The Family Medicine Foundation of West Virginia
29th ANNUAL JOSÉ I. RICARD, MD
FAMILY MEDICINE & SPORTS MEDICINE CONFERENCE
Pullman Plaza Hotel - Huntington, West Virginia
November 12 - 15, 2015
CONFERENCE ACCREDITATION
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This live activity, the 29th Annual José I. Ricard, MD Family
Medicine & Sports Medicine Conference, with a beginning date of
11/12/2015, has been reviewed and is acceptable for up to 26.50
Prescribed credit(s) by the American Academy of Family
Physicians. Physicians should claim only the credit commensurate
with the extent of their participation in the activity. AAFP Prescribed
credit is accepted by the American Medical Association as
equivalent to AMA PRA Category 1 for the AMA Physicians
Recognition Award. When applying for AMA PRA Prescribed hours,
earned hours must be reported as Prescribed hours, not Category 1.
Approved for 26.3 hours of continuing education (which includes
13.6 hours of pharmacology) by the American Nurses Credentialing
Center (ANCC) and West Virginia Nurses Association.
Approved for 26.50 credits of AOA Category 2-A continuing
education by the American Osteopathic Association.
Accepted for Physician Assistant CE credit.
Approved by the West Virginia Board of Examiners for Registered
Professional Nurses. Provider # WV1996-0101RN.
The Sunday program is approved for 7.25 hours of continuing
education by the West Virginia Board of Chiropractic.
Approved for 26.50 contact hours by the West Virginia Board of
Physical Therapy. Approval # FMF-F15-01. Approval of this course
does not necessarily imply that the West Virginia Board of Physical
Therapy supports the views of the presenter or sponsor.
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Approved for 26.5 Category-1 contact hours by the Kentucky Physical
Therapy Association. Approval # 40-15-KPTA.
Approved for 21.00 hours by the Kentucky Board of Licensure for
Occupational Therapy.
Approved for 26.75 hours of continuing education by the Ohio
Physical Therapy Association. Approval # 15S1595.
Approved for 24.25 hours by the Occupational Therapy (#150412)
and Athletic Trainers (#150445) Sections of the Ohio Occupational
Therapy, Physical Therapy, Athletic Trainers Board.
Approved for 26.50 hours by the Board of Certification for Certified
Athletic Trainers. Approved Provider # P657. Approval for 10
Evidence Based Practice (EBP) hours is currently pending.
Approved for 14.00 General Hours of CPE credit by the West Virginia
Board of Pharmacy.
Approved for 5.5 hours by the State of West Virginia Board of
Examiners of Psychologists.
SPONSORS: Family Medicine Foundation of West Virginia,
Marshall University’s Joan C. Edwards School of Medicine,
Marshall Health - Family Medicine, Division of Sports Medicine
COURSE DESCRIPTION: The educational topics included in
this Conference will provide health care professionals with an
update on the following medical conditions:
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Drug Diversion and Best Practice Prescribing
of Controlled Substances
Pervasive Developmental Disorders
Infertility and Reproductive Medicine
Surgical Management of Breast Cancer
Breast Reconstruction
Dementia
Multidisciplinary Approach to Type 2 Diabetes
Oral Health for the Primary Care Provider
Influenza Antiviral Recommendations
Diabetes and the Athlete
Guidelines for Lung Cancer Screening
Avoiding Medical Malpractice Litigation
Overactive Bladder Management the Geriatric Patient
Treatment Options for Arthritic Hip
Conquering Obesity
Venous Disease
Hepatitis C
Harm Reduction Program
Surviving the Unexpected Night Out
Whitewater Medicine & Safety
Preparing for Foreign Travel and
Staying Healthy in Developing Countries
Manual Therapy for Spinal Conditions
Reaching At Risk Youth Through Athletics
Plant Based Diet and Nutritional Considerations for the Athlete
Exercise During Pregnancy
CONFERENCE OBJECTIVES: To provide regional health
care professionals with an update on the diagnosis and treatment of
commonly encountered medical problems. Conference attendees
will review current clinical concepts in core areas of Family
Medicine & Sports Medicine, acquire practical, clinical
information helpful in the diagnosis, treatment, and management of
medical problems, and enhance and advance knowledge, skills, and
professional performance, furthering excellence in health care.
PRE-CONFERENCE WORKSHOP
Thursday, November 12, 2015
“Drug Diversion and Best Practice Prescribing
of Controlled Substances”
Please join the Family Medicine Foundation of West
Virginia for a 3-hour “Drug Diversion Training and Best
Practice Prescribing of Controlled Substances” lecture, to
be held on Thursday, November 12, 2015, from 6:00 pm –
9:15 pm at the Pullman Plaza Hotel in Huntington, WV.
Our lecturer will be Jeannie Sperry, PhD, LP, ABPP, Pain
Psychologist and Clinical Director at the Mayo Clinic in
Rochester, MN, and previous Director of Behavior Science
Education and Director, Primary Care Psychology
Fellowship at the West Virginia University Department of
Family Medicine in Morgantown, WV.
This lecture will satisfy the CME/CE requirements set forth
by the West Virginia Legislature and appropriate licensing
boards for MDs, DOs, PAs, APRNs, pharmacists, RNs, and
LPNs, including recently mandated Naloxone training. This
program is required for each West Virginia licensee who
“prescribes, administers, or dispenses a controlled
substance.” The cost of the lecture is $90.00. Please
RSVP, as seating is limited; light dinner is included.
Learning Objectives:
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Drug diversion, including West Virginia statistics on
prescription drug abuse, misuse, and resulting deaths;
Epidemiology of chronic pain and misuse of opioids;
Indications for opioids in chronic pain treatment, including
general characteristics, toxicities, and drug interactions;
Initiation and ongoing management of chronic pain patients,
including treatment objectives/functional goals, monitoring
and periodic review, referrals, consultations, informed
consent, prescribing agreements, urine screens and pill counts,
patient education on safe use and storage/disposal of opioids,
discontinuation/termination due to lack of benefits or
increased risks, and documentation and medical records;
Examination of patient evaluation and risk assessment and
related tools, with proper usage/administration of Naloxone;
Identification of diversion and drug seeking tactics and
behaviors;
Best practice methods for working with drug seeking patients
and diversion, including new online resources;
Compliance with controlled substances laws and rules;
Registration with and use of the West Virginia Controlled
Substances Monitoring Program established in WV Code
Chapter 60A, Article 9;
Case study of a patient with chronic pain; and
Compliance with state and federal laws.
The Family Medicine Foundation of West
Virginia is proud to partner with the Claude
Worthington Benedum Foundation to develop
an effective and replicable model to manage
chronic pain medication use and abuse in West
Virginia, a state currently facing a prescription
drug abuse epidemic.
As part of this project, the Family Medicine
Foundation of West Virginia has agreed to collect,
analyze, and report on all narrative information,
clinical data, and feedback collected from health
care provider attendees. Please provide as much or
as little information as you feel comfortable with,
including your name, profession, address, phone
number, email, and more. Of course, please omit
protected patient health information in compliance
with HIPAA and other applicable rules and
regulations. All information submitted will be kept
strictly confidential. Thank you for your feedback
and interest in this project!
To get involved or submit information online, please visit
WWW.PAINMODEL.COM
At this site, you will be able to read more about the
project and submit information. The site will be
updated from time to time as the model evolves, so
please check back periodically.
Special thanks to:
MORNING SESSION
Friday, November 13, 2015
7:00 am Complimentary Blood Drawing and Chemistry Profile
For Registrants – 2nd Floor, Upper Mezzanine Area
Courtesy of CAMC LabWorks
7:00
Registration / Breakfast / Exhibit Visitation – 2nd Floor
7:50
“Welcome & Conference Overview”
Robert B. Walker, MD, MS, CIME
Program Chairman / Vice Chancellor of Health Sciences
West Virginia Higher Education Policy Commission
7:55
“Overview of Morning Topics”
Moderator – Matthew Christiansen, MD
Family Practice Resident
Marshall University, Joan C. Edwards School of Medicine
Huntington, WV
8:00
“Pervasive Developmental Disorders”
Kimberly Foley, PhD
Morgantown, WV
8:50
“Infertility and Reproductive Medicine”
Shon Rowan, MD
Morgantown, WV
9:40
Refreshment Break / Exhibit Visitation – 2nd Floor
10:00
“Updates on Surgical Management of Breast Cancer”
Mary T. Legenza, MD
Huntington, WV
10:50
“Aesthetic Breast Reconstruction”
Ben Moosavi, MD
Huntington, WV
12:05pm Lunch
AFTERNOON SESSION
Friday, November 13, 2015
12:45 pm “Welcome”
Steve Williams
Mayor of Huntington, WV
12:50
“Overview of Afternoon Topics”
Moderator – Jazab Ali Sheikh, MD
Family Practice Resident
Charleston Division
West Virginia University Family Medicine
Charleston, WV
1:00
“Dementia”
Cindy Pinson, MD
Huntington, WV
1:50
"Multidisciplinary Approach to Treatment of
Type 2 Diabetes"
Mathew Weimer, MD
Milton, WV
2:40
"Oral Health for the Primary Care Provider"
Dan Brody, DMD
Fort Gay, WV
Andrea Kelly, DDS
Huntington, WV
3:30
Refreshment Break / Exhibit Visitation – 2nd Floor
3:50
“Influenza Antiviral Recommendations”
Angela J.P. Campbell, MD, MPH
Atlanta, GA
5:30
Audience Question & Answer Session
5:45
Adjournment
Dinner Buffet
In loving memory of Dr. José I. Ricard
6:00 pm – 8:00 pm (by reservation only – only 200 guests)
Featuring the Lost Cause Band
Buffet sponsored by
MORNING SESSION
Saturday, November 14, 2015
7:00 am Complimentary Blood Drawing and Chemistry Profile
For Registrants – 2nd Floor, Upper Mezzanine Area
Courtesy of CAMC LabWorks
7:00
7:50
Refreshment Break / Exhibit Visitation – 2nd Floor
“Welcome”
Stephen M. Petrany, MD
Chairman, Family Medicine
Marshall Health
Huntington, WV
7:55
“Overview of Morning Topics”
Moderator – William Stephan Przybysz, MD
Family Practice Resident
Wheeling Family Practice Residency Program
Wheeling, WV
8:00
“Diabetes and the Athlete”
Frank Schwartz, MD, FACE
Athens, OH
8:50
“Why We Should Screen Certain Patients for
Lung Cancer”
Aneel A. Chowdhary, MD
Huntington, WV
9:40
Refreshment Break / Exhibit Visitation – 2nd Floor
10:00
“Avoiding Medical Malpractice”
David Myerberg, MD, JD
Morgantown, WV
10:50
“Overactive Bladder Management in the Geriatric Patient”
Joshua M. Lohri, DO
Charleston, WV
12:05 pm Lunch Buffet / Exhibit Visitation
Foyer Area & Grand Ballroom – 2nd Floor
AFTERNOON SESSION
Saturday, November 14, 2015
12:55 pm “Overview of Afternoon Topics”
Moderator – Andrew Berardinelli, MD
Family Practice Resident
Clarksburg Family Practice Residency Program
Clarksburg, WV
1:00
"Treatment Options for Arthritic Hip"
Alexander D. Rosenstein, MD
Charleston, WV
1:50
“Conquering Obesity”
Brandon Workman, MD
Beckley, WV
2:40
“Venous Disease”
Rickey L. Bradley, DO
Beckley, WV
3:30
Refreshment Break / Exhibit Visitation – 2nd Floor
3:50
“Controlling Hepatitis C”
Tom Rushton, MD
Huntington, WV
4:40
“Harm Reduction Program”
Michael Kilkenny, MD, MS
Huntington, WV
5:30
Audience Question & Answer Session
5:45
Adjournment
Special thanks to
for its generous donations to the Conference
PAUL W. AMBROSE, MD
SPORTS MEDICINE PROGRAM
MORNING SESSION
Sunday, November 15, 2015
7:00 am Complimentary Blood Drawing and Chemistry Profile
For Registrants – 2nd Floor, Upper Mezzanine Area
Courtesy of CAMC LabWorks
7:00
Registration / Breakfast / Exhibit Visitation – 2nd Floor
7:55
“Overview of Morning Topics”
Moderator – Carolyn Curtis, MD
Marshall Sports Medicine Resident
Marshall University, Joan C. Edwards School of Medicine
Huntington, WV
Wilderness Medicine Symposium
8:00
“Surviving the Unexpected Night Out”
Kyle Allred, PA-C
Arcata, CA
8:50
“Whitewater Medicine and Safety”
Kyle Allred, PA-C
Arcata, CA
9:40
Refreshment Break / Exhibit Visitation – 2nd Floor
10:00
“Preparing for Foreign Travel and
How to Stay Healthy Abroad”
Ariane Rasori, RN, FNP-BC
Eureka, CA
10:50
“Manual Therapy for Spinal Conditions”
Craig Swisher, PT, DPT
Huntington, WV
11:50
Audience Question & Answer Session
12:05 pm Sunday Brunch Buffet / Exhibit Visitation
Foyer Area & Grand Ballroom – 2nd Floor
AFTERNOON SESSION
Sunday, November 15, 2015
12:50 pm “Overview of Afternoon Topics”
Moderator – Kara Siford, MD
Marshall Sports Medicine Resident
Marshall University, Joan C. Edwards School of Medicine
Huntington, WV
1:00
“Reaching At-Risk Youth Through Athletics”
Noel Devine
Ft. Myers, FL
1:50
“Understanding a Plant Based Diet and Nutritional
Considerations for the Athlete”
Katie Anderson, PT, ATC
Weston, WV
2:40
“Exercise During Pregnancy”
Ross Patton, MD
Barboursville, WV
3:30
Audience Question & Answer Session
4:30
Adjournment
4:35
Door Prize Drawing for CME Registrants
Mezzanine – 2nd Floor
You must be present to win.
Thanks to our Sunday sponsors:
FACULTY
(in alphabetical order)
Kyle Allred, PA-C
Open Door Community Health Centers
Arcata, CA
Katie Anderson, PT, ATC
Stonewall Jackson Memorial Hospital
Physical Therapy Department
Weston, WV
Rickey Bradley, DO
West Virginia Vein & Skin Centers PLLC
Beckley, WV
Dan Brody, DMD
Valley Health Systems
Fort Gay, WV
Angela J.P. Campbell, MD, MPH
National Center for Immunization and Respiratory Disease
Centers for Disease Control and Prevention
Atlanta, GA
Aneel Chowdhary, MD
Edwards Comprehensive Cancer Center
Huntington, WV
Noel Devine
Ft. Myers, FL
Kimberly Foley, PhD
WVU Family Medicine
Morgantown, WV
Andrea Kelly, DDS
Valley Health Systems
Huntington, WV
Michael Kilkenny, MD, MS
Cabell-Huntington Health Department
Huntington, WV
Mary T. Legenza, MD
Edwards Comprehensive Cancer Center
Huntington, WV
Joshua M. Lohri, DO
Charleston Area Medical Center Urology
Charleston, WV
Ben Moosavi, MD
Ultimate Plastic & Reconstructive Surgery
Huntington, WV
FACULTY
(continued, in alphabetical order)
David Myerberg, MD, JD
Myerberg Law, PLLC
Morgantown, WV
Ross Patton, MD
Marshall Health
Barboursville, WV
Cindy Pinson, MD
Travel MD
Huntington, WV
Ariane Rasori, RN, FNP-BC
Redwood Family Practice &
St. Joseph’s Emergency Department
Eureka, CA
Alexander Rosenstein, MD
Charleston Area Medical Center
Charleston, WV
Shon Rowan, MD
WVU Healthcare
Morgantown, WV
Tom Rushton, MD
St. Mary’s Medical Center
Huntington, WV
Frank Schwartz, MD, FACE
Ohio University
Athens, OH
Craig Swisher, PT, DPT
St. Mary’s Medical Center
Huntington, WV
Mathew Weimer, MD
Valley Health Systems
Milton, WV
Brandon Workman, MD
Raleigh Psychiatric Services
Beckley, WV
EDUCATIONAL CONTRIBUTORS
(in alphabetical order)
The Family Medicine Foundation of West Virginia would
like to acknowledge the following organizations for
educational grants and/or speaker support:
Cabell-Huntington Health Department
Cabell Huntington Hospital
Centers for Disease Control and Prevention
Charleston Area Medical Center
Reconstructive Orthopaedic Surgery
Charleston Area Medical Center Urology
Edwards Comprehensive Cancer Center
This activity has been supported through an independent
educational grant from Gilead Sciences, Inc
Marshall Health
Marshall University
Joan C. Edwards School of Medicine
This activity has been supported through an independent
educational grant from Novo Nordisk
Ohio University College of Osteopathic Medicine
ARHI Diabetes Center
Open Door Community Health Centers
Raleigh Psychiatric Services
Redwood Family Practice
St. Mary’s Medical Center
This activity has been supported through an independent
educational grant from Teva Pharmaceuticals
Travel MD
Ultimate Plastic & Reconstructive Surgery
at Huntington Internal Medicine Group
Valley Health Systems
West Virginia Vein & Skin Centers, PLLC
WVU Department of Family Medicine
WVU Center for Reproductive Medicine
SPORTS CELEBRITY SPEAKER
Noel Devine now dedicates himself to working closely
with at-risk youth at strength and speed events and camps in
his home state of Florida. Devine identifies so well with the
youths he now mentors because he is no stranger to adversity
himself. Devine was only three months old when his father
died from complications from AIDS, and he was 11 years
old when his mother died of AIDS. Devine grew up in a
poor, often violent neighborhood, which is why he quickly
learned to appreciate the love and support he received from
the people of West Virginia.
Noel Devine has played professional football for the
National Football League’s Philadelphia Eagles, the
Canadian Football League’s Edminton Eskimos, and the
United Football League’s Omaha Nighthawks. Devine
achieved historic success during his career as a running back
at West Virginia University from 2007-2010. Devine played
in 51 games for the Mountaineers, totaling 728 rushing
attempts for 4,315 yard and 29 touchdowns, for a career
average of 5.9 yards per carry, and a long run of 92 yards.
He became the 4th player in Big East history to rush for
4,000 career yards, joining fellow Mountaineers Avon
Cobourne and Pat White, and Rutgers’ Ray Rice. Devine’s
ankle injury during his senior year against the top ranked
LSU defense affected his performance and his future pro
career. He is now rehabbing a knee injury, and he has hopes
to continue his pro football career.
Noel Devine is a former 5-star, blue-chip recruit, and he
holds many Florida high school rushing records set during
his career at North Fort Myers High School. Devine once
rushed for 365 yards and 6 touchdowns on only 9 carries,
and returned a kickoff 84 yards for a touchdown - a clear
display of his dominance. His high school highlight tapes
are legendary, with some approaching a million views
worldwide. Despite weighing only 179 pounds, Devine has
bench pressed as much as 405 pounds. His pre-NFL draft
measurements include a 4.5 second 40-yard dash, a 35.5 inch
vertical leap, a 10’ 1” broad jump, and 24 reps of 225 lbs.
SPEAKER DISCLOSURES
(in alphabetical order)
Unless listed below, speakers have disclosed that they have
no financial interest, arrangement, or affiliation with any
commercial organization, and will not be discussing any
products which they had a role in developing. These
speakers have also disclosed that they will not discuss any
off-label use or unapproved or investigational use of any
product.
Kyle Allred disclosed an ownership interest in Adventure
Whitewater, a raft guide outfitting service, and a speaking
faculty relationship with Mountain Medical Seminars
Wilderness & Travel Medicine.
Dr. Frank L. Schwartz disclosed an affiliation with
Medtronic Minimed Corporation, who sponsors his clinical
research studies, as well as a consulting relationship with
sanofi-aventis.
CORPORATE CONTRIBUTORS
The Family Medicine Foundation of West Virginia would
like to acknowledge the following organizations for their
generous contributions as corporate contributors:
QUILT DRAWING
You do not need to be present to win.
Please support the Family Medicine Foundation
of West Virginia by purchasing a chance to win a
beautiful, hand-made, Appalachian quilt!
Entry forms may be found online at
www.fmfwv.org. You may also enter to win at the
registration desk.
The drawing will be held on
Sunday, November 15, 2015, at 4:35 pm
Located in the mezzanine – 2nd Floor.
DOOR PRIZES
Door prize drawings are for CME/CE registrants only.
You must be present to win.
MORE THAN EVER BEFORE!
DRAWINGS ALL THREE DAYS!
HD Flat Screen TV, Microwave Oven,
Winterplace Ski Passes, Le Bistro Gift Cards,
Starbucks Gifts, Blenko Glass, and over 50 other
great prizes!
We are pleased to announce that the Family
Medicine Foundation of West Virginia has teamed
up with tri-state area businesses in order to support
our annual conference and provide a more
satisfying experience for our attendees! We will be
giving away locally-donated door prizes on all three
days of the conference. The grand prize drawing
will be Sunday, November 15, 2015, following the
final lecture in the upper mezzanine – 2nd Floor.
Return form to:
Reservations:
Organization:
Function:
Dates:
Prices:
Pullman Plaza Hotel, 1001 Third Avenue, Huntington, WV 25701
Call (304) 525-1001; Fax: (304) 525-1048
Family Medicine Foundation of West Virginia
29th Annual José I. Ricard, MD Family Medicine & Sports Medicine Conference
November 12 - 15, 2015 (room requests must be received by Oct. 27, 2015)
Single Room = $99.00; King Room = $99.00; Executive Single Room and King Room = $119.00 (all + state and local taxes)
NAME ________________________________________________________________________________________________________________
ADDRESS ______________________________________________ CITY ___________________________ STATE _________ ZIP __________
PHONE ___________________________________________ ARRIVAL DATE ___________________ DEPARTURE DATE ________________
SHARING ROOM WITH _____________________________ # OF PERSONS __________ CHECK IN: 3:00 PM; CHECK OUT: 12:00 (NOON)
SIGNATURE ______________________________________ CREDIT CARD # _____________________________________________________
Exp. Date ____________________
 Visa
 MasterCard
 Discover
 AMEX
 Diners Club
Note: ACCOMMODATIONS WILL NOT BE CONFIRMED WITHOUT THE FIRST NIGHT’S DEPOSIT BY CHECK OR CREDIT CARD. YOU
WILL BE CHARGED FOR THE FIRST NIGHT IF RESERVATIONS ARE NOT CANCELLED 48 HOURS PRIOR TO ARRIVAL.
*** NOTE *** There is a Marshall University home football game this weekend, so please make your reservations early!
Registration Fees
Before Oct. 1
After Oct. 1
CME Hours Available
Thursday (3-hour/$90 drug diversion lecture)
**
3.00
Friday
8.15
490.00
Saturday
8.10
230.00
255.00
Sunday
7.25
(3 days)
335.00
385.00
Thurs, Fri, Sat, Sun.
26.50
(2 days)
235.00
285.00
(1 day)
155.00
165.00
(3 days)
280.00
325.00
(2 days)
230.00
260.00
(1 day)
130.00
160.00
Please make Checks Payable To:
Chiropractic Physician
(Sunday Only)
185.00
210.00
Family Medicine Foundation of West Virginia
ATC
(3 days)
265.00
290.00
650 Main Street, Barboursville, WV 25504
(2 days)
210.00
235.00
Phone: 304.733.6485  Fax: 304.733.6486
(1 day)
155.00
165.00
Physician (MD/DO)
APRN, PA, PT, OT
Pharmacist, RN, LPN, PTA
(3 days)
$ 480.00
$ 560.00
(2 days)
440.00
(1 day)
Resident, Medical Student, Student Trainer, Coach
*Flat Fee
50.00*
60.00*
Fees include registration, breakfast, lunch, breaks, and the Friday evening buffet.
Thursday drug diversion lecture (includes dinner)
Flat Fee
90.00
There are no penalties for cancellation.
A 100% refund will be given if notified by
November 15, 2015.
Sorry, no credit cards accepted.
Online Registration is available at www.fmfwv.org.
90.00
PLEASE RETURN CME REGISTRATION FORM TO: Family Medicine Foundation of West Virginia, 650 Main Street, Barboursville, WV 25504
29th Annual José I. Ricard, MD Family Medicine & Sports Medicine Conference (November 12 - 15, 2015)
Name ________________________________________________________________________________ Days Attending
Fri Sat Sun
(Please Print)
Will you attend the Thursday, Nov. 12 controlled substances monitoring lecture? (new CME/CE requirement for WV licensure renewal)
 Yes
(this lecture is an additional $90.00)
Profession (MD, DO, DC, PA, APRN, RN, LPN, Pharmacist, PT, ATC, etc) _________________
If APRN or FNP, License # ___________________________
Mailing Address _______________________________________________________ E-mail _____________________________________________
(We do not share email addresses.)
City, State, Zip _________________________________________________ Phone _________________________ Fax _______________________
Name of Spouse/Guest _______________________________________________ RSVP Friday Buffet ______________ Limited to first 200 to RSVP
(Please Print)
(# Attending)
Would you like to receive your conference handouts in a notebook or on a flash drive?
 Notebook  Flash drive
……………………………………………………………………………………………………………………………………………..………………………
OFFICE USE: Amount Paid _____________________ Check # _________________ Ck Date _________________ Owes ______________________
Family Medicine Foundation of West Virginia
650 Main Street
Barboursville, WV 25504
Phone: (304) 733-6485
Fax: (304) 733-6486
Return Service Requested
26.50 Hours CME/CE Credit
Register by October 1, 2015 to get the discounted fee!