FINAL PROGRAM - Dermatology

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International Society for Dermatologic Surgery Please enclose with application: 1. Application Fee (non-refundable) e 20 2. Letters of recommendation Name: Birthdate: First/Given Middle Last/Family Month Day Year Category of Membership - Check one only: ® Fellow ® Associate ® Affiliate ® Resident Fellow: Any physician who is licensed to practice medicine, currently performs dermatologic surgery and has completed three (3) years of post graduate training in dermatology. Associate: Any licensed physician who has at least one year, but less than three (3) years of post graduate training in dermatology or any licensed physician who has completed a one (1) year dermatologic surgery fellowship. Affiliate: Any individual who has specific experience or interest in dermatologic surgery or related scientific fields of endeavor. Resident: Any physician who is in an accredited dermatology residency or training program. Office Address: City: State/Province: Postal Code: Country: E-mail Address: Office Telephone: Fax : (Include Country/City Codes) (Include Country/City Codes) Home Address: City: State/Province: Postal Code: Country: Home Phone: _________ (Inc Country/City Codes) Please indicate how you learned about the ISDS: _____________________________________________________ Preferred Mailing Address - Check one: ° Office ° Home Name of Medical School: Year Completed Med School: Specialty - Check one: ° <strong>Dermatology</strong> ° Other Number of Yrs of Specialty Training: Year Completed Specialty Training (i.e., 1984): Institution Name: Specialty Certification: ° Yes ° No Date Certification Received (i.e., June 1984): Name of Specialty Certification Board: If you serve as a faculty member, identify your academic title: Name of Hospital or Institution where you serve as a faculty member: Membership in Professional Societies: APPLICATION FOR MEMBERSHIP The information below will provide the Society with information about the surgical procedures that you perform. Please check off the procedures you perform, and the number of years experience with these procedures. ° General Dermatologic Surgery (Yrs. Exp. ) ° Vein Stripping (Yrs. Exp. ) ° Cryosurgery (Yrs. Exp. ) ° Hair Transplantation (Yrs. Exp. ) ° Mohs Surgery (Yrs. Exp. ) ° Skin Grafts & Flaps (Yrs. Exp. ) ° Cosmetic Surgery & Blepharoplasty (Yrs. Exp. ) ° Laser (Yrs. Exp. ) ° Male Genital Surgery (Yrs. Exp. ) ° Dermabrasion (Yrs. Exp. ) It is your responsibility to provide letters of recommendation from two (2) Fellows of the International Society for Dermatologic Surgery from your country. Contact the ISDS Headquarters if you require a list of the Fellows in your country or if your country does not have two ISDS Fellows. Letters of recommendation have been requested from: 1) Name: 2) Name: _ Payment in EUR must accompany application. INDICATE METHOD OF PAYMENT BELOW: ° Check enclosed, payable to ISDS ° MasterCard ° Visa ° American Express Print card number in spaces below: Expiration Date: Signature: REVIEW INFORMATION BELOW AND SIGN APPLICATION FORM. Form will not be accepted without signature. • I understand that, if I am accepted for membership in the Society, payment of annual dues is required, beginning with the current year. Fellows, Associates, and Affiliates dues are Euro 125.00 and Resident members pay dues of Euro 40. • I hearby waive any and all liability and claims against the ISDS, its officers, directors, and agents for any and all claims arising out of this application and arising out of said party’s membership in the ISDS. • I understand a membership certificate will be issued after a Fellow of the ISDS attends two (2) annual meetings (after acceptance as a Fellow). Signature: Date: Send completed application, along with application fee, to: INTERNATIONAL SOCIETy FOR DERMATOLOGIC SURGERy Silvia Becker, Seeheimer Str. 3, D-64297 Darmstadt – Germany Telephone: +49-6151-951 8892, FAX: +49-6151-951 8893, E-Mail: info@isdsworld.com
CONGRESS REGISTRATION AFTER AUGUST 31, 2007 AND ON SITE Please use our online registration desk 24 hours a day: www.isdsworld.com CONTACT INFORMATION Name Title Address City State Zip Country Phone Fax E-Mail INTENSIVE LEARNING COURSES 1-10 (max 20 participants) EARLY BIRD THURSDAY, OCTOBER 25, 2007 2nd 08:00am-10:00am O (01) O (02) O (03) O (04) O (05) O 40,- Euro O 60,- Euro choice ( ) 10:30am-12:30pm O (06) O (07) O (08) O (09) O (10) O 40,- Euro O 60,- Euro ( ) SCIENTIFIC SESSION EARLY BIRD OCTOBER 25-28, 2007 O MEMBER ISDS / SIDCO * 1 (including Industrial Exhibition, Opening-Reception and Gala-Dinner) O 450,- Euro O 600,- Euro O PHYSICIAN FROM DEVELOPING COUNTRIES MEMBER (50 % DISCOUNT) O 225,- Euro O 300,- Euro ONLY VALID FOR THE SCIENTIFIC SESSION O NONMEMBER O 600,- Euro O 750,- Euro O PHYSICIAN FROM DEVELOPING COUNTRIES NONMEMBER (50 % DISCOUNT) O 300,- Euro O 375,- Euro ONLY VALID FOR THE SCIENTIFIC SESSION O RESIDENT * 2 (only applicable with a copy of a confirmation of the the education hospital/practice) O 120,- Euro O 150,- Euro * 1 PAY FULL REGISTRATION FEE FOR SCIENTIFIC SESSION AND BRING YOUR RESIDENT OR FELLOW FOR FREE PARALLEL SESSIONS EARLY BIRD OCTOBER 25-28, 2007 O MASTER’S COURSE – OCTOBER 25, 2007 – ALL ABOUT LASERS O 125,- Euro O 150,- Euro O MASTER’S COURSE – OCTOBER 26, 2007 – ALL ABOUT FACIAL REJUVENATION O 125,- Euro O 150,- Euro O RESIDENTS WORKSHOP LIVE SURGERY SYMPOSIUM (VIDEO SESSION) – OCTOBER 27, 2007 O 20,- Euro O 40,- Euro SOCIAL <strong>PROGRAM</strong> OCTOBER 25-28, 2007 O SPOUSE PASS (including Industrial Exhibition, Opening-Reception and Gala-Dinner) O 150,- Euro O GOLF BEGINNER CLASS, FRIDAY, OCTOBER 26, 2007 * AFTERNOON O 50,- Euro O BASILICA DI SAN MARCO WITH ORGAN MUSIC, OCTOBER 26, 2007 * 7.00 PM O 25,- Euro O ISDS GOLF TOURNAMENT, SATURDAY, OCTOBER 27, 2007 * 01.30 – 6.00 PM O 140,- Euro O HALF DAY CITY TOUR, SATURDAY, OCTOBER 27, 2007 * 1.30 – 6.00 PM O 60,- Euro O ONE DAY CITY TOUR, FRIDAY, OCTOBER 26, 2007 * 9.00 AM – 4.00 PM O 140,- Euro O EXHIBITOR BADGE O 150,- Euro HOTEL RESERVATION: Please contact Venezia Congressi SAS - Fon +390415228400 - info@veneziacongressi.com PAYMENT TOTAL AMOUNT EURO O Please charge my credit card for payment of total: Euro O VISA O MasterCard O American Express Card Number Expiration Date Name on Card Date Signature # 23
Page 1 and 2: 28 th Annual Congress of the Intern
Page 3 and 4: WELCOME TO VENICE! Dear Colleagues
Page 5 and 6: Procedura Laser Fractale CO2 Active
Page 7 and 8: ROOM INFORMATION THURSDAY, OCTOBER
Page 9 and 10: THURSDAY, OCTOBER 25, 2007 INTENSIV
Page 11 and 12: THURSDAY, OCTOBER 25, 2007 SCIENTIF
Page 14 and 15: FRIDAY, OCTOBER 26, 2007 SCIENTIFIC
Page 16 and 17: FRIDAY, OCTOBER 26, 2007 SCIENTIFIC
Page 18 and 19: SATURDAY, OCTOBER 27, 2007 SCIENTIF
Page 20 and 21: SOCIAL EVENTS FRIDAY, OCTOBER 26, 2
Page 24: COLBAR LifeScience, Ltd. B O O T H

FINAL PROGRAM - Dermatology

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