2018 cns annual meeting advance registration and housing … · hotel room rates single/double room...

REGISTRANT INFORMATION (Please type or print legibly using one form per person.)

FIRST/GIVEN NAME LAST NAME CREDENTIALS

BADGE NAME (as you would like it to appear on your badge)

INSTITUTION/HOSPITAL/OFFICE/COMPANY NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER

MAILING ADDRESS CITY STATE/PROVINCE COUNTRY ZIP/POSTAL CODE

TELEPHONE (If international please include country code) FAX E-MAIL

European Union’s General Data Protection Regulation (GDPR) Requirements: mCheck here if you agree that the CNS can retain this information for the purposes of communication and service support set out in the CNS Privacy Policy. To view the Privacy Policy please visit https://www.cns.org/privacy-policy. Exhibitor E-mail/Phone Opt-out: mCheck here if you do not want your phone number encoded. mCheck here if you do not want your e-mail address encoded.Americans with Disabilities Act: mCheck here if you require special accommodations or services in order to attend. You will be contacted by a CNS representative.Special Dietary Restrictions: mVegetarian mKosher mOther (Please Specify) _____________________________________________________________ mNone

DEMOGRAPHIC INFORMATION Please help us collect accurate attendee demographics by answering the following questions. This information is required in order to process your registration.

REGISTRATION CNS MEMBER MEDICAL REGISTRANT

RECEIVED ON OR BEFORE SEPTEMBER 6

RECEIVED AFTER SEPTEMBER 6

mActive (Domestic) $ 750 $ 950mInternational $ 750 $ 950mAssociate $ 750 $ 950mActive Duty Military $ 0 $ 0mArmed Forces (Guard/Reserve/Retiree) $ 475 $ 675mTransitional $ 750 $ 950mResident (Domestic) $ 150 $ 250mInternational Vista Resident $ 150 $ 250mFellow (Domestic & Int’l.) $ 200 $ 300mSenior $ 450 $ 650mMedical Student $ 0 $ 200mAffiliate $ 350 $ 550

NON-MEMBER MEDICAL REGISTRANTRECEIVED ON OR

BEFORE SEPTEMBER 6RECEIVED AFTER

SEPTEMBER 6

mNeurosurgeon $ 1000 $ 1200mPhysician (MD, DO, etc.) $ 1000 $ 1200mNon-Physician (Clinical Researcher/Scientist)*

$ 1000 $ 1200

mNeurosurgeon (Faculty) $ 850 $ 1050m Resident** $ 400 $ 500mFellow*** $ 450 $ 550mMedical Student $ 250 $ 450mPA/Physician Extender $ 600 $ 800mNurse $ 600 $ 800mNurse Practitioner $ 600 $ 800mCorporate Representative† $ 1250 $ 1450

mANSPA Member†† $ 575 $ 675Non-Member categories ore open to domestic and international registrants.* Non-member/Non-physician category is limited to scientists, engineers, etc. involved in neurological research, and/or product development not affiliated with an exhibiting company . *All non-member Residents must have their Program Director sign registration form. If registering online, a letter from your Program Director certifying that you are a Resident in a neurosurgical training program must be faxed to 972-349-7715, or e-mailed to [email protected] within one week of completing registration. **All non-member Fellows must provide a letter from their Chief of Service verifying Fellow status within one week of completing registration, it may be faxed to 972-349-7715, or e-mailed to [email protected]. †Corporate representatives attend for education only. They must not conduct sales activities in the meeting space, nor influence content in any way. Solicitation of medical attendees is strictly prohibited.††lncludes one year of CNS Affiliate membership in 2019 for ASPNA members only.

PROGRAM DIRECTOR (PRINT OR TYPE NAME) PROGRAM DIRECTOR SIGNATURE

m YES! I am interested in volunteering for the CNS Sergeant-at-Arms Committee. (Valid for residents and fellows only.)

NON-MEDICAL REGISTRATION

Please indicate your professional level: (check one only)m Director/Department Headm Other Senior Managementm Staffm Residentm Nurse/Nurse Practitioner/PAm Other

Gender: (optional)m Male mFemaleAge: (optional)mUnder 35m35-45m46-55m56-65m66+

Please indicate your practice setting: (check one only)m Privatem Full-time Academicm Private (Academic Affiliate or Appointment)m Other

Please indicate your subspecialty: (check all that apply)m Cerebrovascularm Endovascularm Epilepsym Movement Disordersm Painm Pediatric

m Peripheral Nervesm Skull Base Lesionsm Spinem Traumam Tumorm Other

RECEIVED ON OR BEFORE SEPTEMBER 6

RECEIVED AFTER SEPTEMBER 6

mSpouse/Guest/Child 13 & Over $ 150 $ 250mSpouse/Guest/Child 13 & Over (Resident/Fellow)

$ 75 $ 150

mChild (12 & Under) $ 0 $ 0

SPOUSE/GUEST FULL NAME

SPOUSE/GUEST FULL NAME

SUBTOTAL REGISTRATION $____________

Advance Registration Deadline: September 6, 2018 All meeting confirmations will be sent via e-mail.

2018 CNS ANNUAL MEETING

Advance Registration and Housing FormOCTOBER 6–10, 2018 HOUSTON, TEXAS

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HOTEL ROOM RATES Single/Double Room Rate Only Room Rate with local/state tax and fees*

mMarriott Marquis Houston – Headquarters Hotel m$ 269 $ 314.73

mEmbassy Suites by Hilton Houston Downtown m$ 239 $ 279.63

mFour Seasons Hotel Houston m$ 305 $ 359.10**

mHampton Inn Houston Downtown m$ 239 $ 279.63

mHilton Americas – Houston m$ 269 $ 314.73

mHomewood Suites by Hilton Houston Downtown m$ 239 $ 279.63

mWestin Houston Downtown m$ 219 $ 256.23

*Tax rates subject to change. **An additional State Cost-Recovery Fee of $2.25 will be charged per room per night. The fee will be included in the one night room and tax deposit.

HOTEL RESERVATIONS Special Requests mTwo (2) Beds mCrib (additional fee may apply) mRollaway bed (additional fee may apply)

Please note, CNS cannot guarantee bed type or special requests as this is subject to availability upon arrival at the hotel.

If your preferred hotel choice is not available, you will be contacted and confirmed into the next available hotel.

mPlease check this box if you are interested in reserving a suite. (A CNS housing center representative will contact you regarding suite availability and rates. In the meantime, a standard room will be assigned.)

ARRIVAL DATE DEPARTURE DATE

HOTEL CHANGE/CANCELLATION POLICY

Please Note: Each hotel has its own cancellation policy and some may charge an early departure fee. The individual hotel’s policies will be listed in your e-mail confirmation. Any cancellations not made within the hotel’s cancellation policy will result in forfeiture of your one night’s room and tax deposit. The deadline date for new reservations based on availability is September 25, 2018. The hotel requires a deposit of one night’s room and tax to reserve your room. Please continue to make any requests/changes by e-mailing [email protected] or calling 800-931-9543 through September 25, 2018. Beginning September 26, 2018, changes and cancellations must be made with your assigned hotel.

SUBTOTAL HOTEL DEPOSIT $____________

If not registering for optional courses, skip to page 5 for payment.

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SEPTEMBER/OCTOBER 2018

S M T W T F S

30 1 2 3 4 5 6

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1 REGISTRANT INFORMATION (Please type or print neatly in black ink.)

FIRST NAME LAST NAME

2 SYMPOSIA Saturday, October 6, 2018 Sunday, October 7, 2018ALL DAY 8:00 AM – 4:00 PM (Includes Lunch) ALL DAY 8:00 AM – 4:00 PM (Includes Lunch)

FEE: $300 Physician $200 Nurse/NP/PA $100 Resident/Med Student FEE: $300 Physician $200 Nurse/NP/PA $100 Resident/Med Student

m SYM1 Neurovascular Update: Evidence-based Guidelines in Ischemic and Hemorrhagic Stroke for the Practicing Neurosurgeon

m SYM2 Robotics Symposium

m FACULTY m FACULTYSUBTOTAL SYMPOSIA $____________

3 PRACTICAL COURSES Saturday, October 6, 2018ALL DAY 8:00 AM – 4:00 PM (Includes Lunch)

FEE: $650 Physician $425 Nurse/NP/PA $175 Resident/Med Student

m PC01 Severe TBI update: Trends and Tools*m FACULTY

MORNING 8:00 AM – 11:30 AM


m PC02 Minimally Invasive Spine Surgery – Case-based Complications and Future Directions

m PC03 Cervical Spine Case Management: Techniques and Technology Update

m PC04 Bypass Techniques in Cerebrovascular Neurosurgerym PC05 Endoscopic Craniosynostosis Repair: Hands on Course m PC06 Update on Movement Disorders: Case Based Review of

Approaches and Controversies m PC07 Modern Applications of Radiosurgery m PC08 WINS Practical Course on Leadership and Education m PC09 3D Surgical Neuroanatomy (Supratentorial)m FACULTY

AFTERNOON 12:30 PM – 4:00 PM


m PC10 Innovation, Quality and Safety – A Balance Along the Continuum of Care for Neurosurgical Patients

m PC11 Spinal Trauma and Spinal Cord Injury: Case-based Presentations and Future Directions*

m PC12 My Worst Spinal Complication: What I Learnedm PC13 Peripheral Nerve Surgery: Techniques and Exposurem PC14 3D Surgical Neuroanatomy (Infratentorial)

m PC15 Neurosurgeon-hospital Relationships: Options, Negotiations, and Achieving What You Are Worth

m FACULTY

Sunday, October 7, 2018ALL DAY 8:00 AM – 4:00 PM (Includes Lunch)

FEE: Complimentary

m PC16 Association of Neurosurgical Physician Assistants (ANSPA) Fall 2018 CME Meeting Presented in Collaboration with Congress of Neurological Surgeons (CNS)

m FACULTY

MORNING 8:00 AM – 11:30 AM


m PC17 New Era in Stentingm PC18 CPT Updatem PC19 Spinal Biomechanics in Modern Clinical Practicem PC20 Thoracolumbar Spinal Deformity for the Non-Deformity Spine

Surgeon

m PC21 Neurosurgical Treatment of Chronic Headache m PC22 Review of Functional Neurosurgery for the Non-Specialist*m PC23 Surgical Management of Eloquent Area Tumors: Functional

Mapping and/or Navigation m PC24 Brain Tumor Update Part 1: Malignant Brain Tumors

m PC25 Concussion Practical Course m FACULTY

AFTERNOON 12:30 PM – 4:00 PM


m PC26 Big Data – Core Principles of Data Science for Neurosurgeons


m PC27 Surgical Strategies and Techniques for Carotid Stenosis: CEA and Stenting

m PC28 Brain Tumor Update Part 2: Benign Brain Tumors m FACULTY

SUBTOTAL PRACTICAL COURSES $____________

See page 5 for complete payment information

• CNS Annual Meeting registration is required in order to purchase optional course tickets• Register early to receive your preferred choice• All meeting confirmations will be sent via e-mail

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COURSE DIRECTORS/FACULTY/MODERATORS: No one-day speaker badges will be issued. Full meeting registration fees apply from page 1. However, there will be no fee assessed for the course(s) in which you are participating. Please check the faculty box next to your course selection below.



Please check one:mPhysicianmNurse/NP/PAmResident/Med Student

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4 LUNCHEON SEMINARSCost per Luncheon Seminar: $95. Discounted pricing of $75 offered for residents/fellows/medical students/advance practice providers. Ticket price will be applied based on your membership/registration status.

MONDAY, OCTOBER 8, 2018 12:15 – 1:45 PM

m M01 Honored Guest Lunch: The Business of Medicine in the 21st Century: Pearls and Pitfalls (Complimentary to CNS Resident members)

m M02 Navigating MACRA/MIPS and Bundled Payments

m M03 Is Intracerebral Hemorrhage a Surgical Disease?

m M04 Venous Stenting for Pseudotumor

m M05 Controversies in Spinal Deformity Surgery

m M06 Cervical Spondylotic Myelopathy: Anterior Versus Posterior Approaches*

m M07 Management of Chronic Subdural Hematoma

m M08 Management of Brachial Plexus Injuries: from Birth to Adult

m M09 Key Clinical Trials in Epilepsy Surgery

m M10 Update on Diagnosis and Management of Low Grade Gliomas

m M11 Acoustic Neuromas: Current Management Strategies*

m FACULTY

TUESDAY, OCTOBER 9, 2018 12:15 – 1:45 PM

m T12 Medical Malpractice Update 2018

m T13 Dural AV Fistula: Diagnosis, Classification, and Management

m T14 Update on the Management of Anti-coagulation and Anti-platelet Therapies in Neurosurgical Patients

m T15 Spinal Tumor Surgery: Case Based Management

m T16 Peak Performance: Optimizing the Spine Surgical Patient from Preop to Postop

m T17 Combat and Mass-Casualties: Neurosurgery Under Fire

m T18 SCS: Evidence and Applications

m T19 Pediatric Dystonia: Advancements with DBS and Management Updates

m T20 Malignant Gliomas: Advances in Surgery and Adjuvant Therapy*

m T21 Management of Pituitary Adenomas and other Sellar Pathology

m T22 Diversity in Learning: New Initiatives in Mentorship

m FACULTY

WEDNESDAY, OCTOBER 10, 2018 12:15 – 1:45 PM

m W23 Spinal Arteriovenous Fistulae and Malformations: Management Strategies in 2018

m W24 Contemporary and Practical Management of an Enigmatic Process: Cerebral Vasospasm (Delayed Cerebral Ischemia)

m W25 Novel Techniques for Management of Lumbar Spondylolisthesis

m W26 Peripheral Nerve Entrapment Syndromes: Diagnosis and Management*

m W27 Sports-related Injuries

m W28 Pediatric Head Trauma

m W29 Cutting Edge management of Brain Metastasis

m W30 Advanced Imaging of Brain Tumors

m W31 Enhancing Communication Skills to Lead Your Practice

m FACULTY

5 DINNER SEMINARSCost per Dinner Seminar: $190

SATURDAY, OCTOBER 6, 2018 6:30 – 8:30 PM

m DIN1 The Bottom Line in a Changing World – Updates about CPT, ICD-10, MIPS and Bundling

m FACULTY

MONDAY, OCTOBER 8, 2018 7:30 – 9:30 PM

m DIN2 Advances and Controversies in Intracranial AVM Management

m DIN3 Robotics and Spinal Surgery: The Future is Now

m FACULTY

TUESDAY, OCTOBER 9, 2018 7:30 – 9:30 PM

m DIN4 Emerging Indications for Functional Neurosurgery: Tourette, OCD, Depression and Pain

m FACULTY

SUBTOTAL DINNERS SEMINARS $____________

SUBTOTAL LUNCHEON SEMINARS $____________

*SANS Supplemental Exam is available for purchase with the course for an additional $15. SANS Supplemental Exams may also be purchased separately without having to attend the live course (see page 5).



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6 SANS SUPPLEMENTAL EXAMS

m PC01 SANS Severe TBI update: Trends and Tools $ 15

m PC11 SANS Spinal Trauma and Spinal Cord Injury: Case-based Presentations and Future Directions $ 15

m PC22 SANS Review of Functional Neurosurgery for the Non-Specialist $ 15

m M06 SANS Cervical Spondylotic Myelopathy: Anterior Versus Posterior Approaches $ 15

m M11 SANS Acoustic Neuromas: Current Management Strategies $ 15

m T20 SANS Malignant Gliomas: Advances in Surgery and Adjuvant Therapy $ 15

m W26 SANS Peripheral Nerve Entrapment Syndromes: Diagnosis and Management $ 15

SUBTOTAL SANS EXAMS $____________

Continue your education after the Annual Meeting and earn one hour of additional CME credit with SANS Supplemental Exams! The supplemental exams for each of the following courses are available for only $15 each. Any Annual Meeting attendee can purchase these exams, regardless of attendance at the live courses.

7 PAYMENT

Subtotal Registration $

Subtotal Hotel Deposit $

Subtotal Symposia $

Subtotal Practical Courses $

Subtotal Luncheon Seminars $

Subtotal Dinner Seminars $

Subtotal SANS Exams $

TOTAL $

m Check: Full payment must accompany your registration form. Make check (US Dollars drawn on a US Bank) payable to: CNS Annual Meeting Registration and Housing Center, 6100 W. Plano Pkwy, Suite 3500, Plano, TX 75093. (Any checks received from an overseas bank will be returned. Any checks returned for insufficient funds are subject to additional charges.)

m Credit Card Authorization: Credit card will be charged immediately for registration fees. (US dollars drawn on a US bank)

m Visa m American Express m MasterCard

CREDIT CARD NUMBER EXPIRATION DATE (MONTH/YEAR)

NAME OF CARDHOLDER (PRINT)

BILLING ADDRESS (IF DIFFERENT THAN REGISTRANT)

SIGNATURE

By signing this form: I authorize the CNS Registration and Housing Center to charge my credit card for the total payment due, acknowledge that the CNS registration cancellation policies are in effect, and grant the CNS the right to use photos taken at the CNS Annual Meeting which include me in promotional materials for future meetings.

These fees are subject to audit and in case of error, the CNS Registration and Housing Center reserves the right to correct the error and charge the appropriate fees.

Registration Cancellation Policy: Full registration refunds, less a $100 processing fee, will be granted if written requests for cancellation are received by 5:00 pm CT on September 13, 2018. Course, seminar, and event tickets will be refunded in full until September 13, 2018. No refunds of any kind will be given after this date, regardless of cause. Refunds will not be given for no-shows. Any changes to existing badges after the published cut-off date of September 13, 2018, are assessed a $50 processing fee. Written requests may be emailed to [email protected], faxed to 972-349-7715, or mailed to the CNS Annual Meeting Registration and Housing Center, 6100 W. Plano Pkwy, Suite 3500, Plano, TX 75093.

8 RETURN TO CNS REGISTRATION AND HOUSING CENTER You may also register online at www.cns.org.

Fax: 972-349-7715 (credit card only)

Mail: CNS Annual Meeting CNS Registration and Housing Center 6100 W. Plano Pkwy, Suite 3500 Plano, TX 75093



2018 cns annual meeting advance registration and housing … · hotel room rates single/double room...

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