The Third Annual Peter D. Stevens Course on

Innovations in Digestive CareFeaturing Live Surgical & Interventional Cases

& Hands-on Animal Tissue Labs

April 10–11, 2014New York City

Program Co-Directors:

John A. Chabot, MD, FACSFrank G. Gress, MD, MBA, AGAF, FACG, FASGE

Michel Kahaleh, MD, AGAF, FACG, FASGEJeffrey Milsom, MD, FACS, FACG

Amrita Sethi, MDRobbyn Sockolow, MD, AGAF

www.gi-innovations.org

Columbia UniversityMedical CenterHerbert Irving Comprehensive Cancer Center

This course is endorsed by the American Society for Gastrointestinal Endoscopy

Endorsed by the AGA Institute

Innovations­in­Digestive­Caren Overall GoalsThis­two­day­course­will­inform­participants­of­the­latest­innovations­for­the­management­of­gastrointestinal­diseases­and­disorders,­and­will­offer­a­unique­opportunity­to­learn­moreabout­the­current­trends­in­interventional­endoscopic­and­surgical­procedures.­Internationallyrecognized­ faculty­will­ address­ issues­ in­current­clinical­practice,­ complications­and­pitfalls­of­newer­technologies,­and­the­evolution­of­the­field.­Attendee­participation­and­interaction­will­be­emphasized­and­facilitated­through­Q&A­sessions,­live­OR­and­interactivecase­presentations­and­hands-on­animal­tissue­labs.n Learning Objectives•­Describe­endoscopic­drainage­of­pancreatic­fluid­collections•­Demonstrate­minimally­invasive­techniques­in­surgery•­Identify­options­in­acute­and­chronic­pancreatitis•­Discuss­the­latest­progress­in­biliary­and­pancreatic­cancer•­Apply­the­use­of­ablation­therapy­for­GI­cancer•­Learn­and­discuss­the­latest­in­prevention­of­complications­in­endoscopy•­Understand­and­discuss­the­endoscopic­approach/management­of­surgical­complications•­Describe­the­most­current­advances­in­pancreatic­disorders•­Understand­robotic­surgery­for­gastrointestinal­surgery•­Discuss­the­early­diagnosis­of­esophageal­and­gastric­cancer•­Explore­different­palliation­for­pancreatic-biliary­cancers•­Recognize­the­latest­advances­in­colorectal­cancer­surgery•­Identify­the­latest­advances­in­therapeutic­endoscopy•­Apply­optimal­screening­for­pancreatic­and­biliary­cancers•­Understand­the­management­of­malignant­and­benign­biliary­strictures•­Discuss­the­usage­of­interventional­echoendoscopy•­Increase­knowledge­of­the­use­of­robotics­in­the­digestive­tract•­Identify­the­latest­advances­in­imaging­for­colorectal­disease•­Recognize­the­latest­surgical­interventions­for­inflammatory­bowel­disease• Increase­knowledge­about­peroral­endoscopic­myotomy­and­endoscopic­fundoplicationn Target Audience•­Gastroenterologists•­Interventional­Endoscopists•­Gastrointestinal­Surgeons•­General­Surgeons•­Colon­and­Rectal­Surgeons•­Thoracic­Surgeons•­Physician­Assistants•­Nurses1

April­10-11,­2014n AccreditationThe­College­of­Physicians­and­Surgeons­of­Columbia­University­is­accredited­by­the­AccreditationCouncil­for­Continuing­Medical­Education­to­provide­continuing­medical­education­forphysicians.n AMA Credit Designation StatementThe­College­of­Physicians­and­Surgeons­designates­this­live­activity­for­a­maximum­of 14.75AMA PRA Category 1 Credits™.­Physicians­should­claim­only­the­credit­commensurate­with­the­extent­of­their­participation­in­the­activity.Nurses­ and­ physician­ assistants­ are­ encouraged­ to­ check­ with­ their­ accrediting­organization­to­ensure­they­accept­AMA PRA Category 1 Credits™.Break­down­of­AMA PRA Category 1 Credits™.Thursday, April 10, 2014Session­1­=­2.0Session­2­=­2.0Session­3­=­3.0Hands-on­Animal­Tissue­Labs­=­3.0­Please­refer­to­the­program­agenda­for­credit­allocation.n SupportWe­expect­support­for­this­program­through­grants­from­pharmaceutical­and­medical­devicecompanies.n EndorsementsThis­course­meets­the­guidelines­as­established­in­the­“Framework­for­Post-ResidencySurgical­Education­and­Training”­and­is­endorsed­by­the­Society­of­American­Gastroin-testinal­Endoscopic­Surgeons­(SAGES).­This­course­is­also­endorsed­by­the­AmericanGastroenterological­Association­(AGA)­and­the­American­Society­for­Gastrointestinal­Endoscopy­(ASGE). n Course OrganizersColumbia­University­Medical­CenterDepartment­of­Surgery,­External­Affairs­400­Kelby­Street,­11th­Floor­Fort­Lee,­NJ­07­024­

Program AdministratorDeborah­Schwarz,­RPA,­CIBE­Executive­Director­andChief­Communications­Officer­Columbia­University­Medical­CenterDepartment­of­Surgery,­External­Affairs­Program Coordinators Jessica­Scully­Senior­Events­Coordinator­Columbia­University­Medical­Center­Department­of­Surgery,­External­Affairs­Telephone:­201-346-7007­Fax:­201-346-7011­E-mail:­jas2134@columbia.edu

Megan­Montgomery,­MPHDirector,­Center­for­Advanced­Digestive­CareNewYork-Presbyterian/Weill­Cornell­Medical­Center­Telephone:­212-746-5579E-mail:­mem7003@nyp.org2

Friday, April 11, 2014Session­4­=­2.25Session­5­=­4.0

Day­1:­Thursday,­April­10,­20146:45am – 7:25am Registration (Outside of the Myrna L. Daniels Auditorium)*

Breakfast & Vendor Exhibits (The Riverview Terrace)*7:25am­–­7:30am Opening­Remarks­(Myrna­L.­Daniels­Auditorium)*­— Laura Forese, MD, MPH7:30am­–­7:45am Welcome­and­Peter­D.­Stevens­Memorial­Remarks­(Myrna­L.­Daniels­Auditorium)*— Michel Kahaleh, MD, AGAF, FACG, FASGE and

Charles J. Lightdale, MD, AGAF, MACG, FASGE

7:45am – 8:45am Session 1: The Esophagus (Myrna L. Daniels Auditorium)* 2.0 CreditsModerators: Nasser Altorki, MD, FACS and David D. Markowitz, MD7:45am­–­8:00am Advances­in­Gastroesophageal­Imaging­— Charles J. Lightdale, MD, AGAF, MACG, FASGE8:00am­–­8:15am Ablation­Therapy­of­the­Esophagus­— Julian Abrams, MD, MS8:15am­–­8:30am Endoscopic­Treatment­for­Benign­Disorders­of­the­Esophagus­— Michel Kahaleh, MD, AGAF, FACG, FASGE8:30am­–­8:45am Minimally­Invasive­Surgery­of­the­Esophagus­— Joshua R. Sonett, MD, FACS

8:45am – 9:45am Live OR Cases (Myrna L. Daniels Auditorium)*

9:45am – 10:00am Break & Vendor Exhibits (The Riverview Terrace)*

10:00am – 10:45am Session 2: The Pancreas(Myrna L. Daniels Auditorium)* 2.0 CreditsModerators: John A. Chabot, MD, FACS and Wallia J. Wever, MD10:00am­–­10:15am Endoscopic­Ultrasound­Evaluation­of­Cystic­Lesions­of­the­Pancreas— Jose G. de la Mora-Levy, MD, MSc, FASGE10:15am­–­10:30am Advances­in­EUS-guided­Procedures— Kenneth Binmoeller, MD10:30am­–­10:45am Innovations­in­Surgical­Therapy­of­the­Pancreas­— Michael Lieberman, MD

10:45am – 12:00pm Live OR Cases (Myrna L. Daniels Auditorium)*

12:00pm – 1:00pm Lunch & Vendor Exhibits (The Riverview Terrace)*

3

Day­1:­Thursday,­April­10,­2014

4

1:00pm – 1:45pm Session 3: The GI Lumen(Myrna L. Daniels Auditorium)* 3.0 CreditsModerators: Marc Bessler, MD and Amit Maydeo, MS, FASGE1:00pm­–1:15pm Endoscopic­Innovations­in­Bariatric­Surgery­— Amrita Sethi, MD1:15pm­–­1:30pm ESD­and­Full-Thickness­Resection­— Gregory B. Haber, MD1:30pm­–­1:45pm Minimally­Invasive­Surgery­of­the­Upper­GI­Tract­— Yanghee Woo, MD

1:45pm – 4:00pm Live OR Cases (Myrna L. Daniels Auditorium)*

Live OR Demonstrators: Kenneth Binmoeller, MD, Steven A. Edmundowitz, MD, FASGE, Tamas A. Gonda, MD, Frank G. Gress, MD, MBA, AGAF, FACG, FASGE, Simone Guaraldi, MD,Michel Kahaleh, MD, AGAF, FACG, FASGE, Amit Maydeo, MS, FASGE, Jose G. de la Mora-Levy, MD, MSc, FASGE, Cyrus Piraka, MD, John M. Poneros, MD, FASGE, Amrita Sethi, MD, Reem Z. Sharaiha, MD, MSc,Adam Slivka, MD, PhD, Brian G. Turner, MD and Wallia J. Wever, MD

2:30pm – 5:30pm Concurrent Session: Hands-on Animal Tissue Labs 3.0 Credits630­W.­168th­Street,­18th­Floor*Lab­Coordinator:­Kai­Matthes,­MD,­PhDStation 1A: Bleeding/Perforation/Fistula— Reem Z. Sharaiha, MD, MSc

Station 1B: Bleeding/Perforation/Fistula— Brian G. Turner, MD

Station 2: Endoscopic­Retrograde­Cholangiopancreatography(ERCP)/Cannulation/Stone­Management/Stenting— Tamas A. Gonda, MD

Station 3: Endoscopic­Mucosal­Resection­(EMR)— Gregory B. Haber, MD

Station 4: Endoscopic­Retrograde­Cholangiopancreatography­(ERCP)­Spy— Jessica Widmer, DO

Station 5: Single­Balloon­Enteroscopy— Theo Doukides, MD

Station 6: Endoscopic­Ultrasound­of­Pseudocysts— Wallia J. Wever, MD

*­Please­see­page­8­for­meeting­locations­

Day­2:­Friday,­April­11,­2014

5

6:45am – 7:25am Registration (Outside of the Myrna L. Daniels Auditorium)*Breakfast & Vendor Exhibits (The Riverview Terrace)*7:25am­–­7:30am Opening­Remarks­(Myrna­L.­Daniels­Auditorium)*— Robert E. Kelly, MD

7:30am – 8:15am Session 4: The Colon and the Rectum(Myrna L. Daniels Auditorium)* 2.25 CreditsModerators: Cyrus Piraka, MD, MD and John M. Poneros, MD, FASGE7:30am­–­7:45am Minimally­Invasive­Surgical­Techniques­in­Resection­— Jeffrey Milsom, MD, FACS, FACG7:45am­–­8:00am Advances­in­Surgery­for­IBD­-­Salvage­Procedures­and­Continence­Procedures­— P. Ravi Kiran, MBBS, MS, Msc, FRCS, FACS8:00am­–­8:15am Endoscopic­Innovations­in­Colorectal­Disease­— Gregory B. Haber, MD

8:15am – 9:45am Live OR Cases (Myrna L. Daniels Auditorium)*

9:45am – 10:00am Break & Vendor Exhibits (The Riverview Terrace)*

10:00am – 10:45am Session 5: Hepatobiliary(Myrna L. Daniels Auditorium)* 4.0 CreditsModerators: Frank G. Gress, MD, MBA, AGAF, FACG, FASGE and Simone Guaraldi, MD10:00am­–­10:15am Advances­in­Biliary­Imaging­— Adam Slivka, MD, PhD10:15am­–­10:30am Advances­in­Endoscopic­Management­of­Malignant­Biliary­Strictures— Steven A. Edmundowicz, MD10:30am­–­10:45am Cholangiocarcinoma:­Surgical­options­and­outcomes­— Benjamin Samstein, MD

10:45am – 12:00pm Live OR Cases (Myrna L. Daniels Auditorium)*

12:00pm – 1:00pm Lunch & Vendor Exhibits (The Riverview Terrace)*

1:00pm – 2:45pm Live OR Cases (Myrna L. Daniels Auditorium)*2:45pm­–­3:00pm Closing­Remarks­— Michel Kahaleh, MD, AGAF, FACG, FASGE

6

Faculty­List­John A. Chabot, MD, FACSVice­President,­ColumbiaDoctorsDavid­V.­Habif­Professor­of­Clinical­SurgeryColumbia­University­College­of­Physicians­and­SurgeonsChief,­Division­of­GI/Endocrine­SurgeryExecutive­Director,­Pancreas­CenterAssociate­Director,­HICCC­for­Clinical­AffairsNewYork-Presbyterian/Columbia­University­Medical­CenterFrank G. Gress, MD, MBA, AGAF, FACG, FASGEProfessor­of­Medicine­Columbia­University­College­of­Physicians­and­SurgeonsClinical­Chief,­Division­of­Digestive­DiseasesChief,­Interventional­EndoscopyNewYork-Presbyterian/Columbia­University­Medical­CenterMichel Kahaleh, MD, AGAF, FACG, FASGEChief­of­EndoscopyProfessor­of­Clinical­MedicineMedical­Director­Pancreas­ProgramDivision­of­Gastroenterology­&­HepatologyDepartment­of­MedicineWeill­Cornell­Medical­CollegeNewYork-Presbyterian/Weill­Cornell­Medical­Center

Jeffrey Milsom, MD, FACS, FACGJerome­J.­Decosse,­MD­Professor­of­SurgeryWeill­Cornell­Medical­CollegeChief­of­Colon­and­Rectal­SurgeryExecutive­Director,­Center­forAdvanced­Digestive­CareExecutive­Director,­Minimally­Invasive­New­Technologies­Program­(MINT)NewYork-Presbyterian/Weill­Cornell­Medical­CenterAmrita Sethi, MDAssistant­Professor­of­Clinical­MedicineDivision­of­Digestive­and­Liver­DiseasesColumbia­University­College­of­Physicians­and­SurgeonsNewYork-Presbyterian/Columbia­University­Medical­CenterRobbyn Sockolow, MD, AGAFAssociate­Professor­of­Clinical­PediatricsWeill­Cornell­Medical­CollegeChief­of­Pediatric­Gastroenterology­and­NutritionNewYork-Presbyterian/Weill­Cornell­Medical­Center

Kenneth Binmoeller, MDMedical­Director,­Interventional­Endoscopy­Service­(IES)California­Pacific­Medical­CenterTheo Doukides, MDTherapeutic­Endoscopy­Boca­Raton­Regional­Hospital­&­Delray­Medical­CenterSteven A. Edmundowicz, MD, FASGEProfessor­of­MedicineChief­of­EndoscopyWashington­University­School­of­Medicine­in­St.­LouisSimone Guaraldi, MDSection­of­Digestive­Endoscopy­at­INCA­(Instituto­Nacional­de­Cáncer)The­Brazilian­National­Institute­of­CancerGregory B. Haber, MDDirector,­Division­of­GastroenterologyLenox­Hill­HospitalKai Matthes, MD, PhDClinical­Associate­ProfessorHarvard­Medical­SchoolDirector,­Developmental­EndoscopyBeth­Israel­Deaconess­Medical­CenterAssociate­in­Perioperative­Care­Boston­Children's­Hospital

Amit Maydeo, MS, FASGEChairman,­Baldota­Institute­of­Digestive­SciencesGlobal­HospitalMumbai,­IndiaFounder­President,­Association­of­Interventional­GI­EndoscopyChairman,­Indian­College­of­EndoscopyJose G. de la Mora-Levy, MD, MSc, FASGEProfessor­of­MedicineDirector­of­Endoscopic­Ultrasound­&­Co-Director,­Pancreato-Biliary­EndoscopyNational­Cancer­InstituteMexico­City,­MexicoCyrus Piraka, MDSection­Chief,­Advanced­Therapeutic­EndoscopyDirector­of­Advanced­Therapeutic­Endoscopy­FellowshipDivision­of­Gastroenterology/HepatologyHenry­Ford­Health­SystemAdam Slivka, MD, PhDProfessor­of­MedicineAssociate­ChiefGastroenterology,­Hepatology­and­NutritionUniversity­of­Pittsburgh­Medical­Center

n Program Co-Directors

n Guest Faculty

7

Julian Abrams, MD, MSFlorence­Irving­Assistant­Professor­of­MedicineColumbia­University­College­of­Physicians­and­SurgeonsNewYork-Presbyterian/Columbia­University­Medical­CenterNasser Altorki, MD, FACSProfessor­of­Thoracic­SurgeryWeill­Cornell­Medical­CollegeChief,­Division­of­Thoracic­SurgeryNewYork-Presbyterian/Weill­Cornell­Medical­CenterMarc Bessler, MDProfessor­of­Clinical­SurgeryColumbia­University­College­of­Physicians­and­SurgeonsChief,­Division­of­Minimal­Access­and­Bariatric­Director,­Center­for­Metabolic­and­Weight­Loss­SurgeryNewYork-Presbyterian/Columbia­University­Medical­CenterTamas A. Gonda, MDAssistant­Professor­of­Clinical­MedicineColumbia­University­College­of­Physicians­and­SurgeonsNewYork-Presbyterian/Columbia­University­Medical­CenterP. Ravi Kiran, MBBS, MS, MSc, FRCS, FACSProfessor­of­SurgeryColumbia­University­College­of­Physicians­and­SurgeonsChief­and­Program­Director,­Division­of­Colorectal­SurgeryNewYork-Presbyterian/Columbia­University­Medical­CenterMichael Lieberman, MDAssociate­Professor­of­Clinical­SurgeryWeill­Cornell­Medical­CollegeDirector­of­Surgery­at­The­Jay­Monahan­Center­for­Gastrointestinal­HealthDirector­of­Surgical­OncologyNewYork-Presbyterian/Weill­Cornell­Medical­CenterCharles J. Lightdale, MD, AGAF, MACF, FASGEProfessor­of­Clinical­MedicineColumbia­University­College­of­Physicians­and­SurgeonsDirector­of­Clinical­ResearchDivision­of­Digestive­and­Liver­DiseasesNewYork-Presbyterian/Columbia­University­Medical­Center

David D. Markowitz, MDAssociate­Clinical­Professor­of­MedicineColumbia­University­College­of­Physicians­and­SurgeonsNewYork-Presbyterian/Columbia­University­Medical­CenterJohn M. Poneros, MD, FASGEAssistant­Professor­of­MedicineColumbia­University­College­of­Physicians­and­SurgeonsAssociate­Director­of­EndoscopyProgram­Director,­Advanced­Endoscopy­FellowshipNewYork-Presbyterian/Columbia­University­Medical­CenterBenjamin Samstein, MDAssistant­Professor­of­SurgeryColumbia­University­College­of­Physicians­and­SurgeonsSurgical­Director,­Living­Donor­Liver­Transplant­ProgramDirector,­Transplant­Surgery­FellowshipNewYork-Presbyterian/Columbia­University­Medical­CenterReem Z. Sharaiha, MD, MScAssistant­Professor­of­MedicineWeill­Cornell­Medical­CollegeNewYork-Presbyterian/Weill­Cornell­Medical­CenterJoshua R. Sonett, MD, FACSEdwin­C.­and­Anne­K.­Weiskopf­Professor­of­Surgical­Oncology­Columbia­University­College­of­Physicians­and­Surgeons­Chief,­General­Thoracic­Surgery­Director,­Price­Center­Comprehensive­Lung­Care­NewYork-Presbyterian/Columbia­University­Medical­CenterBrian G. Turner, MDAssistant­Professor­of­MedicineWeill­Cornell­Medical­CollegeNewYork-Presbyterian/Weill­Cornell­Medical­CenterYanghee Woo, MDAssistant­Professor­of­Clinical­SurgeryDivision­of­GI­Endocrine­Surgery­Division­of­Acute­Care­Surgery­­MIS­and­Robotic­SurgeryColumbia­University­College­of­Physicians­and­SurgeonsNewYork-Presbyterian/Columbia­University­Medical­Center

Faculty­List­n NewYork-Presbyterian

Columbia University College of Physicians and SurgeonsWeill Cornell Medical College Faculty

Wallia J. Wever, MDGastroenterologo-EcoendoscopistaUnidad­de­Exploraciones­Digestivas­IMLFCaracas-Venezuela­Jessica Widmer, DOAssistant­Professor­of­MedicineHofstra­North­Shore­-­LIJ­School­of­Medicine

n Guest Faculty Continued

8

Travel­&­Hotel­Informationn Parking & Subway InformationParkingParking­is­available­at­the­NewYork-Presbyterian/Columbia­University­Medical­Centerparking­lot,­located­on­the­southwest­corner­of­Fort­Washington­Avenue­and­West­165th­Street.SubwayTake­the­1,­A,­C­lines­to­168th­Street­–­Washington­Heights/Broadway.n Local Area HotelsFor­a­listing­of­local­area­hotels,­please­visit­www.gi-innovations.org­and­select­Hotel Information.­

The­Vivian­and­Seymour­Milstein­Family­Heart­Center173­Fort­Washington­AvenueNew­York,­NY­10032Breakfast, Lunch, Breaks & Vendor ExhibitsFirst­Floor:­The­Riverview­Terrace­

RegistrationFirst­Floor:­Outside­of­the­Myrna­L.­Daniels­Auditorium­Didactics & Live OR CasesFirst­Floor:­Myrna­L.­Daniels­Auditorium

Locationsn Location for Registration, Breakfast, Lunch, Breaks, Vendor Exhibits,

Didactics & Live OR Cases

n Location for the Hands-on Animal Tissue LabsHands-on Animal Tissue Labs630­W.­168th­Street,­18th­FloorNew­York,­NY­10032

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n Registration Options & FeesTWO DAY REGISTRATIONOption A: Didactics & Hands-on Animal Tissue Labs (Thursday, April 10)AND Didactics (Friday, April 11)Physicians $1,000Industry $1,100Allied­Health­Professionals $800­NYP­Healthcare­System­Physicians­&­Allied­Health­Professionals $700­NYP/WCMC/CUMC­Physicians­&­Allied­Health­Professionals $500Fellows,­Residents­&­Students­ $600Option B: Didactics (Thursday, April 10)AND Didactics (Friday, April 11) Physicians $500Industry $600Allied­Health­Professionals $300NYP­Healthcare­System­Physicians­&­Allied­Health­Professionals $200NYP/WCMC/CUMC­Physicians­&­Allied­Health­Professionals FreeFellows,­Residents­&­Students $100NYP­=­NewYork-PresbyterianWCMC­=­Weill­Cornell­Medical­CenterCUMC­=­Columbia­University­Medical­Center­­­­

ONE DAY REGISTRATIONOption C: Didactics & Hands-on Animal Tissue Labs (Thursday, April 10)Physicians $850Industry $950Allied­Health­Professionals $700­NYP­Healthcare­System­Physicians­&­Allied­Health­Professionals $625­NYP/WCMC/CUMC­Physicians­&­Allied­Health­Professionals $500Fellows,­Residents­&­Students­ $600Option D: Didactics (Thursday, April 10)Physicians $350Industry $450Allied­Health­Professionals $200­NYP­Healthcare­System­Physicians­&­Allied­Health­Professionals $125­NYP/WCMC/CUMC­Physicians­&­Allied­Health­Professionals FreeFellows,­Residents­&­Students $100Option E: Didactics (Friday, April 11)Physicians $350­Industry $450­Allied­Health­Professionals $200­NYP­Healthcare­System­Physicians­&­Allied­Health­Professionals $125NYP/WCMC/CUMC­Physicians­&­Allied­Health­Professionals FreeFellows,­Residents­&­Students $100­

Registration­Information

­These­ fees­ include:­ academic­ presentations,­ course­materials,­participation­with­the­hands-on­animal­tissuelabs­(if­applicable),­meals­and­refreshments.­Confirmationof­registration­will­be­sent­upon­receipt­of­the­registra-tion­form­and­payment.

The Third Annual Peter D. Stevens Course on Innovations in Digestive CarePlease­check­which­option­you­will­attend:m Option­A:­Didactics­&­Hands-on­Animal­Tissue­Labs­(Thursday,­April­10)­AND­Didactics­(Friday,­April­11)m Option­B:­Didactics­(Thursday,­April­10)­AND­Didactics­(Friday,­April­11)m Option­C:­Didactics­&­Hands-on­Animal­Tissue­Labs­(Thursday,­April­10)m Option­D:­Didactics­(Thursday,­April­10)m Option­E:­Didactics­(Friday,­April­11)First­Name­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­M.I. Last­Name Degree(s)Company/InstitutionAddressCity State ZipDaytime­Phone Daytime­FaxE-mail­(for­confirmation­purposes)SpecialtySpecial­NeedsAttendee­Signature Daten Payment MethodsONLINE:­To­make­an­online­credit­card­payment­please­visit:­www.gi-innovations.org.For­security­purposes,­credit­card­payments­cannot­be­accepted­in­the­mail­or­byphone.­American­Express,­Discover,­MasterCard­and­Visa­only.BY­MAIL:­Complete­the­attached­registration­form­and­mail­together­with­full­payment­to:­Columbia­University­Medical­Center­Department­of­Surgery,­External­Affairs400­Kelby­Street,­11th­FloorFort­Lee,­NJ­07024Enclose­a­check­or­money­order­made­payable­to­Columbia­University­Department­of­Surgery/GI­Innovations.­Checks­must­be­in­U.S.­dollars­drawn­on­a­U.S.­bank.­PLEASE­NOTE:­Registration­is­limited­and­will­be­handled­on­a­first-come,­first-served­basis.­Telephone­registrations­and/orcancellations­ are­ not­ accepted.­ If­ you­ cancel­ your­ registration­ at­ least­ ten­ business­ days­ prior­ to­ the­ course­(March­27,­2014),­we­will­refund­your­registration­fee,­less­a­$50­administrative­charge.­No­refunds­can­be­made­thereafter.

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