Friday through Sunday, October 9 -11, 2015DoubleTree by Hilton Hotel Tarrytown

Tarrytown, New Yorkwww.nysspa.org

Fall 2015 CME Conference

Registration Brochure

2015/2016 Board of DirectorsJennifer E. Kelly, MPAS, PA-CPresidentMary Springston, PA-C, MS, EdPresident ElectJohn Hallowell, MBA, PA-CVice President/Chief DelegateVirginia Kaufman, PA-C, WCCSecretaryAriana Zaza, MPAS, PA-CTreasurerDaniel Forsberg, PA-C, MPH, CPHPast PresidentJonathan UittoExecutive Director

District DirectorsArea A - Brian Glick, PA-CArea B - Thomas J. Antonini, MPA-CArea C - Sheri Orr, MBA, PA-CArea D - Donna Hall, PA-CArea E - Lauren Morasse, MS, PA-C

Student DirectorsAdam Paul Fenton, PA-S; NYITMike Sacks, PA-S; Hofstra UniversityJennifer Marie Griffith, PA-S; Pace

2015 Fall CME Conference CommitteeShannan Maxey-Ricoy, MS, PA-C (Co-Chair)Christine Zammit, MS, PA-C (Co-Chair)Mary Banahan, MS, PA-C (Co-Chair)Jennifer Kelly, MPAS, PA-CChristine Amendola, PA-CErika Bramlette, MBA, PA-CSusan Cappelmann, MS, MT, PA-CCarlo Gwardschaladse, MBA, PA-CTracy Jackson, PA-CMonica Losquadro, PA-CJoAnn Montecalvo, PA-CSheri Orr, MBA, PA-CKelly Porta, MS, PA-CMaureen Regan, MBA, PA-CErica Reid, PA-SMike Sacks, PA-STravis Sherer, PA-C, AAHIVSBrittni Silvestri, PAAriana Zaza, MPAS, PA-C

Dear Colleague,

The NYSSPA Executive Board and I welcome you to Tarrytown! We hope that you find the 2015 Fall CME conference informative, applicable and fun! We hope you rekindle old friendships and make some new ones. During your time here, see some of what the Hudson Valley has to offer and enjoy dinner at one of the many area restaurants. Minutes to NYC and all that has to offer, we hope you find the conference convenient to all you might enjoy!

We have again arranged the program in “tracks” to allow for little conflict with areas of common interest. Please be sure to attend the Membership Luncheon and meet with your District Director and other members in your region. Please make sure to stop by the Fifth Annual Poster Session and see and discuss the re-search your future colleagues have been producing.

Finally, keep in mind that NYSSPA is a Twenty-Four hour Seven day a week or-ganization, entirely devoted to ensuring professional advancement for you. We provide a resource to assist you in doing your job and advancing your career. Take a moment to talk with board members about your concerns, learn more about utilization, regulation, reimbursement, contracting, or any issues you may have in your practice setting. Get involved, there are many opportunities to lend your talents to the organization or to develop new skills.

Thank you for being a part of the 2015 conference and your continued support of NYSSPA!

Best Regards,

Jennifer Kelly, MPAS, PA-CPresident

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Images © ThinkStock | iStockphoto/Comstock

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7:00 AM – 7:00 PM Registration Open

8:00 AM – 9:00 AM Breakfast with Exhibitors & Posters

8:00 AM – 5:00 PM Exhibits Open

8:00 AM – 5:00 PM Poster Session

10:00 AM – 10:30 AM Coffee Break with Exhibitors & Posters

12:30 PM – 2:00 PM Legislative Luncheon

3:00 PM – 3:30 PM Refreshment Break with Exhibitors & Posters

Receptions7:15 PM – 8:00 PM Student Reception – Students Only 8:00 PM – 12:00 AM NYSSPA Reception & Party

7:00 AM – 6:30 PM Registration Open

7:00 AM – 8:00 AM Breakfast Showcase

8:00 AM – 12:30 PM Exhibits Open

10:00 AM – 10:30 AM Coffee Break with Exhibitors

SCHEDULE OF EVENTS

www.nysspa.org

FALL 2015 CME CONFERENCE / OCTOBER 9 - 11, 2015

Emergency/Trauma Track2:00 PM – 3:00 PM Oncologic Emergencies Katherine L. Kunstel, MMSc, PA-C

3:30 PM – 4:30 PM Post-operative and Post-trauma Respiratory Failure and Pneumonia

Brian Van Ness, MS, PA-C

4:30 PM – 5:30 PM Gender Based Violence in the Emergency Department

Christine Lazaros Amendola, MS, PA-C, NY-SAFE

Behavioral Medicine/Psychiatry Track9:00 AM – 10:00 AM Behavioral Emergencies Shinu Kuriahose, MPAS, PA-C

10:30 AM – 11:30 AM Advances in the Treatment of Depression Jerry Chang, MD

11:30 AM – 12:30 PM Screening and Intervention for Substance Use Disorders in the Primary Care Setting

Frank G. Dowling, MD Allison Maloney, PhD

Professionalism Track 11:30 AM – 12:30 PM Issues Affecting Pimary Care Practice in

2015 Jean Covino, DHSc, MPA, PA-C

2:00 PM – 3:00 PM Is Race a Factor When Prescribing Medication?

Harry Pomeranz, MS, PA-C Reynold Jaglal, MBA, PA-C

3:30 PM – 4:30 PM Like a Sandwich Without the Bread: Examining the Four Dimensions of Health Disparities

James Anderson, MPAS, PA-C, ATC, DFAAPA

4:30 PM – 5:30 PM Navigating the Affordable Care Act in Primary Care

Michelle Melchiorre, MS, PA-C

CT Surgery/Cardiology Track2:00 PM – 3:00 PM PFO’s: Considerations for Catheter Based

Closure & Atrial Fibrillation: What You Need to Know

Sean Levchuck, MD Nicole Cornachio, PA-C

3:30 PM – 4:30 PM Aortic Stenosis: What is TAVR? & Trans-catheter Therapies for Mitral Reguritation

Kristen Pascarello, PA-C Tiffany Wong, PA-C

4:30 PM – 5:30 PM The Role of Hemodynamic Support Devices in the Cath Lab & A Look into the Future: Imaging Modalities in the Cath Lab

Bridget McGarry, PA-C Monica Losquadro, MS, PA-C

Friday, October 9, 2015

Women’s Health Track8:00 AM – 9:00 AM Concomitant Management of Pelvic Organ

Prolapse and Stress Urinary Incontinence Bogdan Grigorescu, MD

9:00 AM – 10:00 AM Screening for Perinatal Mood and Anxiety Disorders in Pediatric Primary Care

Jack Levine, MD

10:30 AM – 11:30 AM 2015 Current Pap Guideline Karen Crowley, MS, PA-C

Saturday, October 10, 2015

Orthopedics Track10:30 AM – 11:30 AM Management Options of Degenerative

Joint Disease of the Hip and Knee Jeffrey Wagner, PA-C

11:30 AM – 12:30 PM To Have or Not to Have Arthroscopy? That is the Question

Donna Romano, MPAS, PA-C

Pediatrics Track8:00 AM – 9:00 AM Early Relationships Matter: The Catalyst

for the New York Association for Infant Mental Health and a New System of Standards and Competencies

Marcy Safyer, PhD, LCSW-R

9:00 AM – 10:00 AM Are You Smarter than a Pediatric Intensivist: Audience Response Session

Edward E. Conway, Jr., MS, MD

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12:30 PM – 2:00 PM Membership Luncheon

Workshops (additional fee applies)2:00 PM – 5:00 PM Clinical Informatics 2:00 PM – 5:00 PM Mini-Skills 2:00 PM – 5:00 PM AANPA PI-CME - Kidneys in a Box

Receptions & Dinner

5:45 PM – 6:30 PM President’s Reception

6:30 PM – 7:30 PM Alumni Receptions

7:30 PM – 8:00 PM Gala Reception

8:00 PM – 12:00 AM Clara Vanderbilt Gala Dinner

8:00 AM – 1:00 PM Registration Open/ CME Certificate Distribution

8:00 AM – 10:00 AM Pre-PA Fair & Professional Workshop

9:00 AM – 10:00 AM Breakfast Showcase

10:00 AM – 1:00 PM Medical Jeopardy

Note: Lectures and speakers may be added or changed after the printing of this brochure. For updated conference information, please visit the NYSSPA website at www.nysspa.org.

SCHEDULE OF EVENTS

www.nysspa.org

FALL 2015 CME CONFERENCE / OCTOBER 9 - 11, 2015

Saturday, October 10, 2015

Sunday, October 11, 2015

Internal Medicine Track 2:00 PM – 3:00 PM Utilization of Abdominal and Renal

Ultrasound in Primary Care Ronald Thompson, MD

3:00 PM – 4:00 PM IBD & Nutrition Joanna Esterow, PA-C

4:00 PM – 5:00 PM A New Perspective of Integrative Medicine”

Geovanni Espinosa, ND, LAc

Hematology/Oncology Track10:00 AM – 11:00 AM Clinical Ethics for the Physician Assistant Sharyn Kurtz, MA, MPAS, PA-C

11:00 AM – 12:00 PM Radiation Oncology

Critical Care/ICU Track2:00 PM – 3:00 PM Traumatic Brain Injury - A Critical Care

Perspective Joseph Lindner, MPAS, PA-C

3:00 PM – 4:00 PM Oxygen Delivery Michael Grossman, MD

4:00 PM – 5:00 PM Sepsis Update 2015 Frank A. Acevedo, MS, PA-C, DFAAPA

Surgery Track8:00 AM – 9:00 AM Injury Prevention Larry M. Gentilello, MD

9:00 AM – 10:00 AM Trauma and Pregnancy Aparna Kolli, MD

10:30 AM – 11:30 AM Breast Cancer and Breast Reconstruction Jennifer Oliver, PA-C

11:30 AM – 12:30 PM The Role of the PA in Robotic Surgery Suzannah Sorin, MPAS, PA-C

Student Track9:00 AM – 10:00 AM EKGs as Easy as ABC’s in 60 Minutes Stacey Singer-Leshinsky, PA-C

10:30 AM – 11:30 AM Understanding Acute Leukemia and its Common Complications

John Katsetos, PA-C

11:30 AM – 12:30 PM The Approach to the Pediatric Patient Christopher Kelly, MD

Educators Track8:00 AM – 9:00 AM PAEA Examinations in the PA Curriculum:

Are They Worth It? Christine Zammit, MS, PA-C Shannan Maxey-Ricoy, MS, PA-C

9:00 AM – 10:00 AM Remediation Techniques Kelly Porta MS, PA-C Mark L’Eplattenier, MPAS, PA-C

10:30 AM – 11:30 AM Incorporating Interprofessional Education into PA Curriculum

Mary Banahan, MS, PA-C

11:30 AM – 12:30 PM Faculty Forum: Challenges in PA Education

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Frank A. Acevedo, MS, PA-C, DFAAPANew York Institute of Technology/Winthrop University HospitalDepartment of Surgical Critical Care Mineola, NY

Christine Lazaros Amendola, MS, PA-C, NY-SAFENorth Central Bronx/Jacobi HospitalDepartment of Emergency Valhalla, NY

James Anderson, PA-C, MPAS, ATC, DFAAPAEvergeen Treatment ServicesSeattle, WA

Mary Banahan, MS, PA-CHofstra UniversityDepartment of Physician Assistant StudiesFarmingdale, NY

Susan O. Cappelmann, MS, PA-C, MT(ASCP)Pace University College of Health ProfessionsDepartment of Physician Assistant StudiesNew York, NY

Jerry Chang, MDZucker Hillside Hospital - North Shore-LIJ Health SystemDepartment of Psychiatry Glen Oaks, NY

Edward E. Conway, Jr., MS, MDMount Sinai Beth Israel Medical CenterDepartment of Pediatrics New York, NY

Nicole Cornachio, PA-CIsland Cardiac SpecialistsDepartment of Cardiology/Electrophysiology Garden City, NY

Jean Covino, DHSc, MPA, PA-CPace University-Lenox Hill HospitalDepartment of Physician Assistant StudiesNew York, NY

Karen Crowley, MS, PA-CNorth Shore University HospitalDepartment of Obstetrics/Gynecology Manhasset, NY

Frank G. Dowling, MDStony Brook UniversityStony Brook, NY

Geovanni Espinosa, ND, LAcNYU Integrative & Functional Urology CenterNew York, NY

Joanna Esterow, PA-CWeill Cornell Medical CollegeNew York, NY

Larry M. Gentilello, MDSouthside Hospital - North Shore-LIJ Health SystemDepartment of SurgeryBay Shore, NY

Bogdan Grigorescu, MDWinthrop University HospitalDepartment of Obstetrics and GynecologyMineola, NY

Michael Grossman, MDSouthside Hospital - North Shore-LIJ Health SystemDepartment of Acute Care SurgeryBay Shore, NY

John Katsetos, PA-CNew York Presbyterian: Weill Cornell Medical CenterDepartment of Hematology-OncologyNew York, NY

Christopher Kelly, MDNew York Methodist HospitalDepartment of Pediatric Emergency MedicineBrooklyn, NY

Aparna Kolli, MDSouthside Hospital - North Shore-LIJ Health SystemDepartment of Acute Care SurgeryBay Shore, NY

Katherine L. Kunstel, MMSc, PA-CPace University - Lenox Hill HospitalDepartment of Physician Assistant StudiesNew York, NY

Shinu Kuriakose, MPAS, PA-CStony BrookPhysician Assistant ProgramStony Brook, NY

Sharyn Kurtz, MA, MPAS, PA-CMemorial Sloan Kettering Cancer CenterDepartment of MedicineNew York, NY

Mark L’Eplattenier, MPAS, PA-CHofstra UniversityDepartment of Physician Assistant StudiesHemsptead, NY

Sean Levchuck, MDSaint Francis HospitalDepartment of Cath Lab/CardiologyRoslyn, NY

Jack Levine, MDNassau University Medical CenterDepartment of PediatricsEast Meadow, NY

Faculty Listing

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Joseph Lindner, MPAS, PA-CJacobi Medical CenterDepartment of Trauma/Surgical Critical CareBronx, NY

Carina Loscalzo, MS, PA-CHofstra UniversityDepartment of Physician Assistant StudiesHemsptead, NY

Monica Losquadro, MS, PA-CSaint Francis HosptialDepartment of Cath LabRoslyn, NY

Allison Maloney, PhDLong Island Mind Body Medicine GroupGarden City, NY

Bridget McGarry, PA-CSaint Francis HosptialDepartment of Cath LabRoslyn, NY

Michelle Melchiorre, MS, PA-CBoriken Neighborhood Health CenterDepartment of Family MedicineSpringfield, NJ

Jennifer Oliver, PA-CMemorial Sloan Kettering Cancer CenterDepartment of SurgeryNew York, NY

Kristen Pascarello, PA-CSaint Francis HosptialHeart Valve CenterRoslyn, NY

Harry Pomeranz, MS, PA-CSacred Heart University College of Health ProfessionsPhysician Assistant ProgramFairfield, CT

Kelly Porta, MS, PA-CHofstra UniversityDepartment of Physician Assistant StudiesHemsptead, NY

Shannan Maxey-Ricoy, MS, PA-CHofstra UniversityDepartment of Physician Assistant StudiesHempstead, NY

Donna Romano, MPAS, PA-CPremier Orthopedic Surgery and Sport Medicine, PLLCMelville, NY

Marcy Safyer, PhD, LCSW-RAdelphi UniversityInstitute for ParentingGarden City, NY

Stacey Singer-Leshinsky, PA-CSt. John’s UniversityDepartment of Clinical Health ProfessionsNew York, NY

Suzannah Sorin, MPAS, PA-CNYU Langone Medical CenterDepartment of Surgery-RoboticsNew York, NY

Ronald Thompson, MDRadiology Enterprises, LTDRadiologyConyers, GA

Brian Van Ness, MS, PA-CHackensack University Medical CenterDepartment of Surgical- Trauma ICUHackensack, NJ

Jeffrey Wagner, PA-CSouthside Hospital - North Shore-LIJ Health SystemDepartment of OrthopedicsBay Shore, NY

Tiffany Wong, PA-CColumbia University Medical CenterHeart Valve CenterNew York, NY

Christine Zammit, MS, PA-CHofstra UniversityDepartment of Physician Assistant StudiesHemsptead, NY

Faculty Listing

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Great Jack O’ Lantern BlazeOver 5,000 hand-carved, illuminated pumpkins set against the mysterious backdrop of Van Cortland Manor’s 18th-century build-ings and riverside landscape.

$20 Friday night ($16 ages 3-17)$25 Saturday night ($20 ages 3-17)Recommended for all ages

Irving’s Legend Master storyteller Jonathan Kruk offers a dramatic per-formance of Washington Irving’s classic tale, The Legend of Sleepy Hollow. Featuring the Headless Horseman, Ichabod Crane, Brom Bones, and Katrina Van Tassel. Flavored with live spooky organ music by Jim Keyes, Kruk’s spellbind-ing storytelling captivates all audiences.

$20 both nights (children < 18, $16)Recommended for ages 10+

Horseman’s HollowTaking the tale of The Legend of Sleepy Hollow to its darkest extremes, Horseman’s Hollow takes visitors through an 18th-century town driven mad by the Headless Horseman. Creatures, human and otherwise, lurk in the shadows. Heads will roll...maybe even your own!

$20 Friday night$25 Saturday nightThe event organizers advise: “This event is NOT suitable for adults who are claustrophobic, have heart or respiratory conditions, are prone to seizures, or have other chronic health conditions. Enter at your own risk!”

Sleepy Hollow Cemetery ToursA trip to Sleepy Hollow isn’t com-plete without a visit to Sleepy Hollow Cemetery and its famous residents, including Elizabeth Arden, Brooke Astor, Andrew Carnegie, Walter Chrysler, Samuel Gompers, Washington Irving, and William Rockefeller.

$19.99 for Guided Walking ToursRecommended for all ages

ANNUAL NYSSPA FALL CME CONFERENCE WEEKEND

Since our annual Fall NYSSPA CME Conference is scheduled for Columbus Day weekend this year (October 9-11), why not bring the whole family and enjoy some of the fabulous fall activities that Tarrytown and its surrounding communities have to offer. The Hudson Val-ley region is jammed packed with activities that will entertain young and old alike. Below gives a sampling of some of the events going on that weekend.

For more information on these and other events in the area, please visit http://www.hudsonvalley.org or http://visitsleepyhollow.com/Photos courtesy of www.hudsonvalley.org.

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General Information

Continuing Medical Education (CME) Credits - Category 1

The New York State Society of Physician Assistants utilizes the ACCME standards for programs of the AAPA (American Academy of Physician Assistants) in order to provide CME to participants.

NYSSPA takes responsibility for the content, quality and scientific integrity of the CME Activity. This program is not yet approved for CME Credit. NYSSPA plans to request at least 30 hours of AAPA Category I CME credit from the Physician Assistant Review Panel. Total number of approved credits is yet to be determined.

Each PA should claim only those hours of credit that he/she actually spent in the educational activity. This program is planned in accordance with AAPA’s CME Standards for Live Programs and for commercial support of Live Programs

FOR ASSISTANCE OR ADDITIONAL INFORMATIONThe NYSSPA Registration team is happy to assist with any questions or concerns you may have. Please do not hesitate to contact us at (877) 769-7722, or you can send an e-mail to nysspareg@nysspa.org

NOT A NYSSPA MEMBER?Discounted registration fees are one of the many benefits of becoming a member of the New York State Society of Physician Assistants. If you are not a NYSSPA member, and you submit a completed membership form on or before the deadline, you will receive the NYSSPA member registration rate. For your convenience, a membership application is included in this brochure, available on the website (www.nysspa.org) or call NYSSPA Headquarters at (877) 769-7722, for more information.

SCHOLARSHIP COMMITTEE ACTIVITIESThe Scholarship Committee is planning a fund-raising activity during the Fall Conference to benefit the Scholarship Fund.

ACCOMMODATIONS The Fall CME Conference will be held at the DoubleTree by Hilton Hotel, Tarrytown, New York. You can reserve a room at the negotiated rate of $165 (single/double occupancy) plus tax (Thursday–Sunday). Rooms will be available at this rate until September 15, 2015 or until the block is full, whichever comes first. You can call the hotel directly at 914-631-5700 and be sure to mention that you are a NYSSPA conference attendee. You can also reserve a room online by clicking here and to the left of the page when entering your dates, click on the link Add special rate codes. Under group code enter NSP. Check-in time is 3:00 pm and check-out time is 12:00 pm. It is recommended that you make your hotel reservation as early as possible to insure availability. Parking is complementary.

FALL 2015 CME CONFERENCE / OCTOBER 9 - 11, 2015

EXHIBITSEducational and informational exhibits will be available for viewing during the Conference and representatives will be available to answer questions. Please visit the exhibits as they are an integral part of the meeting.

SPECIAL NEEDSThe Hilton Tarrytown Doubletree is accessible to persons with disabilities. Specially equipped sleeping rooms are available by request in advance of arrival. Registrants with questions regarding special housing, equipment, transportation and auxiliary requirements should indicate this on the registration form or contact NYSSPA Meetings, 877-769-7722. Please give prior notification so that we can make arrangements in advance of the meeting.

ATTIREAttire for the Conference is business casual with the exception of the Gala Dinner where business attire is requested.

CELL PHONE USAGENYSSPA acknowledges that cell phones are very important in our lives; however, during the lectures, it is requested that all cell phones should be turned off or on the silent/vibrate mode.

CONFERENCE CONTACTSNYSSPA Conference HQ

100 North 20th Street, Suite 400Philadelphia, PA 19103

FOR MEETING MANAGEMENT AND CORPORATE SUPPORT:Telephone: 877-769-7722

E-Mail: meetings@nysspa.org

FOR EXHIBIT MANAGEMENT AND SPONSORSHIP:Telephone: 877-769-7722E-Mail: tdiggs@nysspa.org

REGISTRATION QUESTIONSTelephone: 877-769-7722

E-Mail: nysspareg@nysspa.org

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General Information

FALL 2015 CME CONFERENCE / OCTOBER 9 - 11, 2015

NYSSPA MISSIONTo improve the quality of healthcare and promote the

Physician Assistant profession in the State of New York.

DoubleTree by Hilton Hotel Tarrytown, Tarrytown, NY • October 9-11, 2015

ONLINE: (Preferred) at www.nysspa.org BY MAIL: Send completed form with check payment to NYSSPA 2015 Fall CME Conference, 100 North 20th Street, Suite 400, Phila-delphia, PA 19103

REGISTRATION INFORMATION (Please print or type) o Please check if assistance is needed

Name __________________________________ (Name on Badge) _______________ Degree/PA-C (list clearly) _________

Affiliation ________________________________________________________________ PA Program Attended (ing) _____

Address _____________________________________________ City _______________ State ________ Zip _________

Business Telephone ________________________ E-Mail Address ____________________ Fax Number ________________

Spouse/Guest Name: _______________________ (Name on Badge) _____________________________________________

REGISTRATION FEE Early Bird Advanced On-Site Please check one: Through 8/14/15 8/14/15 - 9/25/15 After 9/25/15

o NYSSPA Member $325.00 $_________ $350.00 $_________ $425.00 $_________

o Constituent Chapter Member $325.00 $_________ $350.00 $_________ $425.00 $_________

o NYSSPA PA Student Member $150.00 $_________ $150.00 $_________ $200.00 $_________

o One Day Only – Member: $175.00 $_________ $205.00 $_________ $275.00 $_________ o Friday o Saturday o Sunday

o Join & Register $500.00 $_________ $525.00 $_________ $600.00 $_________

o Non-Member $525.00 $_________ $575.00 $_________ $650.00 $_________

o PA Student Non-Member $250.00 $_________ $250.00 $_________ $300.00 $_________

o One Day Only – Non-Member: $350.00 $_________ $375.00 $_________ $450.00 $_________ o Friday o Saturday o Sunday

o Spouse/Guest $140.00 $_________ $140.00 $_________ $175.00 $_________

Optional Information: o PA Faculty o PA Preceptor o Interested in PA Education – contact cappelmann@nysspa.org o Vegetarian Meal Requested o Special Needs Assistance Requested

Registration fees include: CME Lectures, AM/PM Breaks, Legislative Luncheon, Exhibit Hall access, the Past President’s Reception and Gala Dinner.

The Spouse/Guest registration fee includes continental breakfast, exhibit hall refreshments, lunches and receptions (Student’s & NYSSPA) and the Gala Dinner. Spouse/Guest registration does not include admittance to any presentations. Due to the professional nature of the conference, children under the age of 18 are restricted from the educational sessions.

TRACK OF STUDY (please check one box for each track time-frame):

Friday, October 9:AM Tracks: o Women’s Health o Behavioral Medicine/PsychiatryPM Tracks: o Professionalism o Emergency/Trauma o CT Surgery/Cardiology

Saturday, October 10: AM Tracks: o Pediatrics o Orthopedics o Educators o StudentPM Tracks: o Internal Medicine o Critical Care/ICU

Sunday, October 11:AM Tracks: o Hematology/Oncology

Fall 2015 CME Conference Registration

DoubleTree by Hilton Hotel Tarrytown, Tarrytown, NY • October 9-11, 2015

Conference Workshops & Events Member Non-Member Time

Saturday, October 10

o Clinical Informatics $ 60.00 $_________ $100.00 $_________ 2:00 pm – 5:00 pm

o Clinical Informatics (Stand Alone) $160.00 $_________ $160.00 $_________ 2:00 pm – 5:00 pm

o Mini Skills $ 50.00 $_________ $ 75.00 $_________ 2:00 pm – 5:00 pm

o PI-CME Workshop $ 15.00 $_________ $ 15.00 $_________ 2:00 pm – 5:00 pm

Sunday, October 11

o Pre-PA Fair & Professional Workshop $ 75.00 $_________ $ 75.00 $_________ 8:00 am – 10:00 am

Membership Fee

o Renewal $175.00 $_________

o New Member $175.00 $_________

o Student Membership $ 75.00 $_________ (Valid for duration of student enrollment)

Total Registration Fees $_________ $_________

Membership Information: A membership application is included in the registration brochure or is available on the web site: www.nysspa.org.Or call NYSSPA Headquarters: 877-769-7722 for more information.

PAYMENT METHOD REGISTRATIONS RECEIVED WITHOUT PAYMENT WILL NOT BE PROCESSED

o Enclosed is a check payable to “NYSSPA”. Checks must be payable in U.S. dollars. A $75.00 processing fee will be charged for returned checks.

ACCEPTABLE FORMS OF PAYMENT• Checks: are acceptable when registration is submitted by mail or completed online or onsite at the conference. Checks must

be payable (in US Dollars) to NYSSPA and issued by a US Correspondent bank. The registrant is responsible for any and all bank charges. Check with your bank before processing payment.

• Credit cards: may be used for online registration or completed on site at the conference. NYSSPA accepts Visa, MasterCard and American Express. NYSSPA reserves the right to charge the correct amount if different from your calculated total.

• Cash: is acceptable (US dollars only) when registration is done in person at the conference. Only US Dollars will be accepted for on-site registration (foreign currency will not be accepted). Please do not send cash through the mail!

CONFIRMATIONSYour registration will be acknowledged with an electronic confirmation within one week of receipt. If confirmation is not received by that time, please call (877) 769-7722 or e-mail nysspareg@nysspa.org. Please be sure to provide a valid e-mail address so that we may send your confirmation electronically.

CANCELLATION POLICYRequests must be submitted in writing to NYSSPA Registration, 100 North 20th Street, Suite 400, Philadelphia, PA 19103 and postmarked no later than October 5, 2015. All fees paid will be refunded minus a $75 processing fee. THERE WILL BE NO REFUNDS AFTER THE OCTOBER 5, 2015 DEADLINE.

Fall 2015 CME Conference Registration

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You’re Invited to Join NYSSPA Today!

NYSSPA’s Membership Year is from July 1 - June 30. 18-Month Membership is for those individuals who are joining mid-year between the months of October-April.

Membership CategoriesFull Member $175 Annually

$225 18-Month$300 2-Year Membership

Any person who is registered in New York State as a PA and is a fellow member of the American Academy of Physician Assistants

Affiliate Member $175 Annually$225 18-Month$300 2-Year Membership

Any person who is registered in New York State as a Phy-sician Assistant and is eligible for fellow membership in the AAPA but who chooses not to become such

Associate Member $175 Annually$225 18-Month$300 2-Year Membership

Physician Assistants from other states, or PAs in New York State who are not employed; Non-Physician Assistants who support the goals of NYSSPA

Sustaining Members $75 Annually Physician Assistants eligible for Full or Affiliate member-ship who have chosen not to practice in a PA-oriented career or who have retired from the PA profession

Student Member $75 Any person enrolled in a PA program or interested in pursuing a career in the Physician Assistant profession

Student membership is valid for the duration of your student enrollment

NYSSPA’s Significant Accomplishments

• Successful lobbying for and passage of the Re-statement of Physician Assistant Practice Act

• Successfully lobbied for the legislative removal of the 24-hour Countersignature Requirement for PAs

• Secured DEA Licensure for the PA privilege to prescribe Schedule II-V Medications

• Protected Physician Assistants’ rights to First Assist in surgery

• Obtained Licensure for Physician Assistants from the Department of Education

• Awarded over $60,000 in PA student scholarships over the past decade

• Supported appointment of a PA Representative on the board of the OPMC

These initiatives take time, money and personnel; they could not have been achieved without a strong NYSSPA Mem-bership. NYSSPA needs you now and the best way to support the Society and the PA profession in New York is to join as a member. NYSSPA also has a membership program specifically for physicians interested in joining, which is called the Physician Partnership Program.

Join NYSSPA today! www.nysspa.org

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NYSSPA Membership Application

r New r Renewal/Former

First/Middle/Last Name ______________________________________________ Credentials _______________________

Home Address/Street _________________________________________________________________________________

City _________________________________________ State _______ Zip _____ County/District ________________

Home Phone __________________________________________ Home E-mail ___________________________________

Cell # _________________________________ Preferred Mailing Address: r Home r Work

Place of Employment __________________________________________________________________________________

Referred by __________________________________________

Practice/Department/Specialty __________________________________________________________________________

Employment Address ____________________________________ City/State/Zip _________________________________

Work Phone _____________________________ Work Fax _________________________ Work E-mail ________________

AAPA# (if applicable) ______________________ NCCPA Registration # ______________ NYS License # ______________

PA Program graduated from or currently attending __________________________________ Graduation Date _____________ (Required for Student Membership)

r Please do not list me in the membership directory. r I am interested in being a Mentor

Please indicate your interest in serving on a Committee(s)r Business Development r Finance r Membership r Reimbursement r Surgical Caucusr Committee on Diversity r Government Affairs r Newsletter r Scholarship r Websiter Conference Planning r Judicial Affairs r Professional Relations r Social Mediar Elections r Leadership r Public Education r Student Affairs

Annual Dues PaymentPlease note that a portion of your dues will be used to support legislative lobbying efforts on behalf of NYSSPA and all New York State Physician Assistants.

Dues Amount: Membership Length: r 1 Year r 18 months r 2 Years Membership Type: r Full r Affiliate r Associate r Sustaining r Student (valid through enrollment) $ ________

Voluntary Scholarship Contribution:

Help NYSSPA give annual scholarships annually to deserving students – the voices of our future. ($50 suggested) $ ________

Support NYSSPA’s lobbying efforts with a PAC contribution. ($50 suggested) $ ________

Total: $ _______

If paying by check, please make check payable to NYSSPA and mail to NYSSPA, 100 North 20th Street, Suite 400, Philadelphia, PA 19103Credit card payments can be faxed to NYSSPA at (215) 564-2175.

r Visa r MasterCard r Amex

Card # ____________________________________________ Exp Date ___________________________ Security Code __________

Signature __________________________________________

Automatic RenewalNo more renewal notices. If paying by credit card you may authorize NYSSPA to automatically deduct your dues on an annual basis. r Yes, I want my membership to be automatically renewed each year and authorize NYSSPA to charge my credit card.

Join NYSSPA today! www.nysspa.org

Save The Date!Fall 2016 CME Conference

October 7 - 9, 2016DoubleTree by Hilton Hotel

Tarrytown Tarrytown, New York