South Carolina Orthopaedic Association & South Carolina Association of Orthopaedic Executives

AnnuAl MEEting 2 0 1 2

August 2-5, 2012

the sAnctuAry At KiAwAh islAnd KiAwAh islAnd, sc

South Carolina orthopaediC aSSoCiation & South Carolina aSSoCiation of orthopaediC exeCutiveS

annual Meeting

Meeting Objectives:Upon completion of this activity, participants will be able to learn the results of new research and clinical advances, learn how to expand the care provided in your orthopaedic practice, update basic knowledge and skills, exchange ideas with experts and

peers in musculoskeletal care, analyze the health policy trends affecting your patients and practice, assess the latest in orthopaedic equipment and services, provide opportunities to strengthen professional relationships, demonstrate surgical techniques, facilitate

evidence based improved outcomes in patients, and promote patient safety.

stateMent Of accreditatiOnThis live activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation

Council for Continuing Medical Education through the joint sponsorship of the American Academy of Orthopaedic Surgeons and the South Carolina Orthopaedic Association. The American Academy of Orthopaedic Surgeons is accredited by the ACCME

to provide continuing medical education for physicians.The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 7 AMA PRA Category 1

Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

prograM CoMMittee:Stephen Ridgeway, MD

Piedmont Orthopaedic Associates, Greenville, SC President, SCOA

Coleman Fowble, MDMidlands Orthopaedics, PA, Columbia, SC

President Elect, SCOALangdon Hartsock, MD

Medical University of South Carolina, Charleston, SC

auguSt 2-5, 2012the SanCtuary at Kiawah iSland | Kiawah iSland, SC

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What an amazing week to be at Kiawah Island as the PGA Tour prepares to invade the island for the PGA Championship and the entire sporting world gets their opportunity to see the beauty of this serene destination. What a terrific backdrop for our 2012 Annual Meeting.

On behalf of the leadership of the South Carolina Orthopaedic Association, I would like to extend a very

special welcome to all of my colleagues who are joining us for this year’s 62nd SCOA Annual Conference. The Program Committee has put together an excellent agenda, combining stimulating scientific education with critical socio-economic and advocacy information that will benefit us all.

I would encourage you and your family to take advantage of the unique opportunity to hear Walter Edgar from the University of South Carolina address the membership on Saturday morning. All of our families are invited to attend. Walter is the premier authority on the history of our great state and his talk on “Charles Towne’s Golden Age” is certain to entertain and educate.

Due to the PGA Championship, we are unable to utilize the Ocean Course for this year’s Presidential Farewell Reception. The reception this year will take place on the Grand Lawn at the back of the resort. We will again arrange organized activities for the children that evening to enable all of you to participate in this reception.

As always, thank you for the opportunity to serve our profession and thank you for joining us this weekend as we celebrate our profession. Please let the leadership and staff of our organization know if there is anything we can do to ensure a terrific weekend for you and your family.

Sincerely,

Stephen Ridgeway, M.D.

The World’s focus turns to Kiawah…. About our DestinationLocated on a beautiful barrier island just a few miles from historic Charleston, South Carolina lies Kiawah Island Golf Resort, the Official Golf & Tennis Resort at Kiawah Island. Endless possibilities await our guests to our island resort. Experience for yourself why readers of Golf World Magazine voted Kiawah Island Golf Resort “#1 Resort in the U.S.”

• Five award-winning championship South Carolina golf courses including the Ocean Course, home of the 2007 Senior PGA and 2012 PGA Championships, offering challenging play for golfers of all levels.

• Hard and clay courts are available at the #1 Tennis Resort in the World, as ranked by Tennisresortsonline.com.

• A variety of recreational activities are sure to please everyone in your family. From kayaking, nature tours, bicycling to beach fun at the “Top Family Resort”, as voted by Travel + Leisure Family Magazine.

• Hotel and vacation rental accommodations. Stay at our Award-Winning oceanfront Sanctuary Hotel.

• Outstanding dining options that include The Ocean Room, the resort’s premier steakhouse, The Atlantic Room at The Ocean Course, our signature seafood restaurant, Tomasso at Turtle Point, Charleston’s finest Italian food and Jasmine Porch, authentic Lowcountry cuisine, plus many other restaurant options located throughout the island that are sure to please.

The staff at Kiawah Island Golf Resort invite your family to visit and enjoy everything our resort, as well as the neighboring Charleston, South Carolina area has to offer. We want you to enjoy a gracious tradition of golf and hospitality.

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guest speakersWALTER EDGAR

Walter Edgar, the Director of the Institute for Southern Studies at the University of South Carolina, is a Carolina Trustee Professor, the Claude Henry Neuffer Professor of Southern Studies, the George Washington Distinguished Professor of History, and a Louise Fry Scudder Professor of Liberal Arts.

Born in Mobile, Alabama, he did his undergraduate work at Davidson College and his graduate work at the University of South Carolina. He is the author and editor of more than a dozen books on South Carolina and the American South, including his most recent publication The South Carolina Encyclopedia (2006) of which he was editor-in-chief. He is also the author of South Carolina: A History (1998) and Partisans and Redcoats: The Southern Campaign that Turned the Tide of the American Revolution (2001).

He is in much demand as a speaker and annually delivers twenty-five to thirty talks and lectures to a wide variety of audiences. In addition to his scholarly pursuits, he is the host of two programs on South Carolina Public Radio: “Walter Edgar’s Journal,” a look at contemporary events in context and “South Carolina from A to Z.”

In 1995 he retired as a colonel in the Army Reserves after thirty years of commissioned service. Among his awards and honors are honorary degrees from Davidson College, the Citadel, Coker College, Newberry College, and Coastal Carolina University. In 2001 he received the Distinguished Alumnus Award from the University of South Carolina and in 2008 was inducted into the South Carolina Hall of Fame. He has been listed in Who’s Who in America since 1985.

JOHN R. TONGUE, MD AAOS President

Orthopaedic surgeon John R. Tongue, MD, of Lake Oswego, OR, became the president of the American Academy of Orthopaedic Surgeons (AAOS) at its 2012 Annual Meeting in San Francisco.

An active member of the AAOS, Dr. Tongue has served on the leadership line and as

the Chair of the Board of Councilors and has previously volunteered on numerous committees and task forces, including the Council on Education, the Committee on Public Education and the Council on Research.

Dr. Tongue has received numerous honors and accolades, including the AAOS Humanitarian Award, the National Highway Traffic Safety Association Public Service Award for his work in passing the Oregon Safety Belt Law, and the Oregon Medical Association’s Doctor-Citizen of the Year award.

A graduate of Northwestern University in Evanston, Illinois, and the St. Louis University School of Medicine in Missouri, Dr. Tongue served as an intern and general surgery resident at the University of Oregon Medical School in Portland, OR. He then completed his orthopaedic surgery residency at the San Francisco Orthopaedic Residency Training Program. He completed a sports medicine fellowship at the Orthopaedic Fracture Clinic in Eugene, Ore., and a hand surgery fellowship at the University of California in San Francisco.

Currently, Dr. Tongue maintains his private practice in Tualatin, OR, and also is a clinical associate professor at Oregon Health Sciences University in Portland.

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COMMISSIONER ANDREA C. ROCHE

Commissioner Roche was appointed to the SC Worker’s Compensation Commission on June 30, 2006. She served a term as Chairman of the Commission from 2008-2010. Before serving on the Commission, Commissioner Roche was a partner in the law firm Barnes, Alford, Stork and

Johnson, practicing primarily workers’ compensation defense and appellate advocacy. Commissioner Roche is a 1994 graduate of the Yale Law School and a 1988 graduate of the University of North Carolina at Chapel Hill. Following graduation from Yale, Commissioner Roche clerked for the Honorable Robert F. Chapman on the United States Court of Appeals for the Fourth Circuit. Commissioner Roche also clerked for the Honorable Carol Connor of the South Carolina Court of Appeals and served as a staff attorney for the Court. Prior to law school, Commissioner Roche was manager of the Ripley’s Believe It or Not! Museum in New Orleans. She currently serves as an ex officio member of the Board of Directors of the South Carolina Workers’ Compensation Educational Association and is also on the Board of Directors of South Carolina Kids’ Chance. She and her husband Jimmy live in Columbia.

NELDA D. FIELDS, MBA, FACMPE, FHFMA Healthcare Consulting Group, WebsterRogers LLP

Nelda D. Fields, FHFMA, FACMPE, MBA is Director of the Healthcare Consulting Group with WebsterRogers LLP. She applies healthcare financial management and accounting knowledge to assist healthcare entities in their operations. Ms. Fields prepares, analyzes, and reports on financial statements and practice management

functions, and develops physician compensation models, compliance programs, and RBRVS charge structure. She performs process system reviews and implements revenue cycle process changes. She works closely with healthcare entities for implementation of PM and EHR systems and to realize government incentive dollars. Ms. Fields received her BS degree in business administration, cum laude, from Francis Marion College in Florence, S.C., and her MBA degree from Charleston Southern University in Charleston, S.C. She is a fellow in the Healthcare Financial Management Association (FHFMA) with specialty in the area of patient financial services and physicians’ practice management.

Ms. Fields is a fellow in the American College of Medical Practice Executives (ACMPE). She was the recipient of the 2003 Richard L. Davis, FACMPE – Barbara B. Watson, FACMPE National Scholarship from the American College of Medical Practice Executives. She was a speaker at the National HFMA Annual on reengineering the patient revenue cycle. She also is a speaker for MGMA Regional, State and local conferences. She is a distinguished faculty member with Lorman Education Services, and presents regularly on healthcare topics.

guest speakers

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WELCOME RECEPTIONThe annual Welcome Reception will be held the first evening of the meeting, Thursday, August 2nd from 6:00 to 7:30 pm in the Grand Oaks D&C & Foyer. All meeting attendees, exhibitors, and their families are encouraged to attend.

SPOuSE & FAMILy BREAkFASTS We have arranged breakfast for family members on Friday and Saturday morning from 8 am to 10 am in the Ocean Room. We hope you will enjoy an opportunity to meet other family members and guests attending the meeting and plan some group activities for the day.

ORGANIzED GOLF OuTING The golf outing will take place on Friday, August 3rd on the Turtle Course starting at 1:30 pm. The cost per player is $150. All attendees interested in playing in the organized event should register prior to the meeting or at the meeting registration desk at the hotel.

ORGANIzED TENNIS The organized tennis will take place on Friday, August 3rd starting at 1:30 pm. All attendees interested in playing in the organized event should register prior to the meeting or at the meeting registration desk at the hotel.

FAMILy RECEPTION & DINNER The Beachside Terrace & Lawn will once again play host to our family reception and dinner on Friday evening, August 3rd from 7 to 10 pm. All meeting attendees, exhibitors, and their families are encouraged to attend. There is no charge for attending but you will need to RSVP and receive wrist bands for the number of adults and children who will be attending. We will require attendees to show their wrist bands to enter the dinner so we have a accurate head count of attendees. Entertainment will be provided.

5k FuN RuN Please join us the morning of Saturday, August 4th for a little

special eventsexercise in the most exhilarating setting imaginable. The run will take participants along the beach enjoying stunning views of the ocean and surroundings. The run will start at 6:30 am. We are planning to meet on the Grand Lawn and then walk down to the beach for the run. Please check with the registration desk for a map or if you have any questions.

PRESIDENTIAL FAREWELL RECEPTION This year we have secured the Grand Lawn for the farewell reception that is certain to provide a fantastic conclusion to our weekend. The reception will take place from 6:30 to 8:00 pm on Saturday, August 4th. This event is for adults only. The reception will give all attendees the opportunity to wind-down and spend the final hours of our annual event in the company of colleagues. Dress is “snappy casual”. Exhibitors and their guests are encouraged to attend but tickets are required. We will provide substantial food during the event but if you want to keep the evening going you may want to make reservations for dinner immediately following the reception at any of the outlets at the resort. We hope to give you the opportunity to enjoy each others company for a little while longer as we recognize the contributions of our outgoing President, Stephen Ridgeway, M.D.

ORGANIzED kIDS ACTIvITy SATuRDAy NIGHT We have arranged for the hotel to provide organized activities for children attending the reception on Saturday evening from 6:30 to 9:30 pm. The activities will include dinner. We hope this will give the adults an opportunity to enjoy the Farewell Reception on the Grand Lawn. The cost per child is $55 and we do need the ages of each of the children. There is a location to include this information on the registration form. Pre-registration is required and can be noted on the meeting registration form or on-site. Please check with the Meeting Registration desk for final details on where to check in the children on Saturday evening.

Housing instructions:Hotel reservations should be made directly with

The Sanctuary at kiawah Island, (843) 768-2121. Make sure that you mention you are participating in the South Carolina Orthopaedic

Association meeting to ensure you receive the group rate of $489 per night. Less expensive Villa Accommodations are available upon request.

The room block expires July 1st, so make sure you have reserved by that date.

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South Carolina orthopaediC aSSoCiation2012 annual Meeting prograM

august 2, 2012 (tHursday )

3:30–5:30 pm SCOA Board of Directors Meeting Calhoun

3:00–7:00 pm Registration Grand Oaks Ballroom Foyer Hospitality Desk

6:00–7:30 pm Welcome Reception Grand Oaks Ballroom D & C & Foyer

august 3, 2012 (friday )

6:45-Noon registrationGrand Oaks Ballroom Foyer Hospitality Desk

7:00–8:00 am continental breakfastGrand Oaks Ballroom D&C

8:00-10:00 am spouse and family breakfast Ocean Room

7:00–8:00 am Business Session – (All Members may attend)Grand Oaks Ballroom B

8:00–9:00 am GENERAL SESSION IGrand Oaks Ballroom B Moderator: Stephen Ridgeway, MDJoint Meeting of SCOA and SCAOE

8:00 – 8:10 am Welcome & Opening RemarksStephen Ridgeway, MD SCOA President Greenville, SC

8:10 – 8:50 am AAOS ReportJohn R. Tongue, MDAAOS President, Tualatin, OR

8:50 – 9:00 am Questions & Answers

9:00 - 9:30 am PQRS and the value Based ModifierNelda D. Fields, MBA, FACMPE, FHFMA WebsterRogers, LLP Charleston, SC

9:30 - 9:45 am Questions & Answers

9:45–10:45 am Coffee Break & Exhibits in Grand Oaks Foyer

10:45– 2:25 pm GENERAL SESSION IIGrand Oaks Ballroom B Moderator: Thomas Joseph, MD

RESIDENT COMPETITION 10:45-10:55

Pseudomeniscus Formation after Total knee ArthroplastyDylan Watson, MDGreenville Hospital System Greenville, SC

10:55-11:05 Angle Stable Locking Screws Reduce Incidence of Malalignment in Distal Tibia Fractures Treated with Intramedullary Nails John Adams, MDGreenville Hospital System Greenville, SC

11:05-11:15 The Clinical Implications of Heterotopic Ossification Following Radial Head Arthroplasty for Trauma Zeke Walton, MDMedical University of South Carolina Charleston, SC

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11:15-11:25 visionaire versus Conventional Total knee ArthroplastyBrandon Broome, MDGreenville Hospital System Greenville, SC

11:25-11:35 Selecting an Orthopaedic FellowshipJustin Hoover, MD University of South Carolina Columbia, SC

11:35-11:45 Safety of FHL Harvest using Hamstring Tendon StripperMelissa Earles, MDGreenville Hospital System Greenville, SC

11:45-11:55 Pediatric Methicillin-Resistant Staphylococcus Aureus Hand and upper Extremity Infections S. Matt Hollenbeck, MD Greenville Hospital System Greenville, SC

11:55-12:05 Orthopaedic Surgeons in Training can Quickly Learn to Diagnose Full Thickness Rotator Cuff Tears using ultrasonographyKevin Kruse, MDGreenville Hospital System Greenville, SC

SCIENTIFIC PRESENTATIONS 12:05-12:15

Alendronate Reduces the Risk of Early Femoral Failure after Metal on Metal Hip ResurfacingThomas Gross, MDMidlands Orthopaedics Columbia, SC

12:15-12:25 Comparison of Conventional Polyethylene Wear and Signs of Cup Failure in Two Similar Total Hip DesignsPace, Keith, Alvarez, Snider, Tanner, DesJardins

Kevin Keith, B.S. (presenter)Clemson University

12:25 pm Adjournment

1:30 – 5:45 pm Organized GolfTurtle Course

1:30– 4:15 pm Organized TennisKiawah Island Resorts Courts

7:00 – 10:00 pm Family Reception & DinnerThe Sanctuary Kiawah Island Resort Hotel Beachside – Terrace & Lawn

august 4, 2012 (saturday )

6:30 am 5k Walk / RunParticipants Meet on the Grand Lawn

6:45 am – Noon RegistrationGrand Oaks Ballroom Hospitality Desk

7:00 – 7:50 am Continental BreakfastGrand Oaks Ballroom C & D & Foyer

8:00 – 9:30 am spouse and family breakfastOcean room

7:00 – 7:50 am Business Session – (All Members may attend) grand Oaks ballroom b

state Legislative and regulatory update Tony Denny – scOa Lobbyist

election of Officers for 2012-2013 address from incoming President

Coleman Fowble, MDcolumbia, sc

7:50 – 10:00 am GENERAL SESSION IIIGrand Oaks Ballroom B Moderator: Coleman Fowble, MD7:50 – 8:00 am Welcome & Announcements 8:00 – 8:50 am Presidential Guest Speaker“Charles Towne’s Golden Age” Walter EdgarDirector Institute for Southern Studies at the University of South Carolina (Attendees family and guest welcome to join)8:50 – 9:00 am Question & Answers9:00 – 10:00 am Legislative Roundtable

2012 annual Meeting prograM Continued

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10:00–11:00 am Coffee Break & Exhibits in Grand Oaks Foyer

11:00–12:40 pm GENERAL SESSIONS IvGrand Oaks Ballroom B Moderator: Stephen Ridgeway, MD11:00 - 11:30 am The Role of Orthopaedic Surgeons in Workers Compensation Commissioner Andrea C. Roche SC Workers’ Compensation Commission Columbia, SC11:30 – 11:45 am RESIDENCy PROGRAM uPDATESMedical University of South CarolinaCharlestonUSC School of MedicineColumbiaGreenville Hospital System University Medical CenterGreenvilleSCIENTIFIC PRESENTATIONS 11:45-11:55 am Reverse Shoulder Arthroplasty Michael Kissenberth, MD Steadman Hawkins Clinic Simpsonville, SC

2012 annual Meeting prograM Continued

11:55-12:05 pm Reducing Postoperative Complications by Improving Preoperative Screening and Patient Preparation Kim Chillag, MD Moore Clinic Columbia, SC12:05-12:15 pm Own the BoneKyle Jeray, MDGreenville Hospital System Greenville, SC12:15-12:25 pm The Contrivances of a ContrarianRichard Gross, MDMedical University of South Carolina Charleston, SC12:25–12:40 pm BOyD CuP COMPETITION: Review & Award Recipients Scott Porter, MDGreenville, SCLee Leddy, MDCharleston, SC12:40 pm Adjournment

7:00 – 8:30 pm Casual Cocktail ReceptionThe Sanctuary Kiawah Island Resort Hotel The Sanctuary Grand Lawn Heavy Appetizers and Refreshments will be served

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South Carolina aSSoCiation of orthopaediC exeCutiveS2012 annual ConferenCe agenda

****Please note the SCAOE Meeting for administrators is not accredited for any CME credits for physician attendees.

august 2, 2012 (tHursday )3:00–8:00 pm Registration

Grand Oaks Ballroom Foyer Hospitality Desk6:00–7:30 pm Welcome Reception

Grand Oaks Ballroom C&D & Foyer8:00–10:00 pm SCAOE Dinner

Sponsored by: MAG Mutual and Millennium Labs Drayton Room

august 3, 2012 (friday )

SCAOE GENERAL SESSION 1 Grand Oaks Ballroom A

10:00-11:00 am Where Quality and Payment Intersect: Guidelines, utilization and Payer Policies

Ashlen AndersonAmerican Academy of Orthopaedic Surgeons

Fraser CobbeSouth Carolina Orthopaedic Association

11:00 – 11:45 am Defending the Practice from the Expanded use of Audits William (Bill) Hutson, CPCU, RPLUSenior Sales Executive MAG Mutual Insurance Co.

11:45-12:00 pm update on the South Carolina Orthopaedic Risk Purchasing GroupRoy E. (Chip) Goen, MBA, CICVice President, Sales MAG Mutual Insurance Agency, LLC

12:00 – 1:00 pm Lunch & Business Meeting Election of Officers SCAOE GENERAL SESSION 2 1:00–1:45 pm Are you Prepared for Meaningful use

Tim SchmidtCEO Managed Care Advisory Group

1:45-2:30 pm Group Discussion – Medicare utilization Reports, PQRS and the value Based Modifier – Practical Applications for Orthopaedic PracticesNelda D. Fields, MBA, FACMPE, FHFMAWebsterRogers, LLP Charleston, SC

2:30-3:00 pm Health Care Challenges in Workers CompensationCommissioner Andrea C. RocheSC Workers’ Compensation Commission Columbia, SC

3:00-3:30 pm update on Integrated Physical Therapy Services in SC Fraser CobbeExecutive Director South Carolina Orthopaedic Association

3:30–4:00 pm Open DiscussionModerators: Pete Mansfield & Geoff McLeod

4:00 pm Closing Remarks and Adjournment

2012 SCOA ANNUAL MEETINGAugust 2-4, 2012 ~ The Sanctuary at Kiawah Island, SC

ExHIBIT SHOW HOuRSSet-up:

Thursday, August 2 .................................................. 2 to 5 pm

Show Hours:Thursday, August 2 .................................................. 6:00 to 7:30 pm (reception)Friday, August 3 ...................................................... 7:00 to 8 am (breakfast)Friday, August 3 ...................................................... 9:00 to 10:00 am (break)Saturday, August 4 .................................................. 7:00 to 8 am (breakfast)Saturday, August 4 .................................................. 9:45 to 10:15 am (break)

Break down:Saturday, August 4 .................................................. 10:30 to 2 pm

Please note: all food & beverage will be in the exhibit hall so while the official exhibit hours are listed above, attendees will be coming and going during regular session hours as well.

• Representatives are encouraged to participate in all meeting sessions.• Please make sure you have registered for Golf or Tennis on Friday if you plan to participate so we

can secure enough spots.• The dinner event Friday evening is for everyone, including children. The event if free to participate

but we will be requiring all attendees to have a ticket to attend. Therefore reservations are mandatory.

• Saturday evening’s reception on the Grand Lawn is open for everyone. Reservations are required to attend and a $50 fee is required for exhibitor representatives.

Please make sure you have returned the Sponsor Event Registration form to sign up for any of the special events. Please check with the Registration Desk to confirm your registration.

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The South Carolina Orthopaedic Association and the South Carolina Association of Orthopaedic Executives would like to recognize and thank the following companies who have

already registered for the 2012 Annual Conference. Exhibitor Registration is still open!

Contact scoa@cobbemanagement for additional details.

PLATINUM LEVEL EXHIBITORSMAG Mutual Insurance Company

GOLD LEVEL EXHIBITORSMillennium Laboratories

SILVER LEVEL EXHIBITORSBiomet (Millennium Medical Ortho, Inc)

Linear Medical Solutions

EXHIBITORSConvatec

Ferring PharmaceuticalsSouthern Orthopaedics LLC

South Carolina Orthopaedic Association South Carolina Association of Orthopaedic Executives

2012 Annual Meeting Registration FormAugust 2-4, 2012 | The Sanctuary at kiawah Island | kiawah Island, SC

PLease nOte: This form is not intended for use by industry representatives. Representatives interested in attending should contact the SCOA.

Name: ___________________________________________________ Preferred Badge First Name ________________________

Spouse/Guest Name: _______________________________________ Preferred Badge First Name _______________________

Email Address: ______________________________________________________________________________________________

Address: ___________________________________________________________________________________________________

City: ______________________________________ State:______ Zip:___________ Telephone:____________________________

Registration fees should be made by check payable to SCOA and include any additional fees found below under Special Registrations. Requests for refunds must be made in writing prior to the conference.

Meeting Registration Fees Per Person: SCOA Member w/Guest ....................................................... $100SCOA Emeritus Member w/Guest ...................................... $100 SCAOE Member w/Guest ......................................... No Charge Non-Member (SCOA & SCAOE) ....................................... $300Resident w/Spouse/Guest .......................................... No Charge

4 ways to register for Meeting:1 www.regonline.com/2012scoaam 2 FAx form to (813) 949-89943 MAIL to: SCOA, 17503 Mallard Court, Lutz, FL 335594 CALL SCOA at (813) 949-3121

REGISTRATIONS & FEES TOTAL NuMBER FOR EACH EvENT:Registration Fee from Above ....................................................................................................................... $_____________Family Buffet ~ Friday, August 3rd (7-10 pm) ______# of Adults _____ # of Kids ................................. $ NO CHARGE Beachside Terrace & LawnReception ~ Saturday, August 4th (7-8:30 pm) ______# of Guests ............................................................ $ NO CHARGE Grand Lawn - Adults Only – Reservations required.Saturday Evening Baby Sitting ~ Organized activities and dinner for kids - 6:30-9:30 pm $55 per child _______# of children _________________________ Ages of each child ........................ $ _____________Golf Tournament ~ Friday, August 3rd (1:15-5:30 pm) $150 p/p Reservations MuST be guaranteed & paid by July 20 ($150 Fee – Includes transport, green & cart fees, box lunch)_____ # of Golfers .......... $ _____________Tennis Tournament ~ Friday, August 3rd (1:15 pm) Free to participate -_______ # of players .................. $ NO CHARGEOREF 5k Fun Run ~ Saturday, August 4th (6:30 am) Free to participate _______ # of runners ............... $ NO CHARGE GRAND TOTAL ........................................................................................................................................ $_____________

I hereby authorize the following amount to be charged to my credit card. Amount: _____________________________Credit Card Number: ______________________________________________________Expiration Date: _______________ (AMEX, MC, Visa, Discover)

Billing Zip Code: _________ Security Code: ____________ (3 numbers on back of Visa/MC, 4 numbers on front of Amex)

May be returned to SCOA via Fax: 813-949-8994

South Carolina Orthopaedic Association 17503 Mallard Court | Lutz, Florida 33559