Attendee Form
“Current Topics in Safety, Health & Environmental Issues”
The 2016 Chesapeake Educational Seminar
www.jhsph.edu/erc/chespdc.html
Presented by
The American Society of Safety Engineers Chesapeake Chapter and
The American Industrial Hygiene Association Chesapeake Section together with
The Johns Hopkins Education and Research Center for Occupational Safety and Health
Thursday, April 21, 2016
Johns Hopkins University Applied Physics Laboratory Kossiakoff Center, Laurel, Maryland
Check-in/On-site Registration opens at 7:30 a.m. Conference will begin promptly at 8:30 am and conclude at 4:15 pm
Morning Keynote
"Maryland's Climate Change CommissionGoals to Prepare for and Mitigate
Environmental Consequences
from Climate Change"
The Honorable Ben Grumbles, JD
Secretary of the Maryland Department of the
Environment
Lunch Keynote
"The Safety and Health Profession-Where are we going in the Future"
Dan Anna, PhD, CIH, CSP
President of the American Industrial
Hygiene Association
Afternoon Keynote
“Biocontainment Isolation
Operations at Johns Hopkins”
Brian Garibaldi, MD, MPH
Fellow, Pulmonary and Critical Care Medicine,
Johns Hopkins University School of Medicine
Technical Sessions in Safety, Industrial Hygiene and Occupational Health
Safe Lifting Practices
Alan K. Sokoloff, D.A.C.B.S.P.
Founder, Owner and Clinic Director
Yalich Clinic
Occupational Asthma
Hung Cheung, MD, MPH
Founder and President
Cogency Medical
Impact of Prescription Drugs on Workers
Marianne Cloeren, MD, MPH
Senior Medical Director
Managed Care Advisors
Legal & Ethical Aspects of Safety and Health
Audits
Adele Abrahms, Esq., CMSP
President and Owner
Law Office of Adele L. Abrams PC
Biological Monitoring BEIs
Aaron Tustin, MD, MPH
OEM Resident, Johns Hopkins Bloomberg
School of Public Health
The Aging Worker
Jeremy S. Barron, MD
Director of Ambulatory Care Services,
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Demolition Safety
H. Allen Bennett, CIH, CSP
Senior Scientist, Environmental Health &
Safety
KCI Technologies, Inc
Vapor Intrusion
David Mickunas, BS
Chemist
U.S. EPA/Environmental Response Team
Psychological & Crisis Response
Dan Barnett, MD, MPH
Associate Professor, Environmental Health
Sciences, Johns Hopkins Bloomberg School
of Public Health
Vendors, Exhibitors, and Networking Opportunities
Continental Breakfast, Refreshments, and Lunch Included
Early Bird Registration deadline is April 7, 2016
Only $95.00 for Individuals and Only $75.00 Each for Groups of 5 or More
Walk-in Registration: $125.00 for Individuals and for Groups
Registration Form on s or download a copy at http://www.jhsph.edu/erc/chespdc.html
Professional Recertification Points (COC, CM) have been requested.
For more information please contact AIHA: [email protected] or ASSE: [email protected]
2016 Chesapeake Educational Seminar Attendee Registration Form
Early Bird Registration (through April 7, 2016)
Note: Your registration form must be postmarked by April 1 if mailed, or faxed by 5:00PM on April 7. Please keep your fax
transmission receipt.
Individual 1 to 4 attendees; $95.00 each
Group 5 or more attendees from the same organization, one transaction; $75.00 each
Walk-in Registration
Individual and Groups day of registration; $125.00 each
Full-time Student Registration
Individual
$20.00 each
Company Name:
Address, City State Zip:
Attendee(s) Name (for name tags):
Phone:
Email (for your confirmation and receipt):
Please do not distribute my contact information to the exhibitors of this conference.
Payment Info
Check: Make checks payable to “Johns Hopkins University” (Please do not send cash)
Mail completed form and check to: ATTN: Keith Choi, Johns Hopkins Bloomberg School of Public Health, 615 N.
Wolfe St., Room W7517, Baltimore, MD 21205
Credit Card (circle one): Visa
MasterCard
Discover
AMEX
Name on Card (print) _
Signature
_ Exp. Date
Card Number
Fax completed form to Keith Choi on the JHU ERC secure fax line: 410- 614- 4986 or
Email completed form to Keith Choi at [email protected] or Mail to the address above.
Total Attendees:
Total Amount Enclosed or Charged: $
Thank you!
Note: Chesapeake ASSE and Chesapeake AIHA reserve the right to substitute topics and speakers for this Educational Seminar. Chesapeake ASSE
and Chesapeake AIHA reserve the right to cancel this Educational Seminar up to 3/23/15. If the Johns Hopkins Applied Physics Lab Kossiakoff Center
is closed for any reason on 4/21/16, this Educational Seminar will be canceled. For facility information, go to www.jhuapl.edu.
A $25.00 cancellation fee will be assessed on all registration cancellations received after 5:00 PM on Friday April 14, 2016. A $50.00 cancellation fee
will be assessed on all registration cancellations received after 5:00 PM on Friday, April 14, 2016. Refunds will not be issued for “no show"
registrants. Refunds, adjusted for cancellation fees, will be issued within 60 days after this Educational Seminar.