Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
DEMENTIA CONFERENCE2018 ANNUAL SOUTHEASTERN PENNSYLVANIA
MONDAY, MAY 7, 2018 8:00 AM – 4:30 PMTHE EVENTS CENTER AT VALLEY FORGE CASINO RESORT
1160 1ST AVENUE KING OF PRUSSIA, PA
WELLBEING & DEMENTIA
FEATURING:STEPHEN G. POST, PH.D. International speaker, bioethicist, best-selling author and researcher
PAMELA A. SAUNDERS, PH.D. Researcher and Professor of Neurology at Georgetown University
DAVID WOLK, MD. Researcher and Co-Director Penn Memory Center
RABBI DAYLE A. FRIEDMAN Chaplain, social innovator, spiritual guide and scholar
SPECIALIZED SESSIONS WILL FOCUS ON: Communication & Coping
Behaviors, Ethics, Spirituality,
Research, Safety & Independence,
Living Well with AD, Managing
Stress and more!
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits
9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful PeopleStephen G. Post, Ph.D.
10:30—12:00 PM Morning Breakout Sessions (SELECT ONE)
12:00—1:15 PM Lunch (Included) & Exhibits
1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE)
3:00—4:15 PM Plenary Session: ‘Oh He Was Forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive ImpairmentPamela A. Saunders, Ph.D.
4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
SCHEDULE AT A GLANCE
2018 SPONSORS & PARTNERS
For more information, call our 24/7 Helpline 800.272.3900
PROGRAMS & SERVICES
Care ConsultationConsumer EducationDiversity & Inclusion
Early Stage InitiativesPublic Policy
Professional Education
Safety ServicesSupport Groups
TrialMatch®
For more information on Alzheimer’s Association Delaware Valley Chapter programs & services, please call our 24/7 Helpline at 800.272.3900 or find us on the web: alz.org/delval.
David Wolk, MDDr. David Wolk is an Associate Professor of Neurology in the Cognitive Neurology Division of the University of Pennsylvania Perelman School of Medicine. He is also Co-Director of the Penn Memory Center and Associate Director of Penn’s Alzheimer’s Disease Core Center (Leader of the Clinical Core). His primary clinical interest has been in the diagnosis and care of individuals with a variety of neurodegenerative conditions. Dr. Wolk’s research has focused on the cognitive neurosience of memory decline associated with aging and Mild Cognitive Impairment/Alzheimer’s Disease. A highly related additional line of his work has been the
development and examination of biomarkers for detection of early disease changes that differentiate normal aging from evidence of neurodegenerative pathophysiology. This work has also included use of morphometric structural imaging methods, MRI measures of cerebral blood flow, and molecular imaging techniques. In addition to early disease detection, Dr. Wolk has explored the relationship of these measures to phenotypic variation for trying to better understand heterogeniety in these populations.
Annual Southeastern Pennsylvania
DEMENTIA CONFERENCE WELLBEING & DEMENTIA Monday, May 7, 2018 The Events Center at Valley Forge Casino Resort
Specialized sessions will focus on: Communication & Coping Behaviors, Ethics, Spirituality, Research, Safety & Independence, Living Well with AD, Managing Stress and more! For more information, call our 24/7 Helpline 800.272.3900 Thank you to our 2018 Conference Sponsors!
SCHEDULE AT A GLANCE
David Wolk, MD. Researcher and Co-Director Penn Memory Center
FEATURED SPEAKERS
Pamela A. Saunders, Ph.D. Researcher and professor of neurology at Georgetown University
Stephen G. Post, Ph.D. International speaker, bioethicist, best-selling author and researcher
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits 9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful People Stephen G. Post, Ph.D. 10:30—12:00 PM Morning Breakout Sessions (SELECT ONE) 12:00—1:15 PM Lunch (Included) & Exhibits 1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE) 3:00—4:15 PM Plenary Session: ‘Oh he was forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive Impairment Pamela A. Saunders, Ph.D. 4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits 9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful People Stephen G. Post, Ph.D. 10:30—12:00 PM Morning Breakout Sessions (SELECT ONE) 12:00—1:15 PM Lunch (Included) & Exhibits 1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE) 3:00—4:15 PM Plenary Session: ‘Oh he was forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive Impairment Pamela A. Saunders, Ph.D. 4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
Rabbi Dayle A. Friedman Chaplain, social innovator, spiritual guide and scholar
Rabbi Dayle A. Friedman, MSW, MAJCS, BCCRabbi Dayle A. Friedman is a spiritual guide, social innovator, chaplain, and scholar. Her latest book is Jewish Wisdom for Growing Older: Finding Your Grit and Grace Beyond Midlife (Jewish Lights, 2015). Friedman has pioneered a fresh vision for aging and spiritual care through her teachings and publications. She offers pastoral care, consulting and spiritual direction through Growing Older, her Philadelphia-based, national practice. She received the 2011 Religion, Spirituality and Aging Award from the American Society on Aging.
FEATURED SPEAKERS
Stephen G. Post, Ph.D.A transformative speaker, Post has inspired thousands with the best of medical and philosophical knowledge based on thirty years of research. Post addresses the ways in which empathic care enhances patient outcomes and professional well-being, the meaning of caring for “deeply forgetful” people, and ethical issues in Alzheimer Disease. Post’s book, The Moral Challenge of Alzheimer’s Disease: Ethical Issues from Diagnosis to Dying (Johns Hopkins University Press, 2000, 2nd edition), was designated a “medical classic of the century” by the British Medical Journal (2009). Post is an elected Member of the Medical and Scientific
Advisory Board of Alzheimer’s Disease International, and one of three recipients of the Alzheimer’s Association distinguished service award “in recognition of personal and professional outreach to the Alzheimer’s Association Chapters on ethics issues important to people with Alzheimer’s and their families” (1998). He has taught at the University of Chicago Medical School, Case Western Reserve University School of Medicine (1988-2008), and Stony Brook University School of Medicine (2008-), where he is Founding Director of the Center for Medical Humanities, Compassionate Care, and Bioethics (designated as a special strength of the Stony Brook School of Medicine by the LCME visiting committee 2011). He is an elected member of the College of Physicians of Philadelphia, the New York Academy of Medicine, and the Royal Society of Medicine, London.
Annual Southeastern Pennsylvania
DEMENTIA CONFERENCE WELLBEING & DEMENTIA Monday, May 7, 2018 The Events Center at Valley Forge Casino Resort
Specialized sessions will focus on: Communication & Coping Behaviors, Ethics, Spirituality, Research, Safety & Independence, Living Well with AD, Managing Stress and more! For more information, call our 24/7 Helpline 800.272.3900 Thank you to our 2018 Conference Sponsors!
SCHEDULE AT A GLANCE
David Wolk, MD. Researcher and Co-Director Penn Memory Center
FEATURED SPEAKERS
Pamela A. Saunders, Ph.D. Researcher and professor of neurology at Georgetown University
Stephen G. Post, Ph.D. International speaker, bioethicist, best-selling author and researcher
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits 9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful People Stephen G. Post, Ph.D. 10:30—12:00 PM Morning Breakout Sessions (SELECT ONE) 12:00—1:15 PM Lunch (Included) & Exhibits 1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE) 3:00—4:15 PM Plenary Session: ‘Oh he was forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive Impairment Pamela A. Saunders, Ph.D. 4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits 9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful People Stephen G. Post, Ph.D. 10:30—12:00 PM Morning Breakout Sessions (SELECT ONE) 12:00—1:15 PM Lunch (Included) & Exhibits 1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE) 3:00—4:15 PM Plenary Session: ‘Oh he was forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive Impairment Pamela A. Saunders, Ph.D. 4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
Rabbi Dayle A. Friedman Chaplain, social innovator, spiritual guide and scholar
Pamela A. Saunders, Ph.D.Pamela A. Saunders, Ph.D, is an associate professor in the departments of neurology and psychiatry at Georgetown University. With a doctorate in sociolinguistics from Georgetown University, her research focuses on language, aging, doctor/patient communication, narrative and reflective writing, and standardized patient education. She has spent the last 20 years conducting research and teaching. Her research portfolio includes funding from the Alzheimer’s Association, the National Institute on Aging, the Hartford Foundation, and the U.S. Food and Drug Administration. She serves in several leadership roles related to medical
education, including as chief course director of the doctoring curriculum and director of the geriatrics clerkship. She is a long-standing member of Georgetown University Medical Center’s Committee on Medical Education and also serves on the Committee on Appointments and Promotions. She co-founded the geriatrics curriculum in 2000 for the medical students at Georgetown’s School of Medicine with funding from the Hartford Foundation. In addition, she teaches reflective writing and Mind Body Medicine skills to medical and graduate students. Most recently, Dr. Saunders developed a new masters degree program in Aging & Health.
Annual Southeastern Pennsylvania
DEMENTIA CONFERENCE WELLBEING & DEMENTIA Monday, May 7, 2018 The Events Center at Valley Forge Casino Resort
Specialized sessions will focus on: Communication & Coping Behaviors, Ethics, Spirituality, Research, Safety & Independence, Living Well with AD, Managing Stress and more! For more information, call our 24/7 Helpline 800.272.3900 Thank you to our 2018 Conference Sponsors!
SCHEDULE AT A GLANCE
David Wolk, MD. Researcher and Co-Director Penn Memory Center
FEATURED SPEAKERS
Pamela A. Saunders, Ph.D. Researcher and professor of neurology at Georgetown University
Stephen G. Post, Ph.D. International speaker, bioethicist, best-selling author and researcher
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits 9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful People Stephen G. Post, Ph.D. 10:30—12:00 PM Morning Breakout Sessions (SELECT ONE) 12:00—1:15 PM Lunch (Included) & Exhibits 1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE) 3:00—4:15 PM Plenary Session: ‘Oh he was forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive Impairment Pamela A. Saunders, Ph.D. 4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
8:00—8:45 AM CEU Check-In / Registration, Continental Breakfast & Exhibits 9:00—10:15 AM Keynote Session: Hope & Deeply Forgetful People Stephen G. Post, Ph.D. 10:30—12:00 PM Morning Breakout Sessions (SELECT ONE) 12:00—1:15 PM Lunch (Included) & Exhibits 1:15—2:45 PM Afternoon Breakout Sessions (SELECT ONE) 3:00—4:15 PM Plenary Session: ‘Oh he was forgettable’: Self Identity & Communicative Coping Behaviors in Persons with Cognitive Impairment Pamela A. Saunders, Ph.D. 4:15—4:30 PM Closing Remarks, Evaluation Submission, Professional CEU Check-Out
Rabbi Dayle A. Friedman Chaplain, social innovator, spiritual guide and scholar
Effective Dialogues for Living Well with Alzheimer’sPamela A. Saunders, Ph.D., Phil Gutis, Tim Weaver, Tom Brophy and MaryLou Brophy“Everything I say is interpreted under the veil of Alzheimer’s.” During this panel session persons living with a diagnosis, their care partners and an expert will share their experiences. Panelists will discuss the effects of a diagnosis on understanding and being understood in conversations. Challenges individuals face and strategies for creating supportive and engaging interactions despite cognitive impairment will also be addressed.
Caregiving and Balancing LifeMarcy Shoemaker, PsyD.Caregiving is a stressful and full-time job that transforms one’s life. There are no preparations for this all-encompassing job. Learning how to manage time, reach out for assistance and how to communicate with medical professionals can be very helpful. The workshop will review the role of the caregiver, the many stresses, resources available and outline ways to balance one’s life. The caregiver will leave the session with a list of ideas and suggestions to enhance the quality of their life.
Moving Towards Precision Medicine in Alzheimer’s DiseaseDavid Wolk, MDResearch over the last decade have supported the notion that Alzheimer’s disease is a relatively heterogeneous condition in which individuals vary in the nature of what aspects of thinking are most affected (for example, memory or language) and the speed in which the disease progresses. Moreover, much recent work has shown that often Alzheimer’s disease is associated not only with the amyloid “plaques” and tau “tangles” that are a hallmark of the disease, but additional brain pathologies, such as cerebrovascular disease and pathologies more commonly associated with other “neurodegenerative” conditions. Making sense of this heterogeneity is of critical importance to not only diagnosis, but to how we effectively treat the disease. Precision medicine involves the targeting of interventions based on the specific characteristics of the individual patient and has been increasingly successful in other areas of medicine, such as cancer. Dr. Wolk will discuss a path towards bringing precision medicine into Alzheimer’s disease research and clinical care.
A
C
B
BREAKOUT SESSIONS
MORNING SESSIONS (10:30-12:00 PM)
Please review the SESSION KEY to select the appropriate session for your experience level.
Caregiver / General – These sessions are more general and appropriate for family caregivers, care partners, friends and entry level professionals.
Advanced Clinical Professional – These sessions are appropriate for healthcare professionals with advanced clinical and practical knowledge. Medical terminology will be presented.
Early Stage – These sessions are appropriate for persons living with dementia in the early stages.
Clergy / Faith Community – These sessions are appropriate for clergy, faith community nurses and congregation leaders looking to build their knowledge to support family caregivers in their congregation / community.
Session space is limited. Please register early to ensure your session preference.
Navigating the Spectrum of Care in Dementia: How to Maximize Safety, Mobility & EnvironmentJen Brown, PT, DPT, GCSThis session will evaluate key components of safety through all levels of dementia in the community, home and facility setting. Equipment needs and resources to help maintain independence and safety will be discussed, along with how to assist caregivers with these tasks. Attendees will also gain information on insurance coverage for equipment and rehab.
D
Wholeness Amid Brokenness: A Spiritual Perspective on DementiaRabbi Dayle A. FriedmanThis presentation seeks to make sense of dementia. It will explore profound questions, such as: where is the soul when the body is gone; what is the meaning of the journey through dementia, and more. We will draw on the notion of the human being as created in the image of the Divine as an anchor as we seek wholeness for people with dementia, and those who care for them.
E
Respect, Relational Autonomy & Safety in Deeply Forgetful People: An Ethical DiscussionStephen G. Post, Ph.D.So much in the care of deeply forgetful people depends on relationships with caregivers. Individual autonomy really comes down to relational and shared decision making. This includes the well-being of caregivers, the safety of affected individuals, and allowing the individual to feel that their preferences are meaningfully taken into account especially in small daily choices where this is possible. This session will be an ethical discussion that focuses on balancing these areas of relational autonomy in deeply forgetful people.
F
AFTERNOON SESSIONS (1:15-2:45 PM)
ENHANCE YOUR CONFERENCE EXPERIENCE!• For information on session learning objectives or presenter disclosures, visit:
https://tinyurl.com/2018SEPAConference
• Don’t forget to visit the exhibits & learn about local resources.
• Stay comfortable—bring a sweater or jacket. Room temperatures can vary, so come layered.
• If you come with a team from your workplace, split up. Go to different session for a variety of information to share with your organization. Plan to network at lunch with other professionals and caregivers you don’t know!
• Power Point presentations will be available on the chapter website alz.org/delval the day before the conference and will remain up for 30 days. Print outs of the Power Points will not be provided at the conference.
EVENT LOCATION: The Events Center at Valley Forge Casino Resort - 1160 1st Avenue, King of Prussia, PA http://www.radisson.com/hotels/pavalley/locations
From Philadelphia International Airport: Take Interstate 95 South to Interstate 476 North. Follow Interstate 476 North to Interstate 76 West and exit at Mall Boulevard. Bear right onto Mall Boulevard and proceed to the traffic light. Turn right onto Gulph Road. Follow for approx. 1.5 miles, turn right onto 1st Avenue. Hotel is on the left.
From North: Take the Pennsylvania Turnpike to Exit 326 (Valley Forge). Proceed through the toll booth and take the first exit, merging onto Gulph Road. Follow for approx. 1.5 miles, turn right onto 1st Avenue. Hotel is on the left.
From Harrisburg (West): Take the Pennsylvania Turnpike East to Valley Forge (Exit 326). Pass through the tollbooths and take the first exit for Valley Forge. Merge onto Gulph Road. Follow for approx. 1.5 miles, turn right onto 1st Avenue. Hotel is on the left.
From Delaware/Washington D.C (South): Take I-95 North to I-476 North. Continue on I-476 North and then travel west on Interstate 76. Continue until you come to the exit for Mall Boulevard. Bear right onto Mall Boulevard and proceed to the traffic light. Turn right onto Gulph Road. Follow for approx. 1.5 miles, turn right onto 1st Avenue. Hotel is on the left.
LODGING INFORMATION: Are you traveling a long distance to the conference? Book a room at a discounted rate of $99 at the Radisson. The reservation cut-ff date is April 6. For reservations, click here, or call 610-354-8118 and reference “Annual Dementia Conference Room Block.”
Please note that participants may not be eligible for continuing education credits if they are not on time and present for the entire session. Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completed evaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leaving early. Note: Your certificate will be emailed to you within three weeks after the conference.
For information on individual session learning outcomes visit: tinyurl.com/2018SEPAConference. For questions, grievances, or instructions for requesting accommodations for individuals with disabilities (ADA), contact [email protected].
Nurses: 5.5 nursing continuing education contact hours are provided through Widener University School of Nursing. Widener University School of Nursing is an approved provider of continuing nursing education by the PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Social Workers: This activity is pending approval from the National Association of Social Workers for 5.5 continuing education contact hours.
CDP, CDCM, CADDCT: Alzheimer’s Association is a Certified Sponsor of professional continuing education with the National Council of Certified Dementia Practitioners and International Council of Certified Dementia Practitioners for members holding certifications as CDP, CDCM and CADDCT. Conference participants will be eligible to receive up to 5.5 CEUS on May 7, 2018. If you have questions about continuing education units please email [email protected]. National Council Certified Dementia Practitioners approved for 5.5 CEUs
Pastoral Care (Association of Professional Chaplains): 5.5 CEUs for clergy and chaplains will be available in partnership with Phoebe Ministries Pastoral Care Department.
PROFESSIONAL CONTACT HOURS AVAILABLEPlease review the CE disciplines below before registering:
• Have a question about the conference? Call 800.272.3900 (M-F, 9-5pm).• Payment is due at the time of registration. Pre-registration is required, however day-of registration will be
available at the door as space permits. A limited selection of breakouts session may only be available at that time. • CANCELLATION POLICY: Refunds will not be provided for any reason after April 9.• All registrations include continental breakfast (available 8am-8:45am) & lunch (begins promptly at 12:15pm).• Breakout session space is LIMITED. Please register EARLY to ensure your session preference, as we will be
closing breakout sessions as they become full. Please be sure to mark a second choice for AM & PM and/or call 800.272.3900 (9am-5pm, M-F) to check session availability if registering by postal mail.
• General non-ce certificates of participation will be available the day of the event at 4:15pm in the registration area.
• We would like to use photographs from our conferences in our promotional materials. By virtue of your attendance, we reserve the right to use your likeness in such materials.
EVENT INFORMATION & POLICIES
2018 SEPA CONFERENCE REGISTRATION FORM2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference with credit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm). Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
CHECK ENCLOSED Check #: ___________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time.
MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend 1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pm Circle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPE
CE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completed evaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leaving early. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers ____ CDP, CDCM, CADDCT ____ Pastoral Care
Non-CE Professional ($50) (General non-CE certificates of participation are available) Nursing Assistant or CNA ($40)
Family Caregiver* (non-professional) ($30)
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
"
2018 SEPA CONFERENCE—REGISTRATION & PAYMENT FORM We strongly encourage attendees to REGISTER ONLINE by April 26 at tinyurl.com/2018SEPAConference withcredit card payment. Attendees who are unable to register online can all 800.272.3900 (M-F, 8-5pm) with a credit card payment, or complete the below form (one form per registrant) and mail with payment by April 24 to: Alzheimer’s Association, 399 Market Street, Suite 102, Philadelphia, PA 19106 ATTN: SEPA Conference 2018
All registrations include continental breakfast (8am-8:45am) & lunch (begins promptly at 12:15pm).
Name:
Address:
Organization Name (if applicable):
Email: Phone:
How did you hear about the conference?:
CREDIT CARD: Visa MasterCard Amer. Express Exp. Date: ________ Code: _______
Card #: ____________________________________ Name on Card: ______________________________________
Optional Demographic Information (This information helps us to expand our outreach efforts): Age: _____
Race/Ethnicity: __Black/African-American __White/Caucasian __Asian __Hispanic/Latino __Other:_________________
BREAKOUT SESSION SELECTIONS: Please select ONE workshop for each session time. MORNING SESSION: 10:30 am—12:00 pm
Circle the letter of the session you want to attend1st Choice: A B C
2nd choice (in case 1st choice is full):
AFTERNOON SESSION: 1:15 pm—2:45 pmCircle the letter of the session you want to attend
1st Choice: D E F
2nd choice (in case 1st choice is full):
PAYMENT INFORMATION—Payment is due with this registration form
REGISTRATION TYPECE Professional ($100) (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completedevaluation form at the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leavingearly. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurses ____ Social Workers
Professional ($50) *Please provide a certificate by mail for: ____ CDP, CDCM, CADDCT ____ Pastoral Care
Nursing Assistant or CNA ($40)
Family Caregiver (non-professional) ($30)
($100) CEU Professional (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completed evaluation format the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leaving early. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurse ____ Social Worker ____ Pastoral Care
($50) Professional (without CEUs) *NEW: Special certificates available for members of the National Council of Certified Dementia Practitioners. [Certified DementiaPractitioner (CDP), Certified Dementia Care Manager (CDCM), or Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT)]. These qualified professionals should email [email protected], the day after the event to request a certificate. Certificates will be provided by email only if attendance is verified. The participant must check-in at the general registration table. Please review the information on the opposite page.
($30) General Admission (Family Caregivers/Partners*, Non-Professionals, Persons with Early Stage Dementia, Students and General Public)
Note: General non-ce certificates of participation are available the day of the event at 4:15 pm in the registration area for all attendees.*Limited number of scholarships available for family caregivers (non-professional). To inquire, call 800.272.3900 (M-F, 8am-5pm) before registering.
($100) CEU Professional (includes CE hours*) Please review the CE information and approval agencies on the opposite page. *Participants must sign in at the beginning of the day and sign out at the appropriate CE table, and submit a completed evaluation format the end of the program (4:15 pm). Partial credits will not be issued to participants arriving late or leaving early. Note: Your certificate will be emailed to you within three weeks after the conference.
____ Nurse ____ Social Worker ____ Pastoral Care
($50) Professional (without CEUs) *NEW: Special certificates available for members of the National Council of Certified Dementia Practitioners. [Certified DementiaPractitioner (CDP), Certified Dementia Care Manager (CDCM), or Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT)]. These qualified professionals should email [email protected], the day after the event to request a certificate. Certificates will be provided by email only if attendance is verified. The participant must check-in at the general registration table. Please review the information on the opposite page.
($30) General Admission (Family Caregivers/Partners*, Non-Professionals, Persons with Early Stage Dementia, Students and General Public)
Note: General non-ce certificates of participation are available the day of the event at 4:15 pm in the registration area for all attendees.*Limited number of scholarships available for family caregivers (non-professional). To inquire, call 800.272.3900 (M-F, 8am-5pm) before registering.
DEM
ENTI
A CO
NFE
REN
CE20
18 A
NN
UA
L SO
UTH
EAST
ERN
PEN
NSY
LVA
NIA
WEL
LBEI
NG
& D
EMEN
TIA
MO
ND
AY, M
AY 7
, 201
8
8:00
AM
– 4
:30
PM
THE
EV
EN
TS C
EN
TER
AT
VA
LLE
Y F
OR
GE
CA
SIN
O R
ESO
RT
1160
1ST
AV
EN
UE
KIN
G O
F P
RU
SSIA
, PA
ALZ
.OR
G/D
ELVA
L |
80
0.27
2.39
00
Reig
ster
ON
LIN
E to
day:
ht
tps:
//tin
yurl
.com
/201
8SEP
ACon
fere
nce
#EN
DA
LZJO
IN T
HE
CO
NV
ERSA
TIO
N @
ALZ
DEL
VAL
399
Mar
ket S
tree
t, Su
ite 1
02Ph
ilade
lphi
a, P
A 1
9106
PHIL
AD
ELPH
IA, P
APE
RM
IT #
5634
NO
N P
RO
FIT
OR
GU
.S. P
OST
AG
E