JUNE 25 - 29, 2012

H O U S E o f D E L E G A T E S & A N N U A L

S C I E N T I F I C M E E T I N G

Ri t z -Car l ton Mar ina del ReyLos Angeles , CA

You are cordiallY invited to join

Your fellow diplomates, members, and

other health-care professionals

for discussions and up-to-date information on

women’s health issues

mondaY, the twentY-fifth of june through fridaY, the twentY-ninth of june, two thousand twelve

ritz-carlton marina del reY

los angeles, california

• Providephysicianspecialistswithup-to-dateinformationaboutWomen’sHealthissues.

• Provideaforuminwhichtodiscussdevelopingandemergingissuesinyourspecialtyorsub-specialty.

• PlanandconductbusinessthatwillfurtherstrengthenthemissionoftheAAPS,itsaffiliatedAcademiesofMedicine,anditsBoardsofCertification.

• EncouragecollegialrelationsthatenableindividualmemberstopursuetheirprofessionalgoalsofparticipationintheAssociation’sactivities.

AnesthesiologyDermatologyDiagnosticRadiologyDisasterMedicineEmergencyMedicineFamilyMedicineObstetricsFamilyPracticeGeriatricMedicine

HospitalMedicineInternalMedicineObstetrics&GynecologyOphthalmologyOrthopedicSurgeryPlastic&ReconstructiveSurgeryPsychiatry

RadiologyandRadiationOncologySurgeryUrgentCare

intended audienceABPS Diplomates and AAPS Members in:

overall meeting objectives

emergency medicine examination development Workshop, June 24 – By Invitation Only. TheAAPSdesignatesthistest-itemwritingactivityforamaximumof4 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.

examination development Workshop i, June 25–TheAAPSdesignatesthistest-itemwritingactivityforamaximumof 9 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.

examination development Workshop ii, June 26–TheAAPSdesignatesthistest-itemwritingactivityforamaximumof5 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.

2012 annual scientific meeting, June 27 and 28:TheAAPSdesignatesthisliveactivityforamaximumof16 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecreditcommensuratewiththeextentoftheirparticipationintheactivity.

cme credit statements

accreditation statementTheAmericanAssociationofPhysician

Specialists,Inc.(AAPS),isaccreditedbytheAccreditationCouncilforContinuingMedical

Educationtoprovidecontinuingmedicaleducationforphysicians.

•Upto16.0CMEcreditsforScientificPresentationsessions

•Upto7.5CMEcreditsforMedicalEthicscourse

•Upto14.0CMEcreditsforExaminationDevelopmentWorkshops(Non-EM)

•Upto18.0CMEcreditsforExaminationDevelopmentWorkshops(EM)

KennethM.Flowe,M.D.,FAAEP,MBA,Co-ChairStephenA.Montes,D.O.,FAASOS,Co-Chair

MuhammadA.Ahmed,M.DLingappaS.Amernath,M.D.

JackV.Greiner,D.O.,PhD,FAASSGustavoG.Leon,M.D.

JerryR.Majers,D.O.,FAAIM,FAAGMHerbertPardell,D.O.,FAAIM

LuisM.Velasco,M.D.

cme committee

earn cme credits by participating in . . .

separate registration required $450.00

one-day course: Friday, june 29, from 8:00 am to 5:00 pm

course objectivesupon completion of this program participants should be able to:

1.Understandthetheoreticalandhistoricalfoundationsofmedicalethics;

2.Engageinallocationofresourcesdecisions;

3.Applyethicaldecision-makingtoolstoactualcircumstances;

4.Understandtheappropriaterolesofmedicalethics/bioethicscommitteesandbeabletoconstructivelycontributetothesecommittees;

5.Recognizethestakeholdersinmedicalethicsdecisionsandweighstakeholderethicalperspectives;and

6.Guidepublicdiscussionofmedicalethicsissuesandexplaintheperspectivesofmedicalprofessionalsonsuchissues.

medical etHics course: practical issues and approaches – 7.5 cme credits

This course provides a solid conceptual grounding in medical ethics, while focusing on practical issues and tested approaches for resolving such issues. This course satisfies a professional development requirement for fulfilling, in part, Board recertification of the American Board of Physician Specialties of the American Association of Physician Specialists.

accreditation statement

TheAmericanAssociationofPhysicianSpecialists,Inc.(AAPS),isaccreditedbytheAccreditationCouncilforContinuingMedicalEducationtoprovidecontinuingmedicaleducationforphysicians.

TheAmericanAssociationofPhysicianSpecialists,Inc.,designatesthisliveactivityforamaximumof7.5 AMA PRA Category 1 Credits™.Physiciansshouldclaimonlythecredit

commensuratewiththeextentoftheirparticipationintheactivity.

ThiscoursefulfillsABPSrecertificationrequirementsforMedicalEthics.CMEcreditearnedforattendingthiscoursemayalsobeappliedtotheCMErecertificationrequirements.

AccordingtoAMApolicy,physiciansmaynotclaimcreditforattendingthesameactivitymorethanonce,unlesstherehasbeenasubstantialchangeinthematerialsthathadbeenpreviouslypresented.

cme credit statement

recertiFication credit

great Hotel in great location• TheRitz-CarltonHotelMarinadelRey,LosAngeles–EASYACCESSTOLAXandshopping,dining,Fisher-man’sVillage,VeniceBeach,Hollywood,andmore.

• Indulgeinwateractivities,boatandkayakrentals,harborcruises,outdooradventures,naturewalks,sportsfishing,andmore.

Flexible options• Customizeyourschedule–choosethesessionsthatworkforyou–eithertheBusinessPackage,CMEPackage,orDiscountPackage.

great pricing• Registrationpackagesallowyoutopayonlyfortheportionofthemeetingyouplantoattend.

• WelcomeReceptionincludedinallpackages.

generous deadlines• TakeadvantageofbestpricesduringEarlyRegistration– THIS IS YOUR BEST BUY!!!

• EarlyRegistrationuptoMarch23,2012

• Still-Time-To-RegisteruptoJune1,2012

medical ethics course• One-daycourseonFriday,June29,2012

advance your career! netWorK! learn! relaX & enjoy!

attend tHe 2012 annual meeting

•BoardofDirectorsMeeting–EveryoneisencouragedtoattendallorpartoftheBODmeetingonMonday,June25.

•OrientationSessionfornewlyelected/appointedAcademyandBoardmembers.Requiredforallnewlyelected/appointedmembersofAcademiesandBoards.ThissessiononTuesday,June26,willoutlineyourdutiesandresponsibilitiesaswellasassociationprocedures.

•FirstTimeAttendeesLunchonWednesday,June27,willintroduceyoutoBODMembersandyourfellowDiplomates.

•Flashdrivesprovidedforyourconvenienceinsteadofbulkyscientificpresentationmaterials.

NO HARD COPIES WILL BE PROVIDED BY AAPS.

HigHligHts For 2012!

aaps auXiliary• Opentoallfamilymembers

• Auxiliaryduesare$60peryear

• AnnualMeetingandBrunchMonday,June25,at9am

• WelcomeReceptionMonday,June25at5:30-7pmTicketscourtesyofAAPSAuxiliary

• ChecktheAuxiliaryscheduleattheRegistrationDesk

sunday, june 24: business & discount pacKages only

12noon–5pm............. RegistrationDesk1pm–5pm.................. EmergencyMedicineExaminationDevelopmentWorkshopBY INVITATION ONLY

monday, june 25: business & discount pacKages only

7:30am–11:30am...... AAPSBoardofDirectorsMeeting8am–5pm.................. Credentialing–AllSpecialties– Open to BOC Members/Credentialing Committee Only8am–5pm.................. ExaminationDevelopmentWorkshopI–AllSpecialties–Open to Diplomates Only9am–11am................ AuxiliaryBrunchandMeeting11:45am–1pm.......... PastPresidentsLunchMeetingLUNCH............................ Onyourown1pm–3pm.................. HouseofDelegates3pm–4:15pm............. CouncilofAcademyPresidentsMeeting3pm–5pm.................. AmericanBoardofPhysicianSpecialties(ABPS)Meeting5:30pm–7pm............. WelcomeReception

tuesday, june 26: business & discount pacKages only

8am–9:15am............. AcademiesofMedicineMeetings(Anesthesiology,EmergencyMedicine,FamilyPractice, InternalMedicine,Radiology,OrthopedicSurgery,andSurgery)8am–9:15am............. BoardsofCertificationMeetings(FamilyMedicineObstetricsandUrgentCareMedicine)9:30am–11am............ CorrespondingBoardsofCertificationMeetings(Anesthesiology,EmergencyMedicine, FamilyPractice,InternalMedicine,Radiology,OrthopedicSurgery,andSurgery)9:30am–11am............ AcademiesofMedicineMeetings(DisasterMedicineandDermatology)

scHedule oF eventsScheduleissubjecttochangebeyondthecontrolofAAPS.

monday-Friday:7am–5pm.................. RegistrationDesk7am–8am.................. Breakfast

11am–12:30pm......... AAPSFoundation AJCMEditorialBoard11:15am–12:45........... BoardsofCertificationMeetings(DisasterMedicine,HospitalMedicine,andDermatology)12noon–5pm............. ExaminationDevelopmentWorkshopII– Open to Diplomates OnlyLUNCH............................ Onyourown12:30pm–2:30pm..... PublicMemberMeeting2pm–3:15pm............. CMECommittee2:30pm–4pm............. Academy&BoardOrientation3pm–4pm.................. GovernmentalAffairsCommittee(GAC)Meeting3:15pm–4:30pm........ MembershipCommitteeMeeting4pm–5:45pm............. StrategicPlanningCommitteeMeeting6:15pm–7pm............. President’sReception7pm–10pm................ President’sAwardsDinner

Wednesday, june 27: cme & discount pacKages only

7am–8am.................. CMEBreakfastforregistrants8am–5:30pm............. CMEScientificSessionsforregistrants12noon–1:30pm........ CMELunchforregistrants12noon–1:30pm........ First-TimeAttendeesLunch

tHursday, june 28: cme & discount pacKages only

7am–8am.................. CMEBreakfastforregistrants8am–5pm.................. CMEScientificSessions12noon–1pm............. CMEPackageLunchforregistrants

Friday, june 29: medical etHics only

7am–8am.................. MedicalEthicsBreakfast8am–5pm.................. MedicalEthicsCourse12:30pm–1:30pm...... MedicalEthicsLunch

AndresAbreu,D.O.----------------- ScreeningMammographyandAssociatedMedicareCostsinElderlyWomen

JosephM.Damiani,M.D.,FAAPRS------ BreastAugmentation–TheGood,theBadandtheUgly

FranklinO.DeLaCruz,M.D.----------- HypertensioninPregnancy

MarkDeSantis,D.O.----------------- AdvancingTrendsinWomen’sImaging

KennethM.Flowe,M.D.,FAAEP,MBA --- HIVandtheOppressionofWomeninEastAfrica

SurinderK.Kad,M.D.,FAAIM,MPH,MBA- Amenorrhea:DiagnosticEvaluationandTreatmentOptions

DavidM.Lemonick,M.D.,FAAEP------- OrthopedicIssuesinWomen:WhatEveryPhysicianShouldKnow

RecognizingandTreatingPostpartumEmergencies:WhatEveryPhysicianShouldKnow

DouglasL.Marciniak,D.O.,FAAIM------ HeartDiseaseinPregnancy

DavidR.Meece,M.D.,FAAEP--------- FemaleAthleticTriad–RamificationsforHealth

LeslieMukau,M.D.,FAAEP,FACEP------ JohnsHopkinsandtheFeministLegacy:HowaGroupofBaltimoreWomenShapedAmericanGraduateMedicalEducation

MarkPastin,Ph.D. ------------------ IsGenderanEthicalIssueinMedicine?

ThomasG.Pelz,D.O.,FAAIM---------- EvaluationoftheWomanwithCAD

JayanthG.Rao,M.D.,FAAR,MRCP----- BreastCancerin2012fromaRadiationOncologistPerspective

speaKers

JRMacMillanRodney,M.D.----------- ElectronicFetalMonitoringUpdate2012:FamilyMedicineObstetrics

UsingiPhoneandiPadTechnologytoImproveObstetricalUltrasoundSkillsinRuralFamily&EmergencyMedicine

Wm.MacMillanRodney,M.D.--------- IntrauterineDevicesforFamilyPlanning,Diagnosis,&ManagementofComplications

BetsyB.Schenck,D.O.,FAAEP--------- TheHighRiskWoman–Age18-24

EduardoScholcoff,M.D. ------------- AdvancedLifeSupportinObstetrics:EssentialEmergencySkillsinOB

GaryL.Shultz,D.O.,FAAR------------- LocallyRegionalAdvancedBreastCarcinomaTreatmentwithIMRTCorrespondingReductioninOrganatRisk

Presenter Disclosure:TheAmericanAssociationofPhysicianSpecialists,Inc.,believesinfulldisclosure.Eachpresenterorsponsorisrequiredtodiscloserealorapparentconflictsofinterestrelatingtotopicsofthiseducationalactivity.Presenterdisclosurewillbemadetoallparticipantsintheeduca-tionalactivitymaterialsandatthebeginningofeachpresentation.

4375AdmiraltyWayMarinadelRey,CA90292HotelReservations800-474-6501•HotelDirect310-823-1700•HotelFax310-574-4300

www.ritzcarlton.comgroup code aapaapg

AAPShasalimitednumberofroomsavailableattheAAPSguaranteedroomrateonafirstcome,firstservedbasis.HotelreservationsmustbemadeNO LATER THAN MAY 30, 2012.WestronglyencourageyoutomakeyourreservationsASAP!

Any problems making hotel reservations, call the AAPS Meetings Department.

accommodationstHe ritz-carlton marina del rey

Hotel reservations

•Singleordoubleoccupancy$195+tax

perroompernight(currently13.1%)

•Childreninsameroomasparents:Free

•Guaranteedroomrateappliesthreedaysbeforeandthreedaysaftermeeting,

basedonavailabilityatthetimeoftherequest.

•Check-inafter3:00pm•Check-out12:00noon

•Hotelcancellationsmustbemademorethan24hourspriortodayofarrivaltoavoidcancellationfee.

tHe Fitness centerSetonthewaterfront,overlookingthepool,theFit-

nessCenterisfurnishedwithstate-of-the-artmachineswithprivateentertainmentsystems.Alsofeatured-freeweights

andcablemachines,exerciseballsandstretchingarea.Separateladies’andgentlemen’slockerareas,

featuringeucalyptussteamroom.

sWimming pool and WHirlpoolThe3,200squarefootheatedoutdoorpoolandwhirlpoolareenvironmentally-

friendly,withasalinepurificationsystemusingonlypure,naturalsaltfromtheocean. Thepooldeckoffersoutdoorteakloungefurnishingsandprivatecabanas.

recreation courtGuestsenjoycomplimentaryuseofthehotel’sbasketballcourt,foosball,andpingpongtable.

tennis courtsThehotelofferstwotenniscourts.Atennisprofessionalisavailableforprivateorgrouplessonsbyappointmentonly.

bicyclesTheConciergeoffersanassortmentofbikesavailableforrent.

yacHt and boat cHartersAprivatedockprovidesaccommodationsforpersonalyachts,partyexcursions,andfishingandsailingcharters.

Hotel amenities

The Ritz-Carlton Marina del Rey offers guests luxury hotel facilities and services as well as convenient freeway access to some of the city’s main visitor attractions.

nearby attractions• WatersideandFisherman’sVillageinMarinadelRey(1mile)

• VeniceBeach(1mile)

• MainStreetandThirdStreetPromenadefeaturinganoutdoorshoppingmallandanumberofhigh-endstoresinSantaMonica(5miles)

• BeverlyHills/RodeoDrive(11miles)

• J.PaulGettyVillaMuseumandGettyCenter(13miles)

• LosAngelesCountyMuseumofArt(LACMA)(13miles)

• StaplesCenter,homeoftheLosAngelesLakers(18miles)

• DodgerStadium(20miles)

• UniversalStudios,Hollywood(24miles)

• HollywoodBowl(26miles)

• Disneyland,WaltDisney’soriginalthemepark(39miles)

HelpFul WebsitesVisitMarinaDelRey.comdiscoverLosAngeles.com

climate and clotHingThesummermonthstypicallyvaryfromahighof73°toalowof56°,anditcanbeovercast-“Junegloom.”Checklocallistingstodetermineweatherconditions.

CasualclothingisrecommendedwiththeexceptionofSaturdayeveningwhenajacketandtieformen(blacktieisoptional)andcorrespondingattireforwomenisrequested.Youmaywanttobring“layers”ofclothingtoaccommodateallmeetingroomtemperatures.Asyouknow,meetingroomscansometimesgetchilly!

nearby attractions & sHopping

travel inFormation

airport LosAngelesAirport(LAX)islocatedapproximatelyfivemilesfromthehotel.

airport transportation Transportationtothehotelisavailableintheairportshuttlearea.

Taxisareapproximately$24.

Hotel parKingHotelparkingvaletonly-

$13fordayand$35forovernight.

special aaps – Hertz rental rateYoucanmakeyourreservationsonlineatHertz.comorcallHertzdirectlyat1-800-654-2240.UseAAPSCodeCV#04SW0001.Meetingrateisguaranteedfromoneweekpriorthroughoneweekafterthemeetingdatesandissubjecttoavailability.

Attendance Policy: You must register for the 2012House of Delegates and Annual Scientific Meetingin order to attend any sessions including businessmeetings,continuingmedicaleducationactivities,and/or examination development workshops. All personsattendingmust pay theappropriate registration fee inadvance regardless of the purpose or the number ofmeetingsyouplantoattend.

To complete registration for the 2012 Annual Meeting,all fees must be paid in full in advance.SeeRegistrationFormforspecificinformation.

Confirmation of Registration: Aconfirmationpacketwillbemailedwithintwo(2)weeksofreceiptofyourregistrationform and PAID IN FULL registration fees. Please retaincopies of your registration information. If you do notreceiveaconfirmationpacketwithintwoweeks,pleasecontacttheAAPSMeetingsDepartmentimmediately.

Schedule changes beyond AAPS control may occur. AAPS is not responsible for notifying registrants of program changes prior to the meeting.

Cancellation Policy: Written cancellations must bereceived by the AAPS Meetings Department prior toApril 15, 2012, in order to receive a refund of MeetingRegistrationFees,lessa$150processingfee.Cancellationsreceivedafterthisdatewillnotbeaccepted.

1.Tobeofficiallyregisteredandtoreceivespecialrates,all fees must be paid in full prior to the appropriatedeadlines: Early Registration byMarch 23, 2012, or Still-Time-To-RegisterbyJune 1, 2012

2.All registrations receivedafterJune1,2012, includingon-site,mustbepaidinfullpriortoadmissiontoanyAAPSactivities.On-SiteRegistrationwillbeacceptedbyCREDIT CARD ONLY.

3.Therearenoexceptionstothefeesanddeadlines.

4.Noonewillbeadmittedtoanybusinesssessions,CMEsessions,breakfastorlunchwithoutavalidbadge.

5.NoonewillbeadmittedtotheWelcomeReceptionorPresident’sAwardsDinnerwithoutaticket.

important registration inFormation

THERE ARE FOUR MEMBER CATEGORIESDiplomate/Emeritus/Member

PresenterAAPS Retired

Non-Member CME Only

THERE ARE THREE REGISTRATION PACKAGESBusiness Only

CME OnlyDiscount Package

Business: Includes all meetings – Board of Directors, Academies of Medicine, Boards of Certification, House of Delegates, Committees, and any other scheduled business meetings; conference materials; and breakfast on Monday, June 25, and Tuesday, June 26. Two days – see pricing on registration form.

CME: Includes up to 16 CME credits for scientific presentations, conference materials, breakfast, and lunch on Wednesday, June 27, and Thursday, June 28. Two days – see pricing on registration form.

Discount: Combines Business and CME Packages. Monday, June 25, through Thursday, June 28. Four days – see pricing on registration form.

THERE ARE THREE REGISTRATION DEADLINES

Early Registration – By March 23, 2012Still-Time-To-Register – By June 1, 2012

Late/On-Site Registration – After June 1, 2012

ADDITIONAL OPTIONSMedical Ethics: Includes one-day course on Friday, June 29, course materials, 7.5 CME credits, breakfast, and lunch. One-day-course – $450.

Welcome Reception on June 25: All tickets are free – sponsored by the AAPS Auxiliary - however, you must register in order to reserve a ticket.

President’s Awards Dinner on June 26: Per ticket $125

IMPORTANT REGISTRATION INFORMATION

REGISTRATION FORM: AAPS 2012 HOUSE OF DELEGATES AND ANNUAL SCIENTIFIC MEETINGTO REGISTER BY FAX: 813-830-6599 (CREDIT CARD ONLY) • MAIL: AAPS, 5550 W. EXECUTIVE DRIVE, SUITE 400, TAMPA, FL 33609-1035

Name________________________________________________________________Email_Address:______________________________________________________

Address_ ____________________________________________________ City_____________________________ State_ _____________Zip_____________________

Home_phone________________________________ _Work_phone____________________________________ _Cell_phone_ ___________________________________

_ Package_Total_$_____________

MEDICAL ETHICS COURSE - FRIDAY, JUNE 29_.........$_450_per_person_x_________(#_attending)_=_ _Medical_Ethics_Registration_Total_$_ ___________

NO ONE WILL BE ADMITTED TO ANY SESSIONS INCLUDING MEALS WITHOUT A VALID BADGE

WELCOME RECEPTION - MONDAY, JUNE 25_....................................$_0_per_person_x_______(#_tickets)_=_ Welcome_Reception_Total_$_____________(Complimentary, but you must register)

PRESIDENT’S AWARDS DINNER - TUESDAY, JUNE 26_................. $_125_per_person_x______(#_tickets)_=_ _President’s_Dinner_Total_$_ ___________

MEETING REGISTRATION PAYMENT _Check_enclosed_ _American_Express_ _MasterCard__ _Visa_ _Grand_Total_to_be_charged:__$

Cardholder’s_Name_________________________________________________Card_Number________________________________ Expiration_Date________________

Cardholder’s_Mailing_Address_ ____________________________________________________ Cardholder’s_Signature_ ______________________________________

ALL PARTICIPANTS MUST COMPLETE DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS BELOW

I DO HAVE A RELEVANT FINANCIAL RELATIONSHIP WITH A COMMERCIAL INTEREST. (You MUST list relevant financial relationships below)

Signature __________________________________________________________________________ Date _________________________

1. Commercial Interest (Example: Company ‘X’)

Nature of Relevant Financial Relationship (Include all those that apply)

2. What was received (Example: Honorarium) 3. For what role? (Example: Speaker)

Example Terminology

What was received:_Salary,_royalty,_intellectual_property_rights,_consulting_fee,_honoraria,_ownership_ interest_ (e.g.,_ stocks,_ stock_ options_ or_ other_ ownership_ interest,_ excluding_diversified_mutual_funds),_or_other_financial_benefit.

Role(s): Employment,_ management_ position,_ independent_ contractor_ (including_ contracted_ research),_consulting,_ speaking_ and_ teaching,_ membership_ on_ advisory_ committees_ or_ review_ panels,_ board_membership,_and_other_activities_(please_specify).

Glossary of Terms

Commercial Interest: The_ACCME_defines_a_“commercial_interest”_as_any_proprietary_entity_producing_health_care_goods_or_services,_used_on,_or_consumed_by,_patients,_with_the_exemption_of_non-profit_or_government_organizations_and_non-health_care_related_companies.Financial relationships:_Financial_relationships_are_those_relationships_in_which_the_individual_benefits_by_receiving_a_salary,_royalty,_intellectual_property_rights,_consulting_fee,_honoraria,_ownership_interest_(e.g.,_stocks,_stock_options_or_other_ownership_interest,_excluding_diversified_mutual_funds),_or_other_financial_benefit.__Financial_benefits_are_usually_associated_ with_ roles_ such_ as_ employment,_ management_ position,_ independent_ contractor_ (including_ contracted_research),_consulting,_speaking_and_teaching,_membership_on_advisory_committees_or_review_panels,_board_membership,_and_other_activities_from_which_remuneration_is_received,_or_expected.__ACCME_considers_relationships_of_the_person_involved_in_the_CME_activity_to_include_financial_relationships_of_a_spouse_or_partner.

Relevant financial relationships: ACCME_ focuses_ on_ financial_ relationships_ with_commercial_ interests_in_the_12-month_period_preceding_the_time_that_the_individual_is_being_asked_to_assume_a_role_controlling_content_of_the_CME_activity._ACCME_has_not_set_a_minimal_dollar_amount_for_relationships_to_be_significant.__Inherent_in_any_amount_is_the_incentive_to_maintain_ or_ increase_ the_ value_ of_ the_ relationship._The_ACCME_ defines_“’relevant’_ financial_relationships”_as_financial_relationships_in_any_amount_occurring_within_the_past_12_months_that_create_a_conflict_of_interest.Conflict of Interest:_Circumstances_create_a_conflict_of_interest_when_an_individual_has_an_opportunity_to_affect_CME_content_about_products_or_services_of_a_commercial_ interest_with_which_he/she_has_a_financial_relationship.

I DO NOT HAVE A RELEVANT FINANCIAL RELATIONSHIP WITH A COMMERCIAL INTEREST. (You MUST list relevant financial relationships below)

Signature __________________________________________________________________________ Date _________________________

TO COMPLETE THE REGISTRATION FORM DO THE FOLLOWING:

1. Review_Important_Registration_Information._

2._ Select_one_of_three_registration_packages_(Business,_CME,_Discount_Package).__

3._ Select_from_Additional_Options_(Medical_Ethics_Course,_Welcome_Reception,_President’s_Dinner).__

4._ Review_registration_table_on_right_and_circle_your_registration_choice.__Enter_fee_amount_in_subtotal._

Early Registration By Mar 23, 2012

Still-Time-To Reg By June 1, 2012

Late/On-Site After June 1, 2012

AAPS_Diplomate/__Emeritus/Member

Business_Package $295 $495 $695

CME_Package $525 $725 $925_______________________

Discount_Package $725 $1125 $1525

Presenter_REGISTRATION_REQUIRED_BY__JANUARY_31,_2012

Business_Package $295 NA NA

CME_Package $325 NA NA

Discount_Package $525 NA NA

AAPS_Retired Business_Package $295 $495 $695

CME_Package $325 $525 $725

Discount_Package $525 $925 $1395

Non-Member CME_Package $650 $850 $1050

First,_list_the_names_of_proprietary_entities_producing_health_care_goods_or_services,_consumed_by,_or_used_on,_patients,_with_the_exemption_of_non-profit_or_government_organizations_and_non-health_care_related_companies_with_which_you_or_your_spouse/partner_have,_or_have_had,_a_relevant_financial_relationship_within_the_past_12_months._ For_ this_purpose_we_consider_ the_ relevant_financial_ relationships_of_ your_ spouse_or_partner_that_you_are_aware_of_to_be_yours.

Second, describe_what_you_or_your_spouse/partner_received_(ex:_salary,_honorarium_etc)._The_American_Association_of_Physician_Specialists,_Inc._does_NOT_want_to_know_how_much_you_received._

Third,_Describe_your_role.

$0.00

5550 West Executive Drive • Suite 400Tampa, Florida 33609-1035

ADDRESS SERVICE REQUESTED

PRESORTEDFIRST-CLASS MAIL

U. S. POSTAGE PAIDPERMIT #100

TAMPA, FL