CONFERENCE BROCHURE & REGISTRATION HOSTED BY: Maryland Dermatologic Society

ADC 2016

www.AtlanticDermConference.org @AtlanticDermADC

93rd Atlantic Dermatological Conference

2 A D C 2 0 1 6 MAY 6 - 8 www.AtlanticDermConference.org

JOIN US IN BALTIMOREDear Colleagues and Friends:

Maryland Dermatological Society (MDS) is excited to be hosting the 93rd Atlantic Derma-tological Conference (ADC 2016)!

It is with great pleasure that we invite you to attend ADC 2016, to be held May 6 – 8, 2016 at the Hyatt Regency Baltimore Inner Harbor, Baltimore, MD.

The planning committee has tailored this meeting for you - the dermatological professional who wants to continue learning and expand your skill set.

We look forward to three days of interactive educational and scientific sessions, product theaters, networking with colleagues and the ADC Exhibit Hall. In the Exhibit Hall, a wide variety of companies will be represented to discuss new and emerging dermatological products, technologies and services.

The Live Patient Viewing Session, the hallmark of ADC, will be Saturday, May 7, 2016. This will be held in the morning at Johns Hopkins Outpatient Center, followed by an expert panel led discussion of cases in the afternoon back at the Hyatt.

Plan now to join us for a truly unique reception on Saturday evening at the National Aquar-ium. ADC has arranged exclusive access to the award-winning National Aquarium, where you will have the opportunity to enjoy the sites and sounds of more than 20,000 fish, birds, amphibians, reptiles and marine mammals.

Sunday, May 8, 2016 will begin with a Baltimore Fun Run: “Don’t Tan It, Tone It!” We hope that you and your guests join us on the meeting’s final day for a morning fun run/walk.

If you have any questions regarding the meeting, please feel free to contact ADC at (317) 205-9480 or via email at info@atlanticdermconference.org. You may also visit www.Atlan-ticDermConference.org.

We look forward to welcoming you to Charm City on May 6 – 8, 2016!

Sincerely,

Sewon Kang, MD Elisabeth Richard, MD Ginette Okoye, MDOverall Chairperson Program Director Deputy Program Director

2016 PLANNING COMMITTEE

OVERALL CHAIRPERSONSewon Kang, MD

PROGRAM DIRECTORSGinette Okoye, MDElisabeth Richard, MD

CLINICAL COMMITTEE Inbal Braunstein, MDMarcia Driscoll, MD, PharmD

RESIDENT COMMITTEE Patricia Groleau, MDLark Guss, MD

DERMATOPATHOLOGY COMMITTEE Max Fischer, MDJanis Taube, MD, MSc

SCIENTIFIC COMMITTEE Anna Chien, MDAnthony A. Gaspari, MDLloyd S. Miller, MD, PhD

SOCIAL & MARKETING COMMITTEECrystal Aguh, MDJihad Alhariri, MDLinda Lutz, MD

DEVELOPMENT COMMITTEE Luis Garza, MD, PhDElisabeth Richard, MD

TECHNOLOGY COMMITTEEThomas J. Hornyak, MDSteven Hoseong Yang, MD, PhD

A D C 2 0 1 6 MAY 6 - 8 3

SCHEDULE+ & FACULTY

FRIDAY, MAY 6, 20167:00 am – 6:00 pm REGISTRATION | 2nd Floor Atrium Ballroom Foyer

8:30 am – 9:30 amMilestone Moments in the Treatment of Hidradenitis Suppurativa & Breakfast*Presented by AbbVie | Maryland Suites

9:30 am – 10:00 am BREAK

10:00 am – 11:00 amYou’ve Got Options: The Changing Paradigm of Plaque Psoriasis*Presented by Celgene | Maryland Suites

11:00 am – 11:30 am BREAK

11:30 am – 12:30 pm Emerging Therapies in Recurrent Melanoma & Lunch* | Presented by Amgen | Maryland Suites

12:00 pm – 7:00 pm EXHIBIT HALL OPEN | Constellation Ballroom F

1:00 pm – 1:05 pmCONFERENCE WELCOME | Sewon Kang, MD, Overall Chairperson Atlantic Dermatological Conference 2016; Chairman, Johns Hopkins Department of Dermatology

SCIENTIFIC SESSIONS | Constellation Ballroom AModerator: Luis Garza, MD, PhD, Johns Hopkins Department of Dermatology

1:05 pm – 1:35 pmAntibiotics for Dermatologists – The Brave New WorldJonathan Zenilman, MD, Chief, Division of Infection Diseases, Johns Hopkins Bayview Medical Center;Professor of Medicine, Johns Hopkins University School of Medicine

1:35 pm – 1:50 pmPhotopheresis 101: The Johns Hopkins ExperienceRonald Sweren MD, Johns Hopkins Department of Dermatology

1:50 pm – 2:05 pmBeyond the Ultraviolet Spectrum: What We Know About Visible LightAnna Chien MD, Johns Hopkins Department of Dermatology

2:05 pm – 2:20 pmWhat’s New in Hair Dye Allergy Anthony A. Gaspari, MD, Department of Dermatology, University of Maryland School of Medicine

2:20 pm – 2:35 pm What’s New in Transplant Dermatology | Manisha Loss, MD, Johns Hopkins Department of Dermatology

2:35 pm – 2:50 pmAAD UPDATE | Abel Torres, MD, JD, President, American Academy of Dermatology; Chairman, Loma Linda University School of Medicine Department of Dermatology

2:50 pm – 3:15 pm BREAK & VISIT THE EXHIBITS | Constellation Ballroom F

The 2016 Atlantic Dermatological Conference brings together the world’s foremost experts to provide dermatologists with the most up-to-date guidelines, techniques, and clinical advances for diagnosing and treating skin disorders. Scientific ses-sions on a variety of topics will be on Friday and Sunday with the highly anticipated live patient viewing on Saturday.

+ Subject to change.* These are non-CME accredited sessions.

4 A D C 2 0 1 6 MAY 6 - 8 www.AtlanticDermConference.org

FRIDAY, MAY 6, 2016 CONTINUED

SCIENTIFIC SESSIONS | Constellation Ballroom A Moderator: Anthony A. Gaspari, MD, Department of Dermatology, University of Maryland School of Medicine

3:15 pm – 3:30 pmCheckpoint Blockade for the Treatment of Advanced MelanomaJanis Taube, MD, MSc, Johns Hopkins Department of Dermatology, Director of the Division of Dermatopathology

3:30 pm – 3:45 pmState of the Science and Latest Treatment in CCCA and Other AlopeciasAffecting Women of African Descent | Chesahna Kindred, MD, MBA, Department of Dermatology, University of Maryland School of Medicine

3:45 pm – 4:00 pmDecolonization to Prevent Recurrent Skin and Soft Tissue Infections Aaron M. Milstone, MD, MHS, Johns Hopkins Department of Pediatrics, Division of Infectious Diseases and Department of Epidemiology

4:00 pm – 4:15 pmWhy Does Damage From Lasers or Peels or Dermabrasion Induce Rejuvenation?Luis Garza, MD, PhD, Johns Hopkins Department of Dermatology

4:15 pm – 4:30 pmHow Do I Approach Nasal Reconstruction After Mohs SurgeryZaineb Makzhoumi, MD, MPH, Department of Dermatology, University of Maryland School of Medicine

4:30 pm – 4:45 pmInfantile Hemangioma Therapy UpdateKatherine B. Püttgen, MD, Johns Hopkins Department of Dermatology, Director of the Division of Pediatric Dermatology

5:30 pm – 7:00 pmWELCOME RECEPTION IN EXHIBIT HALL | sponsored by Amgen | Constellation Ballroom FJoin us in thanking our sponsors for supporting ADC 2016!

SATURDAY, MAY 7, 20167:00 am – 5:30 pm REGISTRATION | 2nd Floor Atrium Ballroom Foyer

7:00 am – 9:30 am CONTINENTAL BREAKFAST IN EXHIBIT HALL | Constellation Ballroom F

7:00 am – 3:30 pm EXHIBIT HALL OPEN | Constellation Ballroom F

7:30 am – 9:00 am CONTINENTAL BREAKFAST AT THE PATIENT VIEWING | Johns Hopkins Outpatient Center

8:00 am – 11:00 am LIVE PATIENT VIEWING | Johns Hopkins Outpatient Center Round-trip shuttle provided beginning at 7:00 am

11:00 am – 11:30 am VISIT THE EXHIBIT HALL | Constellation Ballroom F

A D C 2 0 1 6 MAY 6 - 8 5

SATURDAY, MAY 7, 2016 CONTINUED

11:30 am – 1:00 pm

ADC UPDATES, KEYNOTE PRESENTATION & LUNCH | Constellation Ballroom A • Atlantic Dermatological Conference Update Jeffery Miller, MD, Chair of Dermatology, Penn State Hershey Dermatology • 2017 Toronto Atlantic Derm Meeting | Sam Hanna, MD, DABD, President, Toronto Dermatological Society

KEYNOTE PRESENTATIONChanges in Dermatology Over Half A Century: Are the Joyous Years Over? Gerald Lazarus, MD, Johns Hopkins Department of Dermatology

1:00 pm – 1:30 pm VISIT THE EXHIBIT HALL | Constellation Ballroom F

1:30 pm – 3:00 pm

PATIENT VIEWING DISCUSSION, PART I | Constellation Ballroom AModerators:

Grant Anhalt, MD, Johns Hopkins Department of Dermatology, Division of Dermatopathology

Inbal Braunstein, MD, Johns Hopkins Department of Dermatology, Division of Dermatopathology

Bernard Cohen, MD, Johns Hopkins Department of Dermatology, Division of Pediatric Dermatology

Marcia Driscoll, MD, PharmD, Department of Dermatology, University of Maryland School of Medicine

Anthony A. Gaspari, MD, Department of Dermatology, University of Maryland School of Medicine

Ginette Okoye, MD, Johns Hopkins Department of Dermatology

Pathology Moderators:

Jonathan Cuda, MD, Johns Hopkins Department of Dermatology, Division of Dermatopathology

Gulsun Erdag, MD, Johns Hopkins Department of Dermatology, Division of Dermatopathology

Max Fischer, MD, MPH, Department of Dermatology, Dermatopathology, University of Maryland School of Medicine

Richard Pfau, MD, Department of Dermatology, Dermatopathology, University of Maryland School of Medicine

Bahram Sina, MD, Department of Dermatology, Dermatopathology, University of Maryland School of Medicine

Janis Taube, MD, MSc, Johns Hopkins Department of Dermatology, Director of the Division of Dermatopathology

3:00 pm – 3:20 pm BREAK & VISIT THE EXHIBIT HALL | Constellation Ballroom F

3:20 pm – 5:30 pm PATIENT VIEWING DISCUSSION, PART II | Constellation Ballroom A

7:00 pm – 10:00 pm THE NATIONAL AQUARIUM EVENT

SUNDAY, MAY 8, 20167:00 am – 7:45 am ADC 2016 FUN RUN/WALK | 2016 Baltimore “Don’t Tan It, TONE IT” Fun Run/Walk

7:00 am – 12:30 pm REGISTRATION | 2nd Floor Atrium Ballroom Foyer

7:00 am – 8:00 am CONTINENTAL BREAKFAST | 2nd Floor Atrium Ballroom Foyer

6 A D C 2 0 1 6 MAY 6 - 8 www.AtlanticDermConference.org

SUNDAY, MAY 8, 2016 CONTINUED

SCIENTIFIC SESSIONS | Constellation Ballroom A Moderator: Lloyd S. Miller, MD, PhD, Johns Hopkins Department of Dermatology

8:00 am – 8:15 am Melanoma and Pregnancy | Marcia Driscoll, MD, PharmD, Department of Dermatology,University of Maryland School of Medicine

8:15 am – 8:30 am Pemphigus and Pemphigoid – Rational TherapyGrant Anhalt, MD, Johns Hopkins Department of Dermatology, Division of Dermatopathology

8:30 am – 8:45 am JHU Approach to Lentigo Maligna Melanoma, the Square, the Two Bladed Square and the Importance of Micro StagingRobert Egbers, MD, MS, Johns Hopkins Department of Dermatology, Division of Dermatologic Surgery

8:45 am – 9:00 am Medical Treatments for Stage IV Melanoma | Timothy Wang, MD, Johns Hopkins Department of Dermatology, Director of the Division of Dermatologic Surgery

9:00 am – 9:15 am Biologics in Hidradenitis Suppurativa | Ginette Okoye, MD, Johns Hopkins Department of Dermatology

9:15 am – 9:30 am Senescence and Change in Melanocytic Nevi | Thomas J. Hornyak, MD, PhD, VA Maryland Health Care System & Departments of Dermatology, Biochemistry and Molecular Biology, University of Maryland School of Medicine

9:30 am – 9:45 am Integrative Medicine and DermatologyMamta Jhaveri, MD, MS, Johns Hopkins Department of Dermatology

9:45 am – 10:10 am BREAK | 2nd Floor Atrium Ballroom Foyer

SCIENTIFIC SESSIONS | Constellation Ballroom A Moderator: Anna Chien, MD, Johns Hopkins Department of Dermatology

10:10 am – 10:25 am Recent Insights Into Skin Immunity Against MRSA InfectionLloyd S. Miller, MD, PhD, Johns Hopkins Department of Dermatology

10:25 am – 10:40 am Epigenetic Changes During Chronological and Sun Exposure-Induced Aging in Human Skin Steven Hoseong Yang, MD, PhD, Johns Hopkins Department of Dermatology

10:40 am – 10:55 am Hair Loss in Black Patients: A Discussion on Hair Care, Therapeutic Updates and Management Approach | Crystal Aguh, MD, Johns Hopkins Department of Dermatology

10:55 am – 11:10 am Urticarial Eruptions in Children Brian Green, DO, Department of Dermatology, University of Maryland School of Medicine

11:10 am – 11:25 am Dermatopathology: What’s New (and Old) in ImmunohistochemistryJonathan Cuda, MD, Johns Hopkins Department of Dermatology, Division of Dermatopathology

11:25 am – 11:40 am Novel Approaches to Treating Cutaneous Pigmentation and MelasmaRobert Weiss, MD, Department of Dermatology, University of Maryland School of Medicine

11:40 am – 11:55 pm Use of Cosmetic Tools (Lasers and Injectables) for the Treatment of Medical Conditions Mary Sheu, MD, Johns Hopkins Department of Dermatology

11:55 am – 12:00 pm CLOSING REMARKS | Elisabeth Richard, MD, Johns Hopkins Department of Dermatology

A D C 2 0 1 6 MAY 6 - 8 7

WELCOME RECEPTION Friday, May 6, 2016 | 5:30 pm – 7:00 pm

Exhibit Hall | Constellation Ballroom F

Join us as we thank our exhibitors and sponsors for supporting ADC 2016!

LIVE PATIENT VIEWINGSaturday, May 7, 2016 | 8:00 am – 11:00 amJohns Hopkins Outpatient Center (JHOC)601 N Caroline Street, Baltimore, MD 21287

Shuttle service will begin at 7:00 am. Round-trip shuttle ser-vice will be provided from the Hyatt to the JHOC.

ADC’s live patient viewing session and discussion is always a conference highlight. During this session, patients with ex-ceptional diagnostic or therapeutic challenges are seen and examined by conference attendees. Cases presented also feature rare skin disorders, cutaneous manifestations of sys-temic disease and novel treatments.

The afternoon patient viewing discussion will include a review and analysis of the morning cases moderated by a panel of expert dermatologists and dermatopathologists.

Again, this year we will be featuring interactive sessions to pro-mote audience engagement. This conversation among con-ference attendees will be facilitated through the “Socrative” app, which can be downloaded to smartphones or accessed online in the conference session at www.socrative.com.

After the completion of this session, attendees will gain new insight into diagnosis, treatment, and evaluation of challeng-ing dermatology patients.

THE NATIONAL AQUARIUM EVENTSaturday, May 7, 2016 | 7:00 pm – 10:00 pmCost: $50 | $25 (discounted fee for Residents/Fellows/Students)

501 E Pratt Street, Baltimore, MD 21202

Exclusive access to explore the award-winning aquarium, in-cluding various types of fish, birds, amphibians, reptiles and marine mammals.

Shuttle service will begin at 6:45 pm. Round-trip shuttle ser-vice will be provided from the Hyatt to the Aquarium.

ADC 2016 FUN RUN/WALKSunday, May 8, 2016 | 7:00 am – 7:45 am Cost: Complimentary

2016 Baltimore “Don’t Tan It, TONE IT” Fun Run/Walk Plan to enjoy a run or leisurely walk on Sunday morning!

KEYNOTE PRESENTATION Saturday, May 7, 2016 | 11:45 am – 1:00 pm

Changes in Dermatology Over Half A Century: Are the Joyous Years Over?

Gerald Lazarus, MD, Johns Hopkins Department of Dermatology

8 A D C 2 0 1 6 MAY 6 - 8 www.AtlanticDermConference.org

REGISTRATION FEES Registration fee includes the Friday Welcome Reception in the Exhibit Hall, admittance to scientific sessions, live patient viewing, discussion of cases, continental breakfast and the Saturday Keynote Lunch.

Member TypeThrough

3/25/2016After

3/25/2016

Member* $425 $600

Non-member $475 $650

Resident/Fellow $100 $150

Medical Student $100 $100

Physician Assistant $250 $300

Nurse Practitioner $250 $300

Retired $100 $275

Spouse/Guest+ $125 $125

*ADC Member Status: ADC Members are members in good standing of one of the Atlantic Dermatological Societies listed in the ADC Member Society List.

+Spouse/Guest: fee includes Friday Welcome Reception, entry to exhibit hall and continental breakfasts. This fee does not include the Saturday Keynote Lunch or the National Aquarium Event.

ADC Cancellation Policy Registration fees, less $100 administration fee will be re-funded upon written (email) notice of cancellation received no later than April 5, 2016 to info@atlanticdermconference.org. There will be no provision for partial registration fees or refunds for activities or dinners not attended.

Cancellation must be in writing, and should be sent via email to info@atlanticdermconference.org.

ADC Special NeedsIf you have physical, communication or dietary needs that may affect your active participation, please email the ADC Meeting Planner at the time of your registration.

Questions?Email info@atlanticdermconference.org or call ADC at(317) 205-9480.

Follow us on Twitter: @AtlanticDermADC

HOTEL & CONFERENCE VENUEHyatt Regency Baltimore Inner Harbor 300 Light Street Baltimore, MD, USA, 21202Reservations: (800) 233-1234Phone: (410) 528-1234http://baltimore.hyatt.com/en/hotel/home.html

Reserve your room for ADC at the special group rate of $179 single/double, plus taxes, by calling the Hyatt at (800) 233-1234 or by visiting www.AtlanticDermConference.org. Please mention “ADC 2016” to receive the group rate. The group rate is available until April 6, 2016, or until sold out.

The Hyatt Regency Baltimore Inner Harbor is located in the Inner Harbor area of downtown Baltimore and within walk-ing distance to all of the city’s major attractions, including the National Aquarium, Maryland Science Center, Historic Ships and more.

ADC MEMBER SOCIETIES • The Maryland Dermatologic Society ADC 2016 Host Society www.marylandermsociety.com

• Brooklyn Dermatological Society

• Buffalo-Rochester Dermatological Society

• Dermatological Society of Greater New York

• Dermatological Society of New Jersey

• Long Island Dermatological Society

• Manhattan/Metropolitan Dermatological Society

• Montreal Dermatological Society

• New England Dermatological Society

• New York Dermatological Society

• Ottawa Dermatological Society

• Philadelphia Dermatological Society

• Toronto Dermatological Society

• Washington D.C. Dermatological Society

• Westchester (NY) Academy of Medicine, Section of Dermatology

A D C 2 0 1 6 MAY 6 - 8 9

This activity has been planned and implemented in accor-dance with the essential areas and policies of the Accredi-tation Council for Continuing Medical Education (ACCME) through the joint providership of National Association for Continuing Education and the Maryland Dermatologic So-ciety. The National Association for Continuing Education is accredited by the ACCME to provide continuing medical ed-ucation for physicians.

The National Association for Continuing Education des-ignates this live activity for a maximum of 14.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Policy It is the policy of the National Association for Continuing Ed-ucation to ensure fair balance, independence, objectivity and scientific rigor in all activities. All faculty participating in CME activities sponsored by the National Association for Contin-uing Education are required to present evidence-based data, identify and reference off-label product use and disclose all relevant financial relationships with those supporting the activity or others whose products or services are discussed. Faculty disclosure will be provided in the activity materials.

Commercial SupportIf commercial support is received for this CME activity, partic-ipants will be notified in onsite materials.

Statement of NeedSignificant advances have occurred in the diagnosis and treatment of dermatological conditions. Practitioners in the field need educational opportunities to gain knowledge of recent findings and newly accepted standards related to diagnostic techniques and treatment options. By providing up to date information on the latest advances in diagnostics, therapies, and pathogenesis by those who specialize in the field, our goal is to facilitate best practices and improve cur-rent provider practices.

Target AudienceThis CME activity is designed for Dermatologists, NPs, PAs, Medical Students, Residents/Fellows and other specialists from the Mid-Atlantic region of the United States and Canada.

Learning ObjectivesAt the conclusion of this CME activity, learners should be able to discuss clinical presentation and pathophysiology of dermatologic conditions; discuss the diagnosis and treat-ment of the conditions covered; and discuss general clinical advances in the field of dermatology and issues specific to practitioners in the field.

CME14.50 AMA PRA Category 1 Credits™

SAVE THE DATE - ADC 201794th Atlantic Dermatological Conference

MAY 5-7, 2017Westin Harbour Castle - Toronto, Ontario, Canada

10 A D C 2 0 1 6 MAY 6 - 8 www.AtlanticDermConference.org

AMERICAN VISIONARY ART MUSEUMDiscover visionary art as defined for the purposes of the American Visionary Art Museum as art produced by self-taught individuals whose works arise from an innate personal vision that revels foremost in the creative act itself. www.avam.org

BALTIMORE MUSEUM OF ARTDiscover our internationally renowned collection of historic, modern, and contemporary art. https://artbma.org

BALTIMORE MUSEUM OF INDUSTRY The museum has exhibits on various types of manufacturing and industry from the early 20th century. www.thebmi.org

CYLBURN ARBORETUMCylburn Arboretum is a city park with arboretum and gardens. www.cylburn.org

EDGAR ALLAN POE'S GRAVE Visit the resting place of renowned poet Edgar Allen Poe. www.eapoe.org

FEDERAL HILL PARK Features views of the entire Baltimore Inner Harbor.

FORT MCHENRY NATIONAL MONUMENT Fort McHenry is a coastal star-shaped fort best known for its role in the War of 1812, when it successfully defended Baltimore Harbor from an attack by

WHERE TO GO, WHAT TO SEEBaltimore — The Birthplace of the Star Spangled Banner

the British navy in Chesapeake Bay September 13–14, 1814. www.nps.gov/fomc/index.htm

GEPPI’S ENTERTAINMENT MUSEUMPop culture museum located at the historic Camden Station.www.geppismuseum.com

HISTORIC SHIPS IN BALTIMOREHistoric Ships in Baltimore, created as a result of the merger of the USS Constellation Museum and the Baltimore Maritime Museum, is a maritime museum located in the Inner Harbor. www.historicships.org

MARYLAND SCIENCE CENTER Entertaining and educational to the young and old alike, the Maryland Science Center is undoubtedly one of the city's most exciting places to visit, with hands-on exhibits and spectacular displays about the wonderful world of science and technology. www.mdsci.org

THE NATIONAL AQUARIUM See sharks, dolphins, alligators, turtles, frogs and more. www.aqua.org

ORIOLE PARK AT CAMDEN YARDSOriole Park at Camden Yards became the official home of the Orioles on April 6, 1992. The one-time railroad center is 12 minutes west by foot from the City’s Inner Harbor and only two blocks from the birthplace of baseball’s most

legendary hero, George Herman “Babe” Ruth. http://baltimore.orioles.mlb.com

PORT DISCOVERY CHILDREN’S MUSEUMThe Port Discovery Children’s Museum offers three floors of interactive, educational exhibits and ever-changing programs for children ages birth through 10. www.portdiscovery.org

REGINALD F. LEWIS MUSEUMVisit the Reginald F. Lewis Museum to gain information and inspiration about the lives of African American Marylanders. The museum seeks to realize its mission by collecting, preserving, interpreting, documenting and exhibiting the rich contributions of African American Marylanders from the state’s earliest history to the present and the future. www.lewismuseum.org

SHERWOOD GARDENS More than six acres in size, the public is invited to stroll at leisure throughout the grounds.www.guilfordassociation.org/sherwood

THE MARYLAND ZOOHome to more than 1500 wild animals. www.marylandzoo.org

THE WALTERS ART MUSEUM The Walters Art Museum is internationally renowned for its collection of art. www.thewalters.org

Please check the appropriate box: MEMBER NON-MEMBER RESIDENT/FELLOW MEDICAL STUDENT PHYSICIAN ASSISTANT

NURSE PRACTITIONER SPOUSE/GUEST RETIRED FIRST-TIME ATTENDEE

Full Name with Credentials: _________________________________________________________ Preferred First Name: ____________________________________

Employer:_____________________________________________________________________________________________________________________________________

Employer Address:______________________________________________________________________________________________________________________________

City :_________________________________________________________________________ State: __________________________________ Zip: _____________________

Work Phone: _____________________________________________________________ Home Phone: _________________________________________________________

Email: ________________________________________________________________________________________________________________________________________

Emergency Contact Name: ________________________________________________ Emergency Contact Phone: _______________________________________________

REGISTRATION FEES Registration fee includes the Friday Welcome Reception in the Exhibit Hall, admittance to scientific sessions,

live patient viewing, discussion of cases, continental breakfast and the Saturday Keynote Lunch.

Fees Through March 25, 2016 After March 25, 2016

Member* $425 $600

Non-member $475 $650

Resident/Fellow $100 $150

Medical Student $100 $100

Physician Assistant $250 $300

Nurse Practitioner $250 $300

Retired $100 $275

Spouse/Guest+ $125 $125

*ADC Members are members in good standing of one of the Atlantic Dermatological Societies listed on page 8.+ Spouse/Guest fee includes Friday Welcome Reception, entry to exhibit hall and continental breakfasts. This fee does not include the Saturday Keynote Lunch or the National Aquarium Event.

GUEST INFORMATION: First/Last Name, including credentials (if any): ___________________________________________________________________

OTHER INFORMATION: Special Needs (dietary, kosher, allergies, etc):_____________________________________________________________________

PAYMENT INFORMATION Visa MasterCard AmEx Check or Money Order*

Credit card #:_______________________________________________________________________ Expiration Date:_____________CCV:____________

Billing Address: ________________________________________________________________________________________________________________

Name as it appears on credit card:_______________________________________ Signature:__________________________________________________

(*payable to Atlantic Dermatological Conference 2016, returned checks will be assessed a $35 processing fee.)

(as it should appear on name badge)

MAIL: Atlantic Dermatological Conference (ADC 2016)

8365 Keystone Crossing, Suite 107 | Indianapolis, IN 46240

ON-LINE (Visa/MC/AmEx): www.AtlanticDermConference.org

BY FAX (Visa/MC/AmEx): (317) 205-9481

ATLANTIC DERM REGISTRATION FORMMAY 6 – 8, 2016 | HYATT REGENCY BALTIMORE INNER HARBOR | BALTIMORE, MD

ADC 2016 FUN RUN/WALKSunday, May 8, 2016 | 7:00 am – 7:45 am

Shirt Size (Unisex): XS Small Medium

Large XL XXLCost: Complimentary

TOTAL ENCLOSED$___________________ (U.S. Funds only)

WELCOME RECEPTIONFriday, May 6, 2016 | 5:30 pm – 7:00 pm

One welcome reception ticket is included with each conference registration.

Yes, I will attend.

My spouse/guest will attend. (Must be a registered guest.)

THE NATIONAL AQUARIUM EVENT Saturday, May 7, 2016 | 7:00 pm – 10:00 pm

$50 #: ______ $50 (Guest/s) #: _____

$25 (discounted fee for students/fellows/residents) #: ______

CONFERENCE BROCHURE & REGISTRATION

ADC 2016

ADC 20168365 Keystone Crossing, Suite 107Indianapolis, IN 46240

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THINGS TO DO:

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May 6 - 8, 2016 in Baltimore, MD

✔ Complete and send in the registration

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arrangements at the Hyatt Regency

Baltimore Inner Harbor, Baltimore, MD

✔ For additional details and most

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visit www.AtlanticDermConference.org