration Date

Fax: 231.549.6844

PHONE / HOME:

Boyne Mountain Resort has a two-night minimum on weekends (Friday and Saturday night).

P.O. Box 19

Phone: 1.800.462.6963

PLEASE PRINT

Booking Code: 1063NB

PAYMENT METHOD

BOYNE REWARDS #:

*E-MAIL ADDRESS:

**BOYNE does its best to accommodate requests, but cannot guarantee them.

ROOM TYPE INDICATE 1ST

& 2ND

CHOICE

Mountain Grand Lodge - 3 Bedroom Suite

$237.00

$302.00

$302.00

Mountain Grand Lodge - Parlor/Queen/King $162.00

ARRIVAL DAY/DATE:

SHARE WITH:

Disciples Ridge - 2 Bedroom $296.00

Rates are based on the European Plan which includes lodging only. Rates are per room per night.

Rates and a 7% Resort Services Fee are subject to a 6% Michigan State Sales and Use Tax. Rates are also subject to a 5% Local

Lodging Assessment.

NUMBER OF CHILDREN IN PARTY:

NUMBER OF ADULTS IN PARTY:

BOYNE

DEPARTURE DAY/DATE:

BOYNE MOUNTAIN RESERVATION FORMGroup Name:

Dates:

Mountain Grand Lodge - 1 Bedroom Suite

Beaumont Hospital

June 23-26, 2016

Reservations must be made utilizing this form and be received by May 31, 2016. Reservation requests received after this date will

be taken on a space available basis at current room rates.

When making travel arrangements, please note the check-in and check-out times are on the second page with the room

descriptions. Check in and check out takes place at the Mountain Grand Lodge Front Desk for all room types.

ACCOMMODATIONS

ROOM RATES

Deposits: A deposit equal to the first night's lodging

is required with each reservation. Please make check

or money order payable to Boyne USA Resorts or

include a credit card number. The card will be charged

upon receipt of form. Do not send cash.

Accommodations: Please indicate your 1st and 2

nd lodging preference below. If room type requested is not available, the next

available room type and rate will be confirmed. We cannot guarantee specific rooms/units. All rooms are non smoking.

Tax exempt individuals: Please present the

state tax exempt form 3372 at check in. NOTE:

Personal funds are not exempt from state tax or local

assessments.

*Room confirmations will be e-mailed within 48 hours of receipt of reservation.

Reservations can be made by

calling, on-line, mail or fax

Mountain Grand Lodge - 2 Bedroom Suite

Cancellation Policy: Cancellation and changes

affecting arrival/ departure dates must be made 7 days

prior to arrival date in order to receive refund of

deposit, less a $10.00 administrative fee.

Central Reservations Department

**SPECIAL REQUESTS:

NAME:

AGES OF CHILDREN 18 & UNDER:

PHONE / BUSINESS:On-Line: www.boyne.com

Parlor

Queen

King

One Bedroom Suite

Two Bedroom Suite

Three Bedroom Suite

Disciples Ridge Two Bedroom w/ Loft Condominium

Three bedroom suite with one king in master bedroom, one queen in second bedroom, two sets of bunk beds in

third bedroom all upstairs, one sofa bed in living room, two full baths (tub upstairs, shower downstairs), full

kitchen with table and four chairs, electric fireplace and balcony. The Mountain Grand Lodge observes a

5:00pm check-in and 11:00am check-out.

One bedroom suite with one king or two queens in bedroom upstairs with bathroom (shower) and in room

whirlpool tub, one sofa bed in living room, bathroom (with tub), wet bar (mini fridge), electric fireplace and

balcony. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

Sleeps maximum of ten with one king bedroom, two queen beds in 2nd bedroom, two queen beds in loft, sofa

sleeper in living area, full kitchen and living area with gas fireplace. These units observe a 5:00pm check-in and

11:00am check-out.

BOYNE MOUNTAIN ROOM DESCRIPTIONS

Two bedroom suite with one king in master bedroom, two queen beds in second bedroom, and bath (tub) all

upstairs with one sofa bed in living room, bath (shower), kitchen with table and four chairs, and electric

fireplace. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

One king bed, bathroom (shower), in room whirlpool tub, wet bar (mini fridge), and electric fireplace. The

Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

One queen bed, one sofa bed, bathroom with tub, wet bar (microwave/mini fridge) and electric fireplace. The

Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

Two queens, bathroom (shower only) and wet bar (mini fridge). The Mountain Grand Lodge observes a 5:00pm

check-in and 11:00am check-out.