ADVANCED RHEUMATOLOGY

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MARCH 21-23
WORKSHOP REGISTRATION
MARCH 21, 2013
Optional AM Workshops (FREE, please select one)
1) Yusuf Yazici, MD – Assessment of Rheumatoid
Arthritis Outcomes and Monitoring in Routine
Care n
2) Jonathan Samuels, MD – Ultrasound –
A Hands-On Workshop n
Optional Lunch and Meet the Professor
Workshops ($25, please select one)
3) Joel M. Kremer, MD – Where Should Newer
Treatment Options Fit into Our Treatment
Paradigm? n
4) Christopher T. Ritchlin, MD. MPH – Approach to
the PSA Patient with Inadequate Response to
TNF Antagonists n
5) Jonathan Kay, MD – Rheumatoid Arthritis:
Challenging Cases n
6) Stephen A. Paget, MD – The Vasculitides and
their Differential Diagnosis n
MARCH 22, 2013
Optional AM Workshops (FREE, please select one)
7) Jill P. Buyon, MD – BILAG and SLEDAI Scoring in
Lupus Trials n
8) Soumya M. Reddy, MD – Outcome Measures in a
Psoriatic Arthritis Research Registry n
Optional Lunch and Meet the Professor
Workshops ($25, please select one)
9) Andrew G. Franks, Jr., MD – Cutaneous Lupus:
Treatment Update 2013 n
10) Joan T. Merrill, MD – Scary Lupus n
11) Michael D. Lockshin, MD – aPL in Different
Settings n
Register online at http://cme.med.nyu.edu/rheumatology
SEMINAR IN ADVANCED RHEUMATOLOGY & BOARD REVIEW COURSE #304
REGISTRATION FORM
MARCH 21-23, 2013
NYU Langone Medical Center, Alumni Hall, Farkas Auditorium, 550 First Avenue, New York, NY 10016
(Please do not reduce or enlarge this form.)
PLEASE PRINT ALL INFORMATION CLEARLY IN BLOCK LETTERS & NUMBERS.
Name __________________________________________________
First M.I. Last
Address ________________________________________________
City ___________________________ State ____Zip ____________
Course Confirmation: Please supply your e-mail address to receive
a confirmation letter. Written confirmation will not be mailed. Make
sure your e-mail address is clearly written.
E-mail __________________________________________________
Day Phone ( ) __________ Fax ( ) _______________
Degree ______________________Specialty ___________________
PAYMENT SUMMARY:
n Course Fee.....................................................................................................................................$ _______
n Printed Course Syllabus** .......................................................................$15.00 $ _______
n Meet the Professor Luncheon Workshops ................... # ___ @ $25.00 ea = $ _______
METHODS OF PAYMENT: (Cash and phone registration are not accepted)
If faxing, do not mail or refax, this will only result in a duplicate charge to your account.
n Check in U.S. Dollars only $ ________
n Credit Card Payment (see below)
n International Postal Money Order $ ________
(Foreign registrants, including those from Canada, must
pay by International Postal Money Order or credit card.)
TOTAL AMOUNT DUE $ _______
PAYMENT BY CREDIT CARD: Credit card payments may be faxed to (212) 263-5293.
Full Fee Physicians: $575 Reduced Fee: $375*
Rheumatology Fellows: Free
(with letter of certification from program director)
To register, contact Shelly Yates
Phone: 212-598-6119 Fax: 212-598-6246
shelly.yates@nyumc.org
After March 18, 2013, 12 pm, only on-site
registration is available, provided the
course has not reached capacity.
On-site registrants will incur an additional
$20 charge and will receive a receipt by
e-mail in 1-2 weeks.
*Reduced Fee: Physicians-in-training with letter of certification
from Chief of Service; NYU School of Medicine alumni, former
residents and fellows; MDs employed by the Department of
Veterans Affairs Medical Center; full-time active military personnel;
nurse practitioners; and all other non-MD Healthcare professionals.
Eligibility for reduced fee must be indicated below.
Make check payable to:
NYU Post-Graduate Medical School
Send to: Registration Department
NYU Post-Graduate Medical School
P.O. Box 1855, Murray Hill Station
New York, NY 10016
Bill To: n Visa n MasterCard n American Express Amount to be charged: $________
**A PDF of the syllabus will be e-mailed
to you prior to the course. If you would
like to purchase a printed copy of the
syllabus, you must do so in advance.
Credit Card Number: _________________________ Expiration Date ______________ CVV Code _________________________
Card Member’s Name: ________________________________ Signature _____________________________________________
(please print)
Refund Policy: An administrative charge of 30% of your tuition payment will be assessed for cancellations prior to March 7, 2013.
Cancellations must be in writing and postmarked no later than the above date. (Faxes and e-mails are not accepted). Cancellations
will not be accepted after the above date.
Course Cancellation Policy: In the unusual circumstance that this course is cancelled, two weeks notice will be given and tuition
will be refunded in full. The NYU Post-Graduate Medical School is not responsible for any airfare, hotel or other costs incurred.
Special needs or requests ______________________________________________________________________________
________________________________________________________________________________________________________