the usc advanced endoscopic courses sinus surgery & skull ... · dept. otolaryngology head...

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THE USC ADVANCED ENDOSCOPIC COURSES SINUS SURGERY & SKULL BASE SURGERY New Programs for 2016 February 25 & 26 USC Endoscopic Skull Base Course Lecture & Dissection Course ( 2 Days ) February 27 & 28 USC Advanced Sinus Course Lecture & Dissection Course ( 2 Days ) February 28 Frontal Sinus Master's Class Lecture with Prof. Wormald ( 1/2 Day ) Affiliated Faculty Naveen Bhandarkar, MD University of California Irvine (UCI) Christopher A Church, MD Loma Linda University Daniel F Kelly, MD Saint John's Health Center, Santa Monica Jivianne T Lee, MD University of California Los Angeles (UCLA) Gregory P Lekovic, MD, PhD St. Vincent Medical Center, Los Angeles Martin Hopp, MD, PhD Cedars-Sinai Medical Center (CSMC) Madison Richardson, MD, FACS Cedars-Sinai Medical Center (CSMC) Kristin Seiberling, MD Loma Linda University Jeffrey Suh, MD University of California Los Angeles (UCLA) Marilene B Wang, MD, FACS University of California Los Angeles (UCLA) Adam DeConde, MD University California San Diego (UCSD) John K Niparko, MD University of Southern California (USC) Uttam K Sinha, MD University of Southern California (USC) Paul H Toffel, MD, FACS University of Southern California (USC) USC Faculty Steven L Giannotta, MD University of Southern California (USC) John L Go, MD University of Southern California (USC) Eric J Kezirian, MD, MPH University of Southern California (USC) USC Course Directors Bozena B Wrobel, MD USC Caruso Dept of Otolaryngology University of Southern California Dale H Rice, MD, FACS USC Caruso Dept of Otolaryngology University of Southern California Gabriel Zada, MD USC Department of Neurosurgery University of Southern California Guests of Honor Peter J Wormald, MD, FRACS Professor and Chairman Adelaide University Adelaide, South Australia Heinz Stammberger, MD, (Hon) FRCS, FACS Professor Emeritus (Former Chair) Medical University of Graz Graz, Austria Visiting Faculty Ricardo L Carrau, MD, FACS Ohio State University Philip G Chen, MD University of Texas, San Antonio, TX Alexander G Chiu, MD University of Arizona, Tucson, AZ Richard Douglas, MD, FRACS Auckland, New Zealand Daniel Prevedello, MD Ohio State University Alkis Psaltis, MBBS, PhD, FRACS Adelaide University, South Australia Rodney J Schlosser, MD Medical University of South Carolina Marc Tewfik, MD McGill University, Montreal, Canada W Alex Vandergrift III, MD Medical University of South Carolina Erik K Weitzel, MD Wilford Hall, San Antonio, TX Guests of Honor Peter J Wormald, MD, FRACS Heinz Stammberger, MD, (Hon) FRCS, FACS "REGISTER EARLY" Lab Dissection Limited to the First 28 Participants Registered!

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Page 1: The UsC advaNCed eNdosCoPiC CoUrses siNUs sUrgery & skUll ... · Dept. Otolaryngology Head & Neck Surgery at Adelaide and Flinders Universities in Aus-tralia. He is currently recognized

The UsC advaNCed eNdosCoPiC CoUrses siNUs sUrgery & skUll Base sUrgery

New Programs for 2016February 25 & 26 — USC Endoscopic Skull Base Course Lecture & Dissection Course ( 2 Days )

February 27 & 28 — USC Advanced Sinus Course Lecture & Dissection Course ( 2 Days )

February 28 — Frontal Sinus Master's Class Lecture with Prof. Wormald ( 1/2 Day )

Affiliated Faculty Naveen Bhandarkar, MD University of California Irvine (UCI) Christopher A Church, MD Loma Linda University Daniel F Kelly, MD Saint John's Health Center, Santa Monica Jivianne T Lee, MD University of California Los Angeles (UCLA) Gregory P Lekovic, MD, PhD St. Vincent Medical Center, Los Angeles Martin Hopp, MD, PhD Cedars-Sinai Medical Center (CSMC) Madison Richardson, MD, FACS Cedars-Sinai Medical Center (CSMC) Kristin Seiberling, MD Loma Linda University Jeffrey Suh, MD University of California Los Angeles (UCLA) Marilene B Wang, MD, FACS University of California Los Angeles (UCLA) Adam DeConde, MD University California San Diego (UCSD)

John K Niparko, MD University of Southern California (USC) Uttam K Sinha, MD University of Southern California (USC)Paul H Toffel, MD, FACS University of Southern California (USC)

USC Faculty Steven L Giannotta, MD University of Southern California (USC)John L Go, MD University of Southern California (USC)Eric J Kezirian, MD, MPH University of Southern California (USC)

USC Course DirectorsBozena B Wrobel, MD USC Caruso Dept of Otolaryngology University of Southern California

Dale H Rice, MD, FACS USC Caruso Dept of Otolaryngology University of Southern California

Gabriel Zada, MD USC Department of Neurosurgery University of Southern California

Guests of Honor

Peter J Wormald, MD, FRACS Professor and Chairman Adelaide University Adelaide, South Australia

Heinz Stammberger, MD, (Hon) FRCS, FACS Professor Emeritus (Former Chair) Medical University of Graz Graz, Austria

Visiting Faculty Ricardo L Carrau, MD, FACS Ohio State University Philip G Chen, MD University of Texas, San Antonio, TX Alexander G Chiu, MD University of Arizona, Tucson, AZ Richard Douglas, MD, FRACS Auckland, New Zealand Daniel Prevedello, MD Ohio State University Alkis Psaltis, MBBS, PhD, FRACS Adelaide University, South Australia

Rodney J Schlosser, MD Medical University of South Carolina Marc Tewfik, MD McGill University, Montreal, Canada W Alex Vandergrift III, MD Medical University of South Carolina Erik K Weitzel, MD Wilford Hall, San Antonio, TX

Guests of HonorPeter J Wormald, MD, FRACS Heinz Stammberger, MD, (Hon) FRCS, FACS

"REGISTER EARLY"Lab Dissection Limited to the First

28 Participants Registered!

Page 2: The UsC advaNCed eNdosCoPiC CoUrses siNUs sUrgery & skUll ... · Dept. Otolaryngology Head & Neck Surgery at Adelaide and Flinders Universities in Aus-tralia. He is currently recognized

Guests of HonorUpon completion of the course the participants should be able to:

Lectures• Identify the anatomy of the paranasal sinuses

• Discuss the surgical approaches to the frontal, sphenoid, ethmoid, and maxillary sinus disease

• Identify and manage potential complications of endoscopic sinus surgery

• Discuss the integrated surgical strategy for management of frontal sinus

• Identify advanced application of surgical nasal endoscopy for orbital surgery, endoscopic CSF leak repair, and endoscopic resection of sinus

and skull-base tumors

Laboratory• Perform routine endoscopic sinus procedures:

maxillary antrostomy, total ethmoidectomy, sphenoidotomy, frontal sinusotomy

• Discuss and identify the need for navigation and powered instrumentation in endoscopic sinus surgery.

• Define the rationale and technique for endoscopic frontal sinusotomy and extended approach to frontal sinus – Modified Endoscopic Lothrop procedure

• Perform frontal and maxillary sinus trephination

• Perform advanced endoscopic approaches: anterior skull base, pituitary, anterior cranial fossa, and clivus

Peter John Wormald, MD, FRACS Professor PJ Wormald is Chairman of the Dept. Otolaryngology Head & Neck Surgery at Adelaide and Flinders Universities in Aus-tralia. He is currently recognized as a world leader in Sino-Nasal Disorders, FESS, and endoscopic Skull-Base Surgery. His medical practice and research interests are devoted to rhinology and include the role of the immune system and biofilms in the pathogenesis of chronic rhinosinusitis. He is also involved in development of new clinical treatments and surgery for sino-nasal disorders. He has developed an animal model for eosinophilic sinusitis, to study various aspects of the disorder.

Prof. Wormald is frequently an invited key-note speaker to medical conferences on Sino-Nasal Disorders and Endoscopic Skull-Base Surgery. He is known to be an exceptional lecturer and teacher.

Prof. Wormald has authored 9 books, 26 chapters, and over 290 peer-reviewed articles. In 2005, he authored a best-selling textbook on FESS - Endoscopic Sinus Surgery - Anatomy, 3-D Recon-struction, and Surgical Technique (translated into multiple lan-guages). This textbook has been published in a 2nd & 3rd Editions (2013). Prof. Worlmald has particular teaching interests in the Anatomy of the Sinuses, Frontal Sinus Surgery, and Endoscopic Skull-Base Surgery.

The Research Study Club of Los Angeles designates these live activities for the following AMA PRA Category 1 Credit(s)™

USC Advanced Endoscopic Sinus Surgery Course 18 (Hr) AMA PRA Category 1 Credits™

USC Endoscopic Skull Base Surgery Course 18 (Hr) AMA PRA Category 1 Credits™

Frontal Sinus Master Class 3 (Hr) AMA PRA Category 1 Credits™

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Heinz Stammberger, MD, (Hon) FRCS, FACS Professor Stammberger is the Professor Emeritus (former Chair) of the Department Otolaryngology Head & Neck Surgery at the Medical University of Graz in Austria. He is well-known for his pioneering work with Dr Messerklinger in endoscopic sinus surgery in 1960s and 1970s. He first introduced the tech-niques of endoscopic sinus surgery to Otolar-yngology. In 1991, Prof Stammberger wrote a definitive textbook, Functional Endoscopic Sinus Surgery: The Messerklinger Technique, that has been used by generations of Rhinologists to learn the surgical techniques of Endoscopic Sinus Surgery. He fur-ther developed an interdisciplinary program of minimally invasive trans-nasal skull base surgery (Endoscopic Rhino-Neurosurgery) with the Dept of Neurosurgery at the Medical University of Graz. Today, the “Graz Group” is internationally known in endoscopic Skull Base Surgery as a ”Center of Excellence”.

Prof Stammberger has organized numerous sinus surgery dis-sections courses. He is an exceptional lecturer and teacher, and frequently is invited as a key-note speaker at international confer-ences. He has authored numerous peer-review articles and books. Prof Stammberger is dedicated to advancing the surgical frontiers of both Endoscopic Sinus Surgery and Skull Base Surgery.

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6:30 am Registration and Continental Breakfast with Exhibitors (1 hour)7:25 am Welcome - Bozena B Wrobel, MD and Gabriel Zada, MD

7:30 am Radiology CT/MRI of Parasellar and Anterior Skull Base Pathology.................................................................................John Go, MD7:50 am Preparing the Skull Base for Craniofacial Resection (Lothrop, Ethmoidal Ligation etc).....................................Richard Douglas, MD8:05 am Endoscopic Rhino-Neurosurgery: Pituitary, Clivus, Skull Base and Beyond......................................................Heinz Stammberger, MD8:30 am Endoscopic Skull Base Surgery - Principles and Sinonasal Corridors....................................................................Ricardo Carrau, MD8:50 am Endoscopic Repair of CSF Leaks and Encephaloceles.............................................................................................Bozena Wrobel, MD9:05 am Spontaneous CSF Leaks Management.............................................................................................................................Alkis Psaltis, MD9:20 am Vascularized Flaps for Endoscopic Reconstruction of the Skull Base.......................................................................Ricardo Carrau, MD9:40 am Alternatives for Skull Base Closure...................................................................................................................................Marc Tewfik, MD9:55 am Coffee Break with Exhibitors (30 min)

10:25 am Endoscopic Approach to Pituitary and Sellar Tumors, Extended Approaches - Otolaryngologist's Perspective............Schlosser, MD10:45 am Anatomy of the Sphenoid and Lateral Sphenoid Wall. Anatomy and Surgery of the Pituitary Including Pituitary Translocation...........................................................Daniel Prevedello, MD11:15 am Fibro-Osseous Lesions: Possibilities and Limitations of Endoscopic Techniques............................................Heinz Stammberger, MD11:45 pm Endoscopic Approach to the Anterior Cranial Fossa Lesions....................................................................................Peter J Wormald, MD12:30 pm Extended Approaches to the Maxillary Sinus and Pterygopalatine Fossa..............................................................Alexander Chiu, MD12:50 pm Lunch with Exhibitors (1 hour)

1:50 pm 3-D Skull Base Anatomy.................................................................................................................................................Peter J Wormald, MD2:20 pm Endoscopic Approach to Tumors of the Infratemporal Fossa.....................................................................................Peter J Wormald, MD3:00 pm Paramedian Skull Base: Trans-Pterygoid Approaches................................................................................................Ricardo Carrau, MD3:30 pm Eustachian Tube, Postnasal Space and Nasopharyngeal Resection..........................................................................Schlosser, Vandergrift4:00 pm Clival Chordoma/Chondrosarcoma................................................................................................................................Gabriel Zada, MD4:20 pm Coffee/Tea Break with Exhibitors (30 min)

4:50 pm Craniopharyngiomas...........................................................................................................................................................Daniel Kelly, MD5:10 pm Expanded Endonasal Approaches and Posterior Cranial Fossa Lesions..............................................................Daniel Prevedello, MD5:55 pm Endoscopic Skull Base Surgery : Lesson Learned from Otolaryngologist and Neurosurgeon Perspective.........Schlosser, Vandergrift6:20 pm Managing Complications (including Carotid Injury) in Skull Base Surgery............................................................Peter J Wormald, MD6:50 pm Skull Base Lecture Course Adjourns

Thursday, February 25, 2016Harkness Lecture Hall – IGM Building – 2nd Floor

Friday, February 26, 2016 — Lab DissectionAnatomy Dissection Lab - IGM Building - Surgical Skills Lab (Lower Level)

Skull Base Surgery Course — Day 1: Lecture Course

Skull Base Surgery Course — Day 2: “Hands-On” Dissection Course

6:30 am Registration and Continental Breakfast with Exhibitors (1 hour)

7:30 am Prosection: Septal Flap/Inferior Turbinate Flap For Skull Base Reconstruction

7:50 am Prosection: Endoscopic Approach to the Anterior Cranial Fossa Modified Endoscopic Lothrop Procedure

8:40 am Prosection: Endoscopic Approach to the Pituitary

9:10 am Prosection: Endoscopic Approach to the Clivus, Cavernous Sinus, and ICA

9:40 am “Hands-On” Dissection with the Faculty. • Septal Flap/Inferior Turbinate Flap • Endoscopic Approach to Anterior Cranial Fossa • Modified Endoscopic Lothrop Procedure • Endoscopic Approach Pituitary, Cavernous Sinus, Clivus/ICA12:00 pm Lunch with Exhibitors (1 hour)

1:00 pm Prosection: Endoscopic Approach to Posterior Cranial Fossa The "4 Handed" Technique

1:45 pm Prosection: Endoscopic Approach to Infratemporal Fossa, Pterygopalatine Fossa, Orbital Apex

2:45 pm "Hands-On" Dissection with the Faculty • Endoscopic Approach to Infratemporal Fossa, Pterygopalatine Fossa, Orbital Apex • Endoscopic Medial Maxillectomy • Endoscopic Approach to Posterior Cranial Fossa 4:00 pm Perfusion Model Vascular (Carotid Artery) Injury Skull Base - Gabriel Zada, MD

5:00 pm Skull Base Dissection Course Adjourns

Gabriel Zada, MDFriday - February 26, 2016

4:00 pm - 5:00 pm [1 Hr] Demo & "Hands On"

Perfusion Model Perfusion ModelVascular Injury Skull BaseVascular Injury Skull Base

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Advanced ESS Course — Day 1: Lecture CourseUsC advaNCed eNdosCoPiC

Saturday, February 27, 2016Aresty Auditorium – Harlyne Norris Research Tower (HNRT) (1st floor)

6:30 am Registration and Continental Breakfast with Exhibitors (1 hour)

7:25 am Welcome - Bozena B Wrobel, MD and Dale H Rice, MD

7:30 am What is a Cause of Chronic Rhinosinusitis (CRS)?..................................................................Richard Douglas, MD

7:45 am Role of Microbiome in CRS.............................................................................................................Alkis Psaltis, MD

8:00 am Last Frontiers of Research in CRS...............................................................................................Peter J Wormald, MD

8:20 am Medical Therapy for CRS..........................................................................................................Richard Douglas, MD

8:35 am Topical Therapies for Sinusitis..................................................................................................Rodney Schlosser, MD

8:55 am Optimizing Surgical Technique: Intraoperative Hemostasis......................................................Peter J Wormald, MD

9:10 am Does Nasal Obstruction (Surgery) Matter in Sleep Apnea?..........................................................Eric Kezirian, MD

9:30 am Learning FESS: The Lamella Principle. ...............................................................................Heinz Stammberger, MD

9:50 am Coffee Break with Exhibitors (30 min)

10:20 am 3-D Surgical Anatomy and Imaging of the Paranasal Sinuses.....................................................Peter J Wormald, MD

10:50 am Frontal Recess and Frontal Sinus - Surgical Approaches...........................................................Peter J Wormald, MD

11:30 am Modified Endoscopic Lothrop - Classic Technique.................................................................Bozena Wrobel, MD

11:50 am "Hand Lothrop" - A Different Approach to "Classic Draf 3" Procedure............................Rodney Schlosser, MD

12:05 pm Endoscopic Approaches to Frontal Sinus - Avoiding Routine "Drill Out" Procedures..........Heinz Stammberger, MD

12:25 pm Endoscopic Approaches to Sphenoid Sinus Pathology, Pituitary and Sellar Tumors. ................Ricardo Carrau, MD

12:50 pm Repair of the CSF Leak. ...........................................................................................................Alexander Chiu, MD

1:05 pm Management of JNA ( Juvenile Angiofibroma). ESPAL (Endoscopic Sphenopalatine Artery Ligation)..............................................................Ricardo Carrau, MD

1:30 pm Lunch with Exhibitors (1 hour)

2:30 pm Redefining Success After FESS...............................................................................................Rodney Schlosser, MD

2:45 pm What Leads to FESS Complications: A Case-Based Analysis..............................................Heinz Stammberger, MD

3:10 pm Severe Sinonasal Polyposis: Surgical Options.............................................................................Peter J Wormald, MD

3:30 pm Endoscopic Management of Sinonasal Neoplasm....................................................................Alexander Chiu, MD

3:55 pm Pediatric FESS.................................................................................................................................Alkis Psaltis, MD

4:10 pm Management of Superior, Middle and Inferior Turbinate........................................................Kristin Seiberling, MD

4:20 pm Early Post - Op Care.......................................................................................................................Marc Tewfik, MD

4:35 pm Break with Exhibitors (30 min)

5:05 pm Management of Severely Diseased Maxillary Sinus. Modified Medial Maxillectomy, Prelacrimal Approach....................................................................Alkis Psaltis, MD

5:25 pm Orbital and Optic Nerve Decompression................................................................................Heinz Stammberger, MD

5:50 pm Endoscopic DCR......................................................................................................................Richard Douglas, MD

6:05 pm Balloon Sinuplasty - Indications and Evidence - Panel Discussion......................Lee, DeConde, Hopp, Suh, MD

6:35 pm Lecture Course Adjourns

Page 5: The UsC advaNCed eNdosCoPiC CoUrses siNUs sUrgery & skUll ... · Dept. Otolaryngology Head & Neck Surgery at Adelaide and Flinders Universities in Aus-tralia. He is currently recognized

MEDTRONIC ENT STRYKER KARL STORZ

We also gratefully acknowledge significant contribution from:

Advanced ESS Course — Day 2: “Hands-On” Dissection Course

Major Sponsors

siNUs sUrgery CoUrse

LIMITED TO 28 PARTICIPANTS

Sunday, February 28, 2016 — Lab DissectionAnatomy Dissection Lab - IGM Building - Surgical Skills Lab (Lower Level)

Olympus Smith&Nephew

TEVAThieme

Xoran

AcclarentB3 Precision Medical TechnologiesEntellusFiagonFuel Medical

HemostasisIntersect ENTLaurimedNeil MedNico

7:00 am Registration and Continental Breakfast (1 hour)

8:00 am CT Scan Analysis & 3-D Reconstruction of Frontal Sinus

8:15 am Prosection followed by "Hands-On" Dissection with the Faculty • Endoscopic Maxillary Antrostomy • Frontal Recess and Frontal Sinus Dissection • Anterior and Posterior Ethmoidectomy • “Axillary Flap Technique” • Sphenoidotomy

10:30 am Prosection followed by "Hands-On" Dissection with the Faculty • Endoscopic Modified Lothrop Procedure • Frontal Sinus Trephination

1:00 pm Lunch (1 hour)

2:00 pm Prosection followed by "Hands-On" Dissection with the Faculty • Endoscopic Sphenopalatine Artery Ligation (ESPAL) • Endoscopic Medial Maxillectomy. • Maxillary Sinus Trephination

3:30 pm Prosection followed by "Hands-On" Dissection with the Faculty • Endoscopic DCR . • "Bath Plug Technique” for CSF Leak Repair • Endoscopic Orbital Decompression • Powered Inferior Turbinoplasty and Septoplasty • Optic Nerve Decompression • Lateral Canthotomy and Cantholysis. • Vidian Neurectomy

6:00 pm Advanced Endoscopic Sinus Surgery Dissection Course Adjourns

Page 6: The UsC advaNCed eNdosCoPiC CoUrses siNUs sUrgery & skUll ... · Dept. Otolaryngology Head & Neck Surgery at Adelaide and Flinders Universities in Aus-tralia. He is currently recognized

Registration General Information

Hotel InformationLangham Huntington Hotel & Spa Pasadena, CA 91106The Langham Huntington Hotel & Spa in beautiful Pasadena, is only a 15 minute drive from the USC Health Sciences Campus, and an ideal place to stay. For hotel reservations, contact the Langham Huntington Hotel at (626) 568-3900 and ask for the "USC Rate" if available. Visit the hotel's website and explore the hotel. http://pasadena.langhamhotels.com/en/

Feb 25, 26, 28 — Skull Base Lectures, All Lab Dissections and Master's ClassUSC Institute Genetic Medicine Building [IGM]2250 Alcazar Street, Los Angeles, CA 90033

• HARKNESS LECTURE HALLLectures for the USC Skull Base Course (Feb. 25) will be in the Harkness Lecture Hall at the Institute of Genetic Medicine.Frontal Sinus Master's Class (Feb 28, 11:00 am - 2:00 pm) will be in the Harkness Lecture Hall at the Institute of Genetic Medicine. Master Course planned around the Lunch Break concurrent with Sinus Surgery Hands-On Lab. Pre-Registration and Personal Computer Required.

• USC SURGICAL SKILLS CENTERAll "Hands-On" Lab Dissections (Feb 26 & 28) will be held at the USC Surgical Skills Center located in the lower level of the Institute of Genetic Medicine.

Feb 27 — Advanced Endoscopic Sinus Course LecturesHarlyne Norris Research Tower [HNRT]1450 Biggy Street, Los Angeles, CA 90089

• ARESTY AUDITORIUMLectures for the USC Advanced Endoscopic Sinus Course (Feb 27) will be in the Aresty Auditorium located in the Harlyne Norris Research Tower. The entrance to the ARESTY AUDITORIUM is on Biggy Street (street level) near the intersection with EastLake Ave.

ParkingParking is available at Institute of Genetic Medicine [IGM] Building at the Parking Area P2. The P2 Parking is located on Alcazar Street in the IGM Building at the North Entrance. The P2 Parking Fee is $12.00 per day.Parking is available at the Harlyne Norris Research Tower [HNRT] at the Visitor Entrance on Biggy Street Parking Structure (P6). The P6 Biggy Parking Structure is located on Biggy Street between Zonal and Eastlake Ave. The P6 Parking Fee is $12.00 per day.

Map of USC Health Sciences Campushttp://uscsinuscourse.com/pdf/2016_usc_map.pdf

Please, Register Online @www.uscsinuscourse.com

USC Endoscopic Skull Base CourseFebruary 25 - 26, 2016Physician Full Registration (2 Day Course - Lectures & Dissection lab) $ 1525

February 25 (only)Physician Lecture Only Registration (1 Day – Lecture Only) $ 325

USC Advanced Endoscopic Sinus CourseFebruary 27 - 28, 2016 Physician Full Registration (2 Day Course - Lectures & Dissection lab) $ 1525

February 27 (only)Physician Lecture Only Registration (1 Day – Lecture Only) $ 325

Frontal Sinus Master's ClassFebruary 28, 2016 Physician with Registration for Sinus or Skull Base Course (1/2 Day Course - Lecture Only) $ NC

February 28, 2016Physician without Registration in Sinus or Skull Base Course (1/2 Day Course – Lecture Only) $ 75

All Registrations includeDigital Syllabus, Continental Breakfast and Lunch each day

Registration ConfirmationsMAILed or FAX Registrations MUST BE CONFIRMED by us with an E-MAIL or FAX confirmation. If you have NOT RECEIVED a CONFIRMATION from us by E-MAIL or FAX, it would indicate that we have NOT received your registration. CALL and E-MAIL us IMMEDIATELY. PHONE: (323) 442-5579 E-MAIL: [email protected]

CancellationsCancellations received in writing before January 25, 2016 will be refunded less a $75 administration fee. Refunds will not be processed after January 25, 2016. FAX or E-MAIL cancellations to Ms. Jacqueline Jimenez at: FAX: (323) 442-2059 • E-MAIL [email protected]

USC Keck School of Medicine reserves the right to alter or cancel this program if necessary. In the event of postponement of this course, we will refund the registration. We are not responsible for any related costs, charges or expenses to participants including cancellation fees by airlines, travel agencies and hotels.Alternate Registration — FAX or Mail to:Ms. Jacqueline Jimenez, USC Caruso Dept of Otolaryngology1540 Alcazar Street, Suite 204-M Los Angeles, CA 90033FAX: (323) 442-2059 • PHONE: (323) 442-5579

"REGISTER EARLY"Lab Dissection Limited to the First

28 Participants Registered!

Page 7: The UsC advaNCed eNdosCoPiC CoUrses siNUs sUrgery & skUll ... · Dept. Otolaryngology Head & Neck Surgery at Adelaide and Flinders Universities in Aus-tralia. He is currently recognized

THE USC ADVANCED ENDOSCOPIC SURGERY COURSES

Register Early: Space is limited in the dissection lab to 28 participants only!All Registrations include: Digital Syllabus, Continental Breakfast and Lunch each day

Registration Form

EASY ON-LINE REGISTRATION

Check the boxes below to indicate the Endoscopic Courses for your registration:

February 25 – 26, 2016 — Endoscopic Skull Base Surgery Course Physician Full Registration (2 Day Course - Lectures & Dissection Lab) [Feb 25 & 26] . . . . . . . . . . . . . . . . . . . . . . . $ 1525 Physician Lecture Only Registration (1 Day Lecture Course Only) [Feb 25 only] . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 325

February 27 – 28, 2016 — Advanced Endoscopic Sinus Surgery Course Physician Full Registration (2 Day Course - Lectures & Dissection Lab) [Feb 27 & 28]: . . . . . . . . . . . . . . . . . . . . . . . $ 1525 Physician Lecture Only Registration (1 Day Lecture Course Only) [Feb 27 only]: . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 325

February 28, 2016 — Frontal Sinus Master's Class (11:00 am - 2:00 pm) Physician with Registration for Sinus or Skull Base Surgery Course (1/2 Day Course - Lecture Only) [Feb 28] . . . . . $ NC Physician without Registration for Sinus or Skull Base Surgery Course (1/2 Day Course - Lecture Only) [Feb 28] . . . $ 75

Alternate Registration: Mail or FAX the following registration form below

First Name _____________________________________________________________________________________________

Last Name ______________________________________________________________________________________________

Degree _________________________________________________________________________________________________

Specialty _______________________________________________________________________________________________

Address ________________________________________________________________________________________________

City ___________________________________________________________________________________________________

State ________________________________________________Zip Code _________________________________________

Phone Number ________________________________________Cell Phone ________________________________________

E-mail _______________________________________________Fax ______________________________________________

METHOD OF PAYMENT: Discount On-Line Code (if applicable): ________________

I enclose the check payable to USC Keck School of Medicine in the amount of: $ _________________________________ Please charge my credit card: VISA Mastercard Discover in the amount of: $ __________________________

Credit Card Number ___________________________________ Expiration Date: __________________________________

Signature ____________________________________________

By signing, I authorize the USC Keck School of Medicine to charge my credit card.

Please mail or fax the registration form with the payment to:Ms. Jacqueline JimenezUSC Caruso Department of Otolaryngology 1540 Alcazar Street, Suite 204-MLos Angeles, CA 90033 FAX: 323-442-2059 • PHONE: 323-442-5579

Questions? E-MAIL: [email protected]

ALLDISSECTION LABS LIMITED

FIRST 28 PARTICIPANTS

Please, Register Online: www.uscsinuscourse.com

Master's ClassLimited Registration