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MITOCHONDRIAL MEDICINE 2015:
REGIONAL SYMPOSIUM
May 1-2, 2015
CLINICAL SESSION TOPICS
East Lansing,
Michigan
Mitochondrial Disease Primer
CLINICAL SESSION (CME)
Friday, May 1, 2015
8:30am - 5:30pm
FAMILY & PATIENT SESSION
Saturday, May 2, 2015
8:30am - 2:00pm
Michigan State University
Kellogg Hotel & Conference Center
Auditorium & Lincoln Room
219 S Harrison Rd
East Lansing, MI 48824
For more information on
continuing education (CME),
email symposium@umdf.org
or call 412-443-8642.
Friday, May 1, 2015
Screening and Evaluation of Mitochondrial Disorders
Coordination of Care with Mitochondrial Specialists
Potential Treatments and Therapies
Special Topic: Predictability & Probability in POLG Syndromes
Problem Solving Complicated Cases
PATIENT & FAMILY SESSION TOPICS
Saturday, May 2, 2015
Mitochondrial Disease: What is It and What to Expect?
Screening and Evaluation of Mitochondrial Disorders
Current Therapies in the Treatment of Mitochondrial Diseases
Q&A Session
Topics subject to change
For Speakers, Program Agenda Details and Registration Information,
visit: www.umdf.org/symposium/greatlakes
UMDF REGIONAL
SYMPOSIUM REGISTRATION
PLEASE PRINT CLEARLY IN BLUE OR BLACK INK USING CAPITAL LETTERS. PLEASE KEEP ALL WRITING INSIDE THE BOXES.
Clinical Program - Friday
$75.00
Physician/Researcher
Individual registration for Friday only includes continental breakfast,
lunch, one full day of CME and Friday night reception. (Saturday sessions are free with
Friday registration. Please note most Saturday sessions are similar to Friday’s sessions.)
RNs/Allied Health Professionals/Residents/Fellows/Students
Individual registration for Friday only includes continental breakfast,
lunch, one full day of CME and Friday night reception.
TITLE
(MR., MRS.)
Patient & Family Program - Saturday
Individual Registration
$5.00
Fee is per person. Registration includes Friday night reception, Saturday program,
continental breakfast, and lunch for one person. One form per registrant.
Family Registration
$50.00
$10.00
This covers two adults from one household. Registration includes Friday
night reception, Saturday program, continental breakfast, and lunch for two.
Please use additional registration forms for multiple attendees.
FIRST
NAME
MIDDLE
INITIAL
LAST
NAME
SUFFIX
(SR., JR., III)
PROFESSIONAL
DEGREE (MD, PhD)
M
GENDER
F
EMAIL
ADDRESS
HOME
ADDRESS
CITY
STATE
ZIP
DATE OF
BIRTH
HOME PHONE
M
M
D
D
Y
Y
COMPANY/
ORG NAME
COMPANY/ORG
ADDRESS
CITY
STATE
ZIP
I WANT TO MAKE A
DONATION OF
WORK PHONE
$
,
EXTENSION
.
CREDIT CARD
NUMBER
EXPIRATION
CVV
NAME
ON CARD
PARTICIPANT / GUARDIAN SIGNATURE
COMPLETE THIS FORM AND MAIL IT TO:
UMDF Regional Symposium
8085 Saltsburg Road, Suite 201
Pittsburgh, PA 15239
DATE
OR REGISTER ONLINE!
Check www.umdf.org/symposium/greatlakes
for updates or to register online!
Y
Y