November 13–15, 2015DoubleTree by Hilton Tucson–Reid ParkTucson, ArizonaRegister Online Today!

Internal Medicine 2015–Advances and ControversiesThis live activity has been designated for 16.5 CME credits.

Arizona Chapter Scientific Meeting 2015

Meeting Highlights

• Two SEP modules• Doctor’s DilemmaTM for Medical Students

and Residents• Controversies!–Tumor Necrosis Factor

Inhibitors, Affordable Care Act, and Anticoagulation

• Health Care in Arizona

• Clinical Practice Guidelines: Choosing Wisely–Eliminating Waste and Overordering of Tests

• Clinical Practice Guidelines: High ValueCurriculum Development and Prescribing

• Panel: Medication Management of ChronicPain and the Legalities in Arizona

Dear Colleague,

Join me and your colleagues in internal medicine at the next scientific meeting of the Arizona Chapter of the American College of Physicians, being held on November 13–15, 2015, at the DoubleTree Hilton Tucson-Reid Park.

This is a place for you to recharge, rewind, reflect, and reconnect with your peers, chapter leaders, and speakers. Make your connection to the Arizona Chapter’s rich source of knowledge and networking by attending our premier meeting for general internists, subspecialty internists, hospitalists, allied health practitioners, residents, and medical students.

In addition to earning CME credits, this conference is about making personal connections andgetting involved in your chapter. You’ll engage with people who know your challenges and can help you find solutions. The opportunities available at this meeting will help you meet not only your needs as a physician, but also the needs of the patients you serve.

To ensure your place at this invaluable meeting, register now by visiting us online atwww.acponline.org/about_acp/chapters.

I look forward to seeing you in Tucson.

Sincerely,

Robert M. Aaronson, MD, FACPACP Governor, Arizona Chapter

Meeting HighlightsDear Colleague,

I join with the program planning committee and Governor Aaronson, to welcome you to the Centennial Celebration of the ACP and this meeting of the Arizona chapter! Your planning committee has put together a superb program withoutstanding leaders in our field, all to address current issues and controversies in Internal Medicine.

The controversies emphasis has been designed to focus on issues that we are facedwith on a daily basis where there are not well-constructed guidelines, and to discuss these issues in a helpful way. We will also address the State of Medicine in Arizona, in educational programs, and National and International aspects of our practice. Of course, we also provide state-of-the-art reviewsof several areas of interest, the efficient practice of Internal Medicine, our trainee’s posters and the exciting intellectual Doctor’s Dilemma competition.

We have worked energetically to make this program in its entirety of great interest and practical value. Again, we welcome you and encourage you to pay tribute to the 100 years of the American College of Physicians meeting the needs of all internists.

Sincerely

Eric P. Gall, MD, MACP2015 Program Chair

Schedule at a Glance

11:30 a.m.Faculty Development Registration11:40Welcome and IntroductionsRobert M. Aaronson, MD, FACP, ACP Governor, Arizona Chapter

Eric P. Gall, MD, MACP, 2015 Program Chair

11:45Faculty Medical Education Consortium BuffetLuncheon and Keynote AddressWhat They Must Know! Qualities Your StudentsNeed to Navigate Their Professional LivesCharles B. Cairns, MD, FACEP, FAHA

1:00 p.m.Registration for Medical Student and Resident/Fellow Track1:10Panel: Updates on Vital Topics for PhysiciansModerator: Eric Gall, MD, MACP, 2015 Program Chair

Some of Your Patients Have Valley Fever— Do You Know Which Ones?John N. Galgiani, MD, FACP

1:30Rheumatology for Primary CarePaul J. Howard, MD, MACP

1:50Dermatology for Primary CareMireille C. Algazi, MD, Camp Lowell Medical Specialists, Tucson

2:00Medical Student TrackMeet the Residency DirectorsResident/Fellow Track Preparing for Fellowship and/or Clinical Practice 2:45Networking Break/Visit Exhibitors/View PostersRefreshments Served

Poster Judges Assemble for Session #1Hamed Abbaszadegan, MD, MBA

3:15Session #1: Medical Students and Resident/Fellow Members Poster JudgingRefreshments Served

5:15Doctor’s Dilemma™ Medical Student RoundModerator: Mark A. Zubriski, MD, PhD, FACP

6:30Governor’s Dinner/Socializing7:00Awards Program8:00A Stroll Through the History of ACP and Medicine in ArizonaDavid J. Gullen, MD, MACP

Internal Medicine 2015–Advances and Controversies

Friday, November 13, 2015

Schedule at a Glance

7:00 a.m.RegistrationGovernor’s Advisory Council–Members Only Breakfast8:00Governor’s Welcome/Program Chair Welcome and IntroductionsRobert M. Aaronson, MD, FACP, ACP Governor, Arizona Chapter

Eric P. Gall, MD, MACP, 2015 Program Chair

8:15Controversies!Host/Moderator: Shakaib U. Rehman, MD, FACP, FAACH

Topic 1: Tumor Necrosis Factor InhibitorsJeffrey R. Lisse, MD, FACP

Michael Maricic, MD

9:00Topic 2: Affordable Care ActJames Dalen, MD, MACP

9:45 Topic 3: Anticoagulation: Recent Changes and Pros and Cons of Current TherapiesFadi Shamoun, MD, FACC, FSVM, FASE

10:30Networking Break/Visit Exhibitors/View PostersRefreshments served

11:00Changing Health Care Landscapes in the UnitedStates and Arizona: Academic Health Centers asPart of the SolutionJoe G.N. “Skip” Garcia, MD

NoonBox LunchMentoring Opportunity/Meet With Mentors1:00 p.m.Fostering Excellence in Internal MedicineMolly Cooke, MD, MACP

1:30Chapter Award Presentations1:50Break/Doctor’s Dilemma™ Check-in2:00Doctor’s Dilemma™ Preliminary RoundModerator: Mark A. Zubriski, MD, PhD, FACP

3:15Networking Break/Visit Exhibitors/View Posters Refreshments served

3:30Clinical Practice Guidelines (Choosing Wisely)Discussion (Full Panel), Audience to Share Experiences Teaching/Practicing High Value Care, and Q&AHost/Moderator: Jaya Raj, MD, FACP

Introduction to Session and Choosing Wisely CampaignJaya Raj, MD, FACP

High Value Care Curriculum Development Cheryl W. O’Malley, MD, FACP

Eliminating Waste and Overordering of TestsAllan Markus, MD, MS, MBA, FACP

High Value PrescribingKeriLyn Bollmann, MD

Saturday, November 14, 2015

Schedule at a GlanceOvercoming Barriers to High Value CareJaya Raj, MD, FACP

5:00Poster Judges Assemble for Session #2Hamed Abbaszadegan, MD, MBA

5:30Session #2: Medical Students and Resident/Fellow Members Poster JudgingRefreshments served

Sunday, November 15, 20157:00 a.m.RegistrationBreakfast Round Tables – CommitteesContinental Breakfast with Exhibitors/Job Fair Tables/Poster ViewingAdvocacy–National and State IssuesAnita C. Murcko, MD, FACP

Shakaib U. Rehman, MD, FACP, FAACH

Council of Early Career Physicians (Formerly Young Physicians)Shaghayegh Abdollahi, MD, FACP, FAAP

Council of Resident/Fellow MembersRam Baalachandran, MBBS

Libu Varughese, MD

Hospitalists/International Medical Graduates CommitteeSanthosh Gheevarghese John, MD, FACP

Sabyasachi Roy, MBBS

Medical Students CommitteeDustin McCurry

Steven Taylor

8:00Governor and Program Chair Welcome and IntroductionsRobert M. Aaronson, MD, FACP, ACP Governor, Arizona Chapter

Eric P. Gall, MD, MACP, 2015 Program Chair

8:05Global Health: Why Arizona Internists Should CareMolly Cooke, MD, MACP

9:05Medication Management of Chronic Pain and theLegalities in ArizonaModerator: Anita C. Murcko, MD, FACP

Pete Wertheim, Executive Director at Arizona OsteopathicMedical Association

Dean Wright, RPh, Director Controlled Substances Prescription Monitoring Program

10:00Networking Break/Visit Exhibitors/View PostersRefreshments Served

10:30Oral Vignettes–Internal Medicine ResidentsModerator: Hamed Abbaszadegan, MD, MBA

12:10 p.m.Doctor’s Dilemma™ Team Check-in12:20Doctor’s Dilemma™ Final RoundModerator: Mark A. Zubriski, MD, PhD, FACP

1:05Medical Student and Resident/Fellow Member AwardsPosters and Oral Vignette WinnersDoctor’s Dilemma™ WinnersConcluding Remarks

Meeting Information

Robert M. Aaronson, MD, FACP, ACP Governor, Arizona Chapter,Director of Medical Education, Tucson Medical Center, Tucson

Hamed Abbaszadegan, MD, MBA, Chief Health Informatics Officer, Phoenix VA Health Care System; Clinical Assistant Professor of Internal Medicine and Biomedical Informatics, University of Arizona College of Medicine, Phoenix

Shaghayegh Abdollahi, MD, FACP, FAAP, Chair, Council of EarlyCareer Physicians, Associate Program Director–Internal MedicineProgram, Maricopa Integrated Health System; Clinical AssistantProfessor, University of Arizona College of Medicine, Phoenix

Mireille C. Algazi, MD, Practicing Dermatologist, Camp LowellMedical Specialists, Tucson

Janis E. Blair, MD, FACP, Professor of Medicine, Internal Medicine Program Director, Consultant, Division of InfectiousDiseases, Mayo Clinic Hospital, Phoenix

KeriLyn Bollmann, MD, Associate Program Director, Departmentof Internal Medicine, Banner University Medical Center, Phoenix

Charles B. Cairns, MD, FACEP, FAHA, Interim Dean, College ofMedicine, Assistant Vice President, Clinical Research and ClinicalTrials, Health Sciences, Professor of Emergency Medicine, University of Arizona, Tucson

Molly Cooke, MD, MACP, Director of Education, Global Health Sciences, Professor of Medicine, University of California,San Francisco, CA

James Dalen, MD, MACP, Dean Emeritus and Professor Emeritus, University of Arizona College of Medicine; ExecutiveDirector, The Weil Foundation, Tucson

William G. Elliott, DO, FACC, FACOI, FACP, Director of MedicalEducation, CVMC IM Residency Program Director, Canyon VistaMedical Center, Sierra Vista

Timothy C. Fagan, MD, FACP, Professor of Internal MedicineEmeritus, University of Arizona, College of Medicine, Tucson

John N. Galgiani, MD, FACP, Director, Valley Fever Center for Excellence, Professor, University of Arizona, College of Medicine, Tucson

Eric P. Gall, MD, MACP, MACR, Professor of Medicine, Universityof Arizona, Tucson; (Emeritus) Professor and Past Chair, Depart-ment of Medicine, Chicago Medical School, Rosalind FranklinUniversity of Medicine and Science, Chicago, IL

Joe G.N. "Skip" Garcia, MD, Senior Vice President for Health Sciences, University of Arizona; Elected Member of the Instituteof Medicine; Merlin K. DuVal, MD, Endowed Chair for Leader-ship and Innovation, Professor of Medicine, University of ArizonaHealth Sciences Center, Tucson

Michael Grossman, MD, MACP, Professor of Internal Medicine,Associate Dean of Graduate Medical Education, University ofArizona College of Medicine; Vice President of Academic Affairs,Maricopa Integrated Health System, Phoenix

David J. Gullen, MD, MACP, Professor of Medicine; Consultant,Division of Community Internal Medicine, Mayo Clinic, Scottsdale

Paul J. Howard, MD, MACP, Past Governor, ACP Arizona Chapter; National Director, ACP Arthrocentesis and Bursal Injection Course Director, Arthritis Health, Scottsdale

Santhosh Gheevarghese John, MD, FACP, Chair, IMG/Hospitalists Committee; Hospitalist, University of Arizona Medical Center; Assistant Professor, Clinical Medicine, University of Arizona College of Medicine, Tucson

James Keane, DO, Internist, Desert Bloom Family Practice, Tucson

Helene R. Labonte, DO, FACP, Assistant Professor of Medicine,Mayo Clinic Arizona, Scottsdale

Jeffrey R. Lisse, MD, FACP, Ethel P. McChesney Bilby Professor ofMedicine, University of Arizona Arthritis Center, Medical Direc-tor of the University of Arizona Telemedicine Program, Tucson

Allan L. Markus, MD, MS, MBA, FACP, Internal Medicine Residency Program Director, HonorHealth, Clinical AssociateProfessor of Medicine, UA College of Medicine, Phoenix

Dustin McCurry, Co-Chair, Medical Student Committee, University of Arizona College of Medicine, Phoenix

Michael Maricic, MD, Practicing Rheumatologist, CatalinaPointe Rheumatology, Tucson

Laura Meinke, MD, FACP, FCCP, Program Director, Internal Medicine/Pulmonary and Critical Care Medicine, University ofArizona College of Medicine at University Campus, Tucson

Kevin F. Moynahan, MD, FACP, Deputy Dean for Education, Director, Societies Program, Associate Professor of Medicine,University of Arizona College of Medicine, Tucson

Anita C. Murcko, MD, FACP, Clinical Associate Professor, Univer-sity of Arizona Health Sciences Center, College of Pharmacy; Faculty Associate, Department of Biomedical Informatics, Arizona State University; President and CEO, Cambiare, LLC, Scottsdale

Cheryl W. O’Malley, MD, FACP, Program Director, Internal Medi-cine, Banner University Medical Center-Phoenix/Phoenix VA; Associate Professor of Medicine, University of Arizona, Phoenix

Priya Radhakrishnan, MD, FACP, Robert Craig Academic Chair of Internal Medicine, St. Joseph’s Hospital and MedicalCenter, Phoenix

Faculty

Meeting Information

Faculty (cont.)Jaya Raj, MD, FACP, Internal Medicine Residency Program Direc-tor, St Joseph’s Medical Center; Associate Professor of Medicine,Creighton University School of Medicine; Assistant Professor ofMedicine, University of Arizona College of Medicine, Phoenix

Shaikab U. Rehman, MD, FACP, FAACH, Associate Chief of Stafffor Education, Phoenix VA Health Care Systems, U.S. Departmentof Veteran Affairs; Professor of Internal Medicine, University ofArizona College of Medicine, Phoenix

Yamine Saddouk, MD, DO, Internal Medicine Program Director,Mountain Vista Medical Center, Mesa

Fadi Shamoun, MD, FACC, FSVM, FASE, Medical Director, NPCardiology Fellowship, Medical Director, Anticoagulation Clinic,Assistant Professor of Medicine, Vascular Medicine, Division ofCardiovascular Diseases, Mayo Clinic Arizona, Scottsdale

Shannon E. Skinner, MD, FACP, FAAP, Internal Medicine ResidencyProgram Director, Maricopa Medical Center, Phoenix

Steven Taylor, Co-Chair, Medical Student Committee, Universityof Arizona College of Medicine, Tucson

Eugene Trowers, MD, MPH, FACP, Professor of Medicine, Program Director Internal Medicine Residency, University of Arizona Medical Center-South Campus, Tucson

Pete Wertheim, Executive Director, Arizona Osteopathic Medical Association, Phoenix

Preethi William, MD, Chair, Council of Resident/Fellow Mem-bers (formerly Associates and Fellows-in-Training); GeriatricsFellow, University of Arizona College of Medicine at UniversityCampus, Tucson

Kevin Wilson, DO, FACP, FACOI, Director, Medical Education, Internal Medicine Residency Program Director, Verde ValleyMedical Center, Cottonwood

Dean Wright, RPh, Director, the Controlled Substances Prescription Monitoring Program (CSPMP), Tucson

Mark A. Zubriski, MD, PhD, FACP, Academic Hospitalist, Phoenix VA Health Care System, U.S. Department of VeteransAffairs; Clinical Assistant Professor, University of Arizona College of Medicine, Phoenix

Program CommitteeEric P. Gall, MD, MACP, 2015 Program Chair

Robert M. Aaronson, MD, FACP, Governor, Arizona Chapter

Hamed Abbaszadegan, MD, MBA, Chair Posters/Abstracts

Neil M. Ampel, MD, FACP

Timothy C. Fagan, MD, FACP, 2011 Program Chair

Santhosh Gheevarghese John, MD, FACP

James F. Keane, DO

Helene R. Labonte, DO, FACP, 2014 Program Chair

Allan L. Markus, MD, MS, MBA, FACP

Kevin F. Moynahan, MD, FACP, 2009 Program Chair

Anita C. Murcko, MD, FACP, Advocacy Chair

Rakesh Nanda, MD, FACP

Priya Radhakrishnan, MD, FACP, Chair Awards

Jaya Raj, MD, FACP

Shakaib U. Rehman, MD, FACP, FAACH

Howard M. Shulman, DO, FACP, FACOI, 2010 Program Chair

Steven Taylor, Medical Student

Rupal Vora, MD, FACP, 2013 Program Co-Chair

Mark A. Zubriski, MD, PhD, FACP, Chair, Doctor’s Dilemma™

Dixie Swan, Executive Director (Staff Member)

Teri Harnisch, Meeting Support (Staff Member)

Meeting Information

Learning ObjectivesAt the conclusion of this activity, the participant will be able to:• Apply updated knowledge of valley fever (acute coccid-

ioidomycosis), tumor necrosis factor inhibitor information,and new developments in High Value Care Curriculum, all relating to clinical practice.

• Improve clinical practice by incorporating major new developments in medication management of chronic pain, including discussion of legal considerations in Arizona.

• Understand recent advances in management of anticoagulation treatments.

• Understand political advocacy and reform.

CME AccreditationThe American College of Physicians is accredited by the Accreditation Council for Continuing Medical Education (ACCME)to provide continuing medical education for physicians.

The American College of Physicians designates this live activityfor a maximum of 16.5 AMA PRA Category 1 Credit(s)TM.Physicians should claim only the credit commensurate withthe extent of their participation in the activity.

Chapter AwardsThe Arizona Chapter will be presenting the following Chapterawards on Saturday:• Laureate Award• Volunteerism and Community Service Award• Educator of the Year Award• Internist of the Year Award• Leader of the Year• Researcher of the Year• Resident/Fellow of the Year• Medical Student of the Year• Morton Fuchs Community-Based Education Memorial Award

Chapter Excellence Award: We are pleased to announce thatour chapter is in receipt of the 2014 Chapter Excellence Award.The Chapter Excellence Award recognizes those chapters thatexcel in reaching the standards for managing a chapter, such as communicating to members, instituting Medical Students’and Resident/Fellow Members’ activities, and advancing andrecruiting members. A Chapter Excellence certificate will beawarded at the meeting.

Who Should Attend? • General internists• Subspecialty internists• Family practitioners• Fellows in subspecialty training• Hospitalists• Allied health practitioners• Residents• Medical students interested in internal medicine

Resident/Fellow Members’ ActivitiesClinical vignettes, posters, and research papers preparedby Resident/Fellow Members will be presented at themeeting. Winners will receive $150 for first place, $100 for second place, and $50 for third place. Winners of theResident/Fellow Research Poster and Oral Vignette will beeligible for entrance into the National ACP Poster Competi-tion, and will receive a $1,000 stipend for the travel coststo attend Internal Medicine Meeting 2016 in Washington,DC. Contact Teri Harnisch at teri@azmed.org for informa-tion about entering the competition. Deadline for submissions is September 15, 2015.

• Friday–Speak with Fellowship Directors, one-on-one, in a special Residents’ track

• Saturday–Doctor’s Dilemma™ competition

Medical Student Activities• Face and quiz a panel of Residency Program Directors

from all over the state of Arizona

• The Doctor’s Dilemma™ Medical Student Round

• Poster competition

Maintenance of Certification

Friday, November 13, 20157:00 a.m. Registration and Continental Breakfast for ABIM SEP Modules Attendees

7:30ABIM SEP Module #1: 2015 Infectious Diseases UpdateModerators: Neil Ampel, MD, FACP, and Craig Brown, DO

9:40ABIM SEP Module #2: 2015 Cardiology UpdateModerators: Umaima Fatima, MD, and G. Joseph Orme, DO, MPH

SEP FacultyNeil Ampel, MD, FACP, Professor of Medicine, University ofArizona College of Medicine; Program Director, Infectious Diseases, Southern Arizona VA Health Care System, Tucson

Craig Brown, DO, Fellow in Infectious Diseases, University of Arizona College of Medicine, Tucson

Umaima Fatima, MD, FACC, Phoenix VA Health Care System, Associate Professor at University of Arizona College of Medicine–Phoenix; Associate Director of Cardiology Fellowship Program, VA/Banner University Medical Center, Scottsdale

G. Joseph Orme DO, MPH, Cardiology Fellow, Banner University Hospital, Phoenix

SEP Learning Objectives• Participate in group discussion to determine answers to

multiple-choice questions.

• Apply updated knowledge of internal medicine to clinical practice.

• Understand recent advances in internal medicine.

• Complete an ABIM SEP Module toward partial fulfillment of the ABIM’s Maintenance of Certification.

SEP CME Accreditation The American College of Physicians is accredited by the Accreditation Council for Continuing Medical Education (ACCME)to provide continuing medical education for physicians.

The American College of Physicians designates this live activityfor a maximum of 4.0 AMA PRA Category 1 Credit(s)TM. Physi-cians should claim only the credit commensurate with the extent of their participation in the activity.

Who Should Attend the SEP Pre-Course?• Internists participating in the ABIM Maintenance of

Certification Program

• General internists

• Family practitioners

• Subspecialty physicians

SEP NoteThe Arizona Chapter will provide you with a learner's copy of the ABIM module(s) at the meeting. If you are enrolled inthe ABIM's Maintenance of Certification program, you alsomust order the module* directly from the ABIM by visitingwww.abim.org/online. After the Learning Session, submit youranswers online to the ABIM for Maintenance of Certificationcredit. For more information about the ABIM's Maintenance ofCertification program, visit www.abim.org/moc or call ABIM at 800-441-ABIM (2246).

Each of these modules is eligible for 10 MOC points through ABIM.

Pre-course: ABIM SEP Modules Session for Maintenance of Certification

*If you are already enrolled in the ABIM Maintenance of Certification program, there is no additional fee for this officialversion of the module. If you are not enrolled, you may attendthe Learning Session; however, you must enroll before receivingMaintenance of Certification points for the knowledge module.To enroll, visit www.abim.org/online.

Additional Information

Additional FeesAll registrations must be received by October 9, 2015 or a late registration fee of $50 will be added. This includes on-site registrations. Save money by registering now!

Satisfaction GuaranteeThe College offers a satisfaction guarantee for all of its courses. If meeting attendees are not satisfied with their experience at a chapter meeting, they may write and request a refund of their registration fee.

Registration InformationFor questions about the meeting schedule or location, please contact: Dixie Swan602-347-6916

Late Registration and Onsite FeesPlease complete the section below if you wish to set a late registration and/or an onsite fee.All registrations must be received by October 9, 2015 or a late registration fee of $50 will be added. This includes on-site registrations. Save money by registering now!

Cancellations/RefundsNotice of cancellation must be made in writing (fax, mail, or e-mail). Cancellations will not be accepted by telephone. Aprocessing fee of $25.00 will be deducted from the member’srefund. Individuals who fail to attend the course (no-shows)will not be entitled to any refund.

v BY INTERNET UBY MAIL T BY FAX SBY PHONE(Credit Card only) Make check or money order (Credit Cards only) Call 800-523-1546, ext. 2600,Visit us on the Web payable to ACP. 215-351-2799 or 215-351-2600www.acponline.org/chapters AC002 (M–F, 9 a.m.–5 p.m. ET)

American College of Physicians190 N. Independence Mall WestPhiladelphia, PA 19106-1572

Questions?• For registration information, contact ACP Customer Service

(M–F, 9:00 a.m.–5:00 p.m. ET) toll-free at 800-523-1546, ext. 2600, or direct at 215-351-2600. You may also e-mailcustserv@acponline.org or fax 215-351-2799.

• If you have questions about the chapter, the meeting pro-gram, or have a disability or any special dietary needs, pleasecontact Dixie Swan by telephone at 602-347-6916, or e-maildswan@azmed.org.

Hotel AccommodationsWe have reserved a block of rooms at the following rates untilWednesday, October 14, 2015. When making your reservation,be sure to mention that you will be attending the ACP ArizonaChapter meeting. The rooms are available on a first-come,first-served basis, so make your reservation as early as possibleby calling the hotel directly at 1-800-HILTONS. The reservationis in the name of the AZ Chapter ACP.Single/Double: $119.00; Triple: $129; Quad: $139 DoubleTree Hilton Tucson–Reid Park445 S. Alvernon WayTucson, AZ 85711-4198

Contact Us

Visit us online for details on hotel reservations, directions, parking, and areas of interest.

Arizona Chapter Registration Form CMB

ACP # (found on mailing label)

Name □ MD □ DO □ OTHER

Address

City State ZIP

Daytime Phone Fax E-mail

□ Please exclude me from receiving mailings from the meeting exhibitors.

□ Check here if you are disabled and require assistance. Pleasenotify the Arizona Chapter in writing before your course.We’ll be glad to help.�

Registration FeesCheck one category that best applies. Registration fee includes continental breakfast, lunch, all scientific sessions and materials,and CME documentation.

Chapter Meeting OnlyRegister by 10/09/15 Chapter Meeting Only

Categories (RM1631) Register After 10/09/15□ ACP Member $225 $275□ ACP Resident/Fellow Member $25 $25□ ACP Medical Student Member No Fee No Fee□ Nonmember Physician $325 $375□ Nonmember Resident* $25 $25□ Nonmember Medical Student No Fee No Fee□ Nonmember Allied Health Professional $325 $375

*Nonmember Residents must register by contacting chapter staff at 602-347-6916 in order to get the correct registration rate.

SEP Module #1: 2015 SEP Module #2: 2015 Infectious Diseases Cardiology Update SEP Modules 1 & 2Update (RM1631A) (RM1631B) (RM1631C)

□ ACP Member Fee $75 $75 $150□ Nonmember Fee $90 $90 $180

RM1631Tucson, AZ ● November 13–15, 2015

SEP Module Registration (Continental Breakfast Included)Friday, November 13, 2015

Arizona Chapter Registration Form CMB

Payment Options□ Check enclosed.

(Payable to ACP. Must remit in U.S. funds drawn on a U.S. bank.)

□ Charge to:

Card # ______________________________________________

Exp. Date ______/______ Security Code _______________MM/YY (3- or 4-digit number found on front or back of card)

Signature: __________________________________________

Please indicate your attendance at the following: Day 1–November 13

□ TRFM–Faculty Medical Education Focus (includes luncheon)–11:45 a.m.

□ TRRF–Resident/Fellow Member Track–2:00 p.m.

□ TRMS–Medical Student Track–2:00 p.m.

□ GDBE–Governor’s Dinner (Beef)–$80 per person–6:30 p.m.

□ GDFI–Governor’s Dinner (Fish)–$80 per person–6:30 p.m.

□ GDCH–Governor’s Dinner (Chicken)–$80 per person–6:30 p.m.

□ GDVE–Governor’s Dinner (Vegetarian)–$80 per person– 6:30 p.m.

Day 2–November 14

□ SABR–Continental Breakfast–7:00 a.m.

□ SALU–Box Lunch–Noon

□ SALUV–Vegetarian Box Lunch–Noon

Day 3–November 15

□ SUBR–Continental Breakfast–7:00 a.m.

Grand Total $ _______________

CHS5029