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A MERICAN S OCIETY OF D IAGNOSTIC & I NTERVENTIONAL N EPHROLOGY PHOENIX, ARIZONA FEBRUARY 21-23, 2014 • JW MARRIOTT DESERT RIDGE ADVANCED TECHNIQUES PRE-COURSE • FEBRUARY 21 ST ADMINISTRATOR/MANAGER PRE-COURSE • FEBRUARY 21 ST Meeting Directors: David Fox, MD, FACS Haimanot Wasse, MD, MPH, FASN

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Page 1: HOENIXARIZ P ONA, - cdn.ymaws.com · AmericAn Society of DiAgnoStic & interventionAl nephrology HOENIXARIZ P ONA, FEBRUARY 21-23, 2014 • JW MARRIOTT DESERT RIDGE ADV ANCED TECHNIQUES

AmericAn Society of DiAgnoStic & interventionAl nephrology

PHOENIX, ARIZONAFEBRUARY 21-23, 2014 • JW MARRIOTT DESERT RIDGE ADVANCED TECHNIQUES PRE-COURSE • FEBRUARY 21ST

ADMINISTRATOR/MANAGER PRE-COURSE • FEBRUARY 21ST

Meeting Directors:David Fox, MD, FACSHaimanot Wasse, MD, MPH, FASN

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PHOENIX, AZ

ASDIN 10th Annual Scientific Meeting

Meeting Highlights • Advanced Techniques Pre-Course (separate registration required) • Full-Day Pre-Course Program especially for Administrators and Managers (separate registration required) • State-of-the-art non-traditional sessions covering a range of interventional topics • General Sessions featuring multi-specialty faculty • Poster, abstract and video presentations

(visit www.asdin.org for Call for Abstracts and Call for Video information)

• Peer-to-peer networking • Exhibits

Special Sessions Breakout Sessions:

Renal Denervation Peripheral Arterial Intervention Non-Physician Associates Program Abstract Presentations (Podium and Poster) First Annual Video Competition

Who Should Attend? • Clinical nephrologists interested in optimizing patient care • Established and aspiring interventional nephrologists • Interventional radiologists • Vascular access surgeons • Residents & fellows-in-training • Nephrology or advanced-practice nurses involved in dialysis patient care or vascular access management • Vascular access coordinators, administrators, and coding/billing supervisors/specialists • Radiological technologists

About ASDIN...Founded in 2000, ASDIN’s mission is to promote the appropriate application of new and existing procedures in order to improve the care of patients with kidney disease. These procedures include, but are not limited to, insertion of tunneled hemodialysis and peritoneal dialysis catheters, endovascular procedures, and diagnostic sonography. The Society works closely with other societies and with nephrology training programs to achieve its goals. All physicians (nephrologists and others), administrators, technologists, and nurses involved with the care of nephrology patients are invited to join and become active in the Society.Activities of the Society include: • Establishment of practice standards • Certification of physicians in specific procedures • Accreditation of training programs in specific procedures • Development of training tools and techniques • Sponsoring symposia and training courses • Dissemination of information through periodic meetings and through print and other media

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org2

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Registration is limited to the first 80 registrants. No CME offered for the Pre-Course.

Pre-Course Co-Chairs: Dirk Hentschel, MD, Brigham and Women’s Hospital, Renal Division, Boston, MAIvan Maya, MD, Nephrology Associates of Central Florida, Lake Mary, FL

Friday - February 21, 2014 • 7:00 am - 4:30 pm

7:00 am - 7:50 am Registration (Pre-Registration required)

7:50 am - 8:00 am Introduction Dirk Hentschel, MD and Ivan Maya, MD

8:00 am - 8:30 am Tunneled Catheters - How to Get Unstuck Thomas Vesely, MD, Vascular Access Services LLC, St. Louis, MO

8:30 am - 9:00 am “Unassisted” Evaluation of Access Dysfunction (Eyes, Ears, and Fingers) Tushar Vachharajani, MD, FASN, FACP, WG (Bill) Hefner VA Medical Center, Salisbury, NC

9:00 am - 9:30 am Complications During Endovascular Access Procedures and Bail-out Strategies Abigail Falk, MD, FSIR, Fresenius Vascular Care, New York, NY

9:30 am - 9:50 am Break

9:50 am - 10:20 am Preserving of Vascular Real Estate Peter Wayne, MD, Surgical Care Associates, Louisville, KY

10:20 am - 10:50 am PD Catheter Insertion and Removal Stephen Ash, MD, FACP, Clarion Arnett Health, Lafayette, IN

10:50 am - 11:20 am Access Flow and Renal Artery Stenosis Evaluation by Ultrasound Adina Voiculescu, MD, Brigham and Women’s Hospital, Renal Division, Boston, MA

11:20 am - 11:50 am Renal Artery Interventions - Stenosis and Denervation Alexander S. Yevzlin, MD, University of Wisconsin, Madison, WI

11:50 am – 1:15 pm Lunch (on your own)

1:15 pm - 4:30 pm Hands-on Workshops Coils Deployment Fistula Evaluation by Physical Exam & Ultrasound Foreign Body Retrieval “Live” Video Cases PD Catheter Insertion and Removal Tunneled Catheter Insertion Vascular Access Alternatives (PICCs, Ports &Intra-osseous Devices)

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org 3

PHOENIX, AZ

Advanced Techniques Pre-Course • Friday, February 21st

(Separate registration required)

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Friday, February 21, 2014 • 7:30 am - 5:00 pm

Moderators:Robin Simmons RN, BS, Kansas Vascular Access Center, Wichita, KSSyd Stevens, CPC, CIMC, Midwest Nephrology Consultants, PA, Kansas City, MO

Don’t miss this opportunity to join your Interventional Physicians and Associate Staff this year in Phoenix and to network with your colleagues from across the nation in a special pre-course designed especially for you! This year’s course will cover timely information – all specially tailored for everyone involved in access center management – both clinical and administrative. Not just a “view from 30,000 feet” but a hands-on, interactive experience presented by a diverse, professional group of presenters. Share this with your management team members and plan to attend!

7:30 am - 8:30 am Registration

8:30 am - 10:15 am Current Accountable Care Issues - Where Are We Really Headed? Robert Provenzano, MD, FACP, FASN, Vice President of Medical Affairs, DaVita, Detroit, MI

10:15 am – 10:30 am Break

10:30 am - 12:00 noon Legal Considerations of a Sale or Joint Venture Acquisition of Your Access Center Richard D. Sanders, Esquire, Managing Partner, The Sanders Law Firm, P.C., Atlanta, GA

12:00 noon - 1:00 pm Lunch (included in registration)

1:00 pm - 2:15 pm Today’s Work Force: Challenges in a Multi-Generational Work Place Kathy Slemp, PhD, SPHR, Human Resource Management, College of Adult and

Professional Studies, Friends University, Wichita, KS

2:15 pm - 3:30 pm Peritoneal Dialysis-An Untapped Revenue Source for Your Access Center and Nephrology Practice

3:30 pm - 3:45 pm Break

3:45 pm - 5:00 pm Putting Your Access Center in the Spotlight: The ABC’s of How to Market Effectively Gracie Royle, RN, President, Avanti Vista, Wichita, KS

PHOENIX, AZ

Administrator/Manager Pre-Course • Friday, February 21st

(Separate registration required)

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org4

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Friday, February 21, 2014

7:00 am – 10:00 am Pre-Course Registration

7:50 am – 4:30 pm Advanced Techniques Pre-Course

8:00 am – 5:00 pm Administrator/Manager Pre-Course

1:00 pm – 5:00 pm Exhibitor Move-In

3:00 pm – 7:00 pm �Scientific�Meeting�Registration

5:30 pm – 7:00 pm Welcome Reception/Exhibit Hall

Saturday, February 22, 2014

7:00 am – 7:30 am Continental Breakfast (within Exhibit Hall)

7:00 am – 3:30 pm Exhibits Open

7:00 am – 5:00 pm Registration Open

7:30 am – 7:35 am Introduction - Program Chairs: David Fox, MD, FACS, North Shore

LIJ-Lenox Hill Hospital, New York, NY and Haimanot Wasse, MD, MPH, FASN, Emory University, Atlanta, GA

7:35 am – 7:45 am Welcome and President’s Address Aris Q. Urbanes, MD, ASDIN

President, Lifeline Vascular Access, Grosse Pointe Park, MI

7:45 am - 8:00 am Gerald Beathard Annual State of the Art LectureChanging Times: Challenges and Opportunities in the Current Economic Climate Robert Provenzano, MD, FACP, FASN, Vice President of Medical Affairs, DaVita, Detroit, MI

8:00 am - 9:00 am Economics of Vascular AccessModerator: Anil Agarwal, MD, FACP, FASN, FNKF

Passing the Buck? New Payment Structure and Their Impact on Access Reimbursement Timothy A. Pflederer, MD, Renal Intervention Center, Morton, IL

Declining Reimbursement and the Outpatient Access Center Model: An Update - Aris Q. Urbanes, MD

Hospital Based Access Care: Are We Coming Full Circle? Timothy A. Pflederer, MD

Freestanding vs. Hospital Outpatient Access Center: How Do They Compare? - Gerald Beathard, MD, PhD, FASN, Lifeline Vascular Access, Houston, TX

9:00 am - 9:45 am Practical Matters: Strategies to Weather the Change in Outpatient Access Care Moderators: Tushar Vachharajani, MD, FASN, FACP and Timothy A. Pflederer, MD

Cost Saving Techniques for an Outpatient Center: From Devices to Needles - Jeffrey Hoggard, MD, FACP, FASN, Capital Nephrology Associates, PA, Raleigh, NC

Negotiating with Vendors: Advice for the Little Guy Eric Ladenheim, MBA, MD, Ladenheim Dialysis Access Centers, Fresno, CA

Maximizing�the�Efficiency�of�Your�Center:�Operational�Approaches - Kaveh Kian, MD, MRCP, Denver Nephrologists, PC, Denver, CO

9:45 am - 10:00 am Point/Counterpoint - Access Selection Moderator: Micah Chan, MD, MPH, FACP

Access Selection in the Context of ESRD Network Mandates vs. What About the Patient’s Best Interest?Lawrence M. Spergel, MD, Dialysis Management Medical Group, Sonoma, CA and Anil Agarwal, MD, FACP, FASN, FNKF, The Ohio State University, Columbus, OH

PHOENIX, AZ

ASDIN Scientific Meeting Schedule

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org 5

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PHOENIX, AZ

ASDIN Scientific Meeting Schedule

10:00 am - 10:20 am Break (within Exhibit Hall)

10:20 am - 11:20 am Topics and Controversies in AV Fistula CreationModerators: David Fox, MD, FACS and Jeffrey Hoggard, MD, FACP, FASN

Dual Access in ESRD Patients Undergoing RRT Transition Matthew J. Oliver, MD, MSH, FRCP(C), Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON

An AVF Should be Attempted in the Patient with PAD andHistory of Steal vs. Don’t Bother: Place a Tapered AVG Marc Glickman, MD, FACS, Sentara Heart Hospital, Norfolk, VA and Larry A. Scher, MD, Montefiore Medical Center, Bronx, NY

Vascular Access Creation/Revision Under General or Regional Anesthesia vs. Vascular Access Creation/Revision Performed Using Local Anesthesia Should be the Standard David Fox, MD, FACS and Rick Mishler, MD, FACP, Arizona Kidney and Hypertension Disease Center, Phoenix, AZ

11:20 am - 11:55 am Controversies in Fistula Maturation Moderators: Haimanot Wasse, MD, MPH, FASN and Abigail Falk, MD, FSIR

When is an AVF Mature? Longitudinal Assessment of AVF With Ultrasound - Sandra Donnelly, MD, University of Toronto, Toronto, ON

Collateral Side Branches: Occlusion and Ligation Work vs. Collateral Side Branches: Don’t Occlude or Ligate Jeffrey H. Lawson, MD, PhD, Duke University School of Medicine, Durham, NC and Larry A. Scher, MD

11:55 am - 1:00 pm Lunch (within Exhibit Hall)

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org6

NON-PHYSICIAN/ASSOCIATES BREAKOUT SESSIONS

SATURDAY FEBRUARY 22ND 10:20 am - 12:00 noon

Associate Membership is the fastest growing segment of ASDIN! Join your physician team at this year’s Annual Scientific Meeting, where you can hear the latest in scientific findings and treatment advances as well as network with your colleagues from centers across the country. In addition to offering CE credit for the main meeting general sessions, ASDIN also offers special programing for our Associates.

Share this information with others on your team and represent your center! This is a great opportunity to work closely outside of the procedure room with your physicians and talk about strategic directions for your facility.

Moderators: Kevin Graham, MBA, LVN, CHDN, CASC, FACMPE, Lifeline Vascular Access, College Station, TX and James Michael Moore, RT(R)(CV), Lifeline Vascular Access, Fairmont, WV

Sterilization - Resources, Tools, & Staff Competency Ralph McCardle, RT(R), Lifeline Vascular Access, Morgantown, WV

Monitoring the Conscious Sedation Patient & Managing Through Recovery Monet Carnahan, RN, Fresenius Medical Care, Nashville, TN

Adverse Events in the Access Center - Management & Follow-up Jill Humes, BSN, RN, Renal Intervention Center, Morton, IL

Venous Ablation in the Access Center Leslie Enfinger, NP, Albany Vascular Specialist Center, Albany, GA

Contrast Media - Management & Considerations Melissa Hicks, RT (R) (VI) (ARRT), University of Louisville Hospital Interventional Nephrology Center, Louisville, KY

Benefits�of�PACS�in�an�Access�Center Richard Taylor, ScImage, Los Altos, CA

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PHOENIX, AZ

ASDIN Scientific Meeting Schedule

1:00 pm - 2:00 pm Nuts and Bolts of Endovascular Interventions: How the Experts Do It Moderator: Aris Q. Urbanes, MD

Removing the Stuck Tunneled Catheter - Sanjay Misra, MD, Department of Radiology, Mayo Clinic, Rochester, MN

How Do I Declot a HeRO Device? - Vandana Dua Niyyar, MD, FASN, Emory University, Atlanta, GA

Retrieving the Migrating Stent - Abigail Falk, MD, FSIR, American Access Care, New York, NY

Dealing with Venous Rupture - Theodore F. Saad, MD, Nephrology Associates, PA, Newark, DE

2:00 pm - 2:30 pm Management of Thrombosed and Infected AccessModerators: Dirk Hentschel, MD and Jeffrey Hoggard, MD, FACP, FASN

AVF: Thrombectomy of the Immature vs. the Mature AVF Gerald Beathard, MD, PhD, FASNManagement of the Infected AVG - Marc Glickman, MD, FACS

2:30 pm - 2:45 pm ASDIN Awards Presentation

2:45 pm - 3:10 pm Break (within Exhibit Hall)

3:10 pm - 4:15 pm Technology Update: Renal Sympathetic Denervation for Resistant HypertensionModerators: Kenneth Abreo, MD and Prabir Roy-Chaudhury, MD, PhD

Rationale,�Patient�Profile�and�Application�in�CKD�Patients� Micah Chan, MD, MPH, FACP, University of Wisconsin, Madison, WI

Renal Denervation is a Tool in the Toolbox for Those Who Routinely Manage All Hypertension - The Case for IN Alexander S. Yevzlin, MD, University of Wisconsin, Madison, WI

Renal Denervation is a Specialized Intervention with Unique�Profile�of�Risks�-�The�Case�for�IR - Sanjay Misra, MD

Renal Denervation - the Case for Interventional Cardiology John C. Gurley, MD, University of Kentucky, Lexington, KY

Technology Update - Panel Discussion - Micah Chan, MD, MPH, FACP /Alexander S. Yevzlin, MD/Sanjay Misra, MD/ John C. Gurley, MD

4:20 pm - 5:05 pm Breakout Programming

Renal Denervation - Indications and Technique Micah Chan, MD, MPH, FACP

Peripheral Arterial Intervention - Sanjay Misra, MD

5:15 pm - 6:00 pm Abstract Presentations Moderators: Amy Dwyer, MD and Jamie Ross, MD

6:00 pm - 6:30 pm ASDIN Business Meeting

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org 7

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PHOENIX, AZ

ASDIN Scientific Meeting Schedule

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org8

Sunday, February 23, 20147:00 am - 7:30 am Breakfast (within Exhibit Hall)

7:00 am - 10:30 am Exhibits Open

7:00 am – 12:15 pm Registration

7:30 am - 8:15 am Advanced Techniques Moderators: George Nassar, MD and Alexander S. Yevzlin, MD

Trans-Radial Access Intervention Kevin “Chaim” Herman, MD, Interventional Institute, Holy Name Medical Center, Teaneck, NJ

“Inside-Out” Recanalization of Central Vein Obstruction John C. Gurley, MD

Percutaneous Renal Biopsy in the Outpatient Setting Ivan Maya, MD, FACP, Nephrology Associates of Central Florida, Lake Mary, FL

7:30 am - 8:30 am Video Session Moderator: Yael Vin, MD, MPH

8:15 am - 8:30 am Abstract Awards

8:30 am - 10:00 am Issues in Dialysis Access Management Moderators: Marc Glickman, MD and Theodore F. Saad, MD

Conscious Sedation in the Outpatient Center: Use Anesthesiology vs. We Can Do it Ourselves - Gerald Beathard, MD, PhD, FASN and Arif Asif, MD, FASN, FNKF, Albany Medical Center, Albany, NY

Basilic Vein Transpositions are Always the Best Option in the Obese vs. Grafts are Better in the Obese David Fox, MD, FASN and Jeffrey H. Lawson, MD, PhD

In Vitro Models of Long-Term Catheter Use Thomas Vesely, MD, Vascular Access Services, LLS, St. Louis, MO

Buttonhole Technique - Sandra Donnelly, MD

10:00 am - 10:30 am Break (within Exhibit Hall)

10:30 am - 11:30 am Trials Update Moderators: Arif Asif, MD, FASN, FNKF and Vandana Dua Niyyar, MD, FASN

Update on the REVISE Trial -Thomas Vesely, MD

Update on the RESCUE Trial - Alexander S. Yevzlin, MD

Update on the RENOVA Trial -Theodore F. Saad, MD

Update on the Hemodialysis Fistula Maturation Study Prabir Roy-Chaudhury, MD, PhD, University of Cincinnati, Cincinnati, OH

11:30 am - 12:00 noon Topics in Peritoneal Dialysis Moderators: Ivan Maya, MD, FACP and Steven Wu, MD

Does PD Catheter Placement by IN Increase PD Cather Use in ESRD? - Matthew J. Oliver, MD, MSH, FRCP(C)

Troubleshooting the Dysfunctional PD Catheter Stephen Ash, MD, FACP, Hemocleanse, Lafayette, IN

PD Catheter Placement in Urgent and Emergent Peritoneal Dialysis - Bharat Sachdeva, MD, LSU Health Sciences Center, Shreveport, LA

Closing Remarks and Adjournment

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PHOENIX, AZ

Additional Meeting Information

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org 9

Onsite Registration/Check-inYou may pick up your badge and other registration materials, or register on-site at the Scientific Meeting Registration Desk located in the Foyer (outside the Grand Canyon Ballroom) during these times. Friday, February 21 7:00 am – 10:00 am* Friday, February 21 3:00 pm – 7:00 pm Saturday, February 22 7:00 am – 4:00 pm Sunday, February 23 7:00 am – 12:15 pm

*Special registration for Pre-Course Programs only

Exhibit Hall InformationExhibit Hall will be open the following hours: Friday, February 21 5:30 pm – 7:00pm Saturday, February 22 7:00 am – 3:30 pm Sunday, February 23 7:00 am – 10:30 am

Representatives from a wide range of companies will be available to update participants on current and future products and services during dedicated Exhibit Hall hours.

Meals• Friday: Complimentary Opening Reception in the Exhibit

Hall from 5:30 pm - 7:00 pm• Saturday: Complimentary continental breakfast, two

refreshment breaks and boxed lunch in the Exhibit Hall• Sunday: Complimentary breakfast & refreshment break

in the Exhibit Hall

VideosASDIN will host our first-ever Video Podium Presentation on Sunday, February 23 from 7:30 am – 8:30 am. Dr. Yael Vin will moderate the session. For videos that do not make the podium, we will be continuing our video presentations in the Grand Canyon Foyer on Saturday, February 22 and Sunday, February 23. More information on the Call for Videos may be found on the ASDIN website – www.asdin.org.

AbstractsPoster presentations will take place within the Exhibit Hall on Saturday, February 22. Oral abstract presentations will take place on Saturday, February 22 from 5:15 pm – 6:00 pm.

Additional InformationVisit www.asdin.org for up-to-date program information. For more information, please contact the ASDIN office at 601-924-2220. Program updates and other pertinent information will be posted on the ASDIN website periodically.

Continuing Education and CMEVisit the ASDIN website or call ASDIN for the most up-to-date CME and Continuing Education information.

CE for Nurses This continuing nursing offering is provided by the American Society of Diagnostic and Interventional Nephrology. Provider approved by the California Board of Registered Nursing, Provider Number CEP15468 for a maximum of 10.75 contact hours. One contact hour equals one hour of program attendance.

Scan code above with your smart phone using any free downloadable QR Reader app to go directly to the ASDIN Scientific Meeting Website

FIND US ON FACEBOOK:

ASDIN

FOLLOW US ON TWITTER:

@ASDINNEWS

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Meeting Registration ONLY $425 Member – Physicians $675 Non-Member – Physicians $250 Member – Associates or Fellows

Advanced Techniques Pre-Course ONLY (2/21) $300 Member $425 Non-Member

Administrator/Manager Pre-Course ONLY (2/21) $250 Member $300 Non-Member

COMBINED – Meeting &Advanced Techniques Pre-Course $725 Member – Physicians $550 Member – Fellows/Associates $975 Non-Member – Physicians $675 Non-Member – Fellows/Associates

COMBINED – Meeting & Administrator Pre-Course $350 Member $475 Non-Member

RegistrationGo to www.asdin.org to register online or to download a registration form. Regular registration rates are valid only through January 24, 2014.

Late RegistrationA $75 late fee will apply after January 24, 2014 including on-site registration.

Refund PolicyTo receive a full refund, cancellations for the meeting must be received in writing on or before January 24, 2014. After that date, no refunds will be granted.

Meeting Accommodations

The JW Marriott Desert Ridge Resort & Spa, 5350 East Marriott Drive in Phoenix, AZ is the meeting headquarters. The desert mountain resort has Arizona’s largest ballroom, a pampering spa, outstanding restaurants and championship golf.

Special ASDIN Group Rates: $240 for single/double occupancy; $20 each additional person. Local and state taxes and occupancy rates apply.

To make reservations, call the JW Marriott at 1-800-835-6206 and mention ASDIN as group code. Or, reserve your room online through the conference page on the ASDIN website – www.asdin.org.

The ASDIN discount is available until 5 pm CST on January 29, 2014 or until all rooms are sold, whichever is earlier. After January 29, 2014, rates and availability are at the discretion of the hotel. Rooms are also available at the discounted rate three days pre and post event dates based upon availability.

PHOENIX, AZ

Meeting Registration/Accommodations

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org10

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Full Name___________________________________________

Credentials__________________________________________

NPI # (Physician only)__________________________________

Preferred First Name for Badge__________________________

Company Name_______________________________________

Title_________________________________________________

Address_____________________________________________

City________________________________________________

State/Province_________________________________________

ZIP/Postal Code_______________________________________

Country (if not U.S.)___________________________________

Phone_______________________________________________

Fax_________________________________________________

Email________________________________________________ Please indicate primary specialty affiliation: Interventional Nephrologist Non-Interventional Nephrologist Interventional Radiologist Surgeon Other (please specify)_________________________

Primary reason for meeting attendance? Location Collegial Networking Exhibits Value of registration fee CME Overall topics and faculty Other (please specify)_________________________

Practice Setting (check all that apply) Hospital-based Access Center Ambulatory Surgery Center Hospital Free-standing Access Center University-based Access Center Other (please specify) ______________________

Is this your first time attending an ASDIN Meeting?

Yes No ASDIN Exhibitors will be utilizing lead retrieval software to better track their interaction with our ASDIN attendees. Each Scientific Meeting registrant's badge will include a unique 8-digit ID number on the badge. When this number is provided to an exhibitor with the iLeads software, your name, address, phone number and email will be captured by the software. In addition, each attendee who provides his 8-digit ID number to an exhibitor will receive an email following the meeting which will outline the booths that they visited.

To opt out of this program, please mark check box

$425 Member – Physicians $675 Non-Member – Physicians $250 Member – Associates or Fellows $375 Non-Member – Associates or Fellows

$300 Member $425 Non-Member

$725 Member – Physicians $550 Member – Associates or Fellows $975 Non-Member – Physicians $675 Non-Member – Associates or Fellows

$250 Member $300 Non-Member

$350 Member $475 Non-Member Meal Preference: Check here if vegetarian lunch required $75 late fee applies after January 24, 2014

Total Payment: $____________

Check made payable to ASDIN

Credit Card: AMEX VISA MasterCard

Card #:___________________________________________________

Card Security Code:________ Exp. date (mm/yy):________________

Cardholder’s Name (printed):___________________________________

Signature:__________________________________________________

Billing Address:____________________________________________

City/St/Zip:_______________________________________________

Send completed form to: ASDIN 134 Fairmont Street, Suite B Clinton, MS 39056

Email: [email protected] Fax: 601-924-0720

For additional information: Phone: 601-924-2220 www.asdin.org

Please see ASDIN website for refund policy and

additional program information.

ASDIN and its designated agent(s) are expressly authorized and granted the right to photograph Registrant and to use photographs of Registrant for promotional materials related to ASDIN and/or the ASDIN Scientific Meeting. Please contact the ASDIN office to opt out of this photography release.

PHOENIX, AZ

Scientific Meeting Registration Form

American Society of Diagnostic & Interventional Nephrology • www.ASDIN.org 11