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PLEASE MAIL REGISTRATION FORM AND PAYMENT TO: Duke Eye Center Attn: Renee Wynne DUMC 3802 Durham, NC 27710 Or: Fax to (919) 684-6852 email:[email protected] Non-Profit Org US POSTAGE PAID Durham, NC Permit No. 60 Duke Eye Center 2351 Erwin Rd. Durham, NC 27705 919-684-6593 dukeeyecenter.duke.edu RESOLUTION OF CONFLICTS OF INTEREST In accordance with the ACCME Standards for Commercial Support of CME, the Duke University School of Medicine implemented mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this CME activity. DISCLAIMER The information provided at this CME activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition. ACCREDITATION The Duke University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. CREDIT DESIGNATION The Duke University School of medicine designates this course for a maximum of (TBD) AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. SPECIAL NEEDS STATEMENT The Duke Department/Division of Ophthalmology is committed to making its activities accessible to all individuals. If you are in need of an accommodation, please do not hesitate to call and/or submit a description of your needs in writing in order to receive service. COMMERCIAL SUPPORT ACKNOWLEDGEMENT This CME activity is supported by educational exhibits. A complete list of supporters will be published in the course syllabus. ACCOMMODATIONS Durham Marriott City Center 201 Foster Street Durham, North Carolina 27701 Tel: 919-768-6000 Single Rate & Double Rate: $139.00 Book by 02/19/2016 Reservations: Please specify that you are attending the Duke Eye Pediatrics Retina Meeting Maps and parking information will be provided in your confirmation packet. Advances in Pediatric Retina (APR) Course Payment MARCH 24 - 25, 2017 Cancellation Policy: A written notice of cancellation must be received 10 days prior to the start of this activity. A $20 cancellation fee will be assessed at that time; after that time, cancellation requests cannot be honored. Do you have any dietary restrictions? Please specify: Mastercard or Visa accepted. We no longer accept American Express. Name: Title: Address: Phone: Fax: E-mail: Card #: Expiration date: Amount to be charged: Name of Card Holder: Billing ZIP Code: Date: Signature: MAKE CHECK PAYABLE TO DUKE UNIVERSITY DUKE EYE CENTER $160 Advances in Pediatric Retina (APR) Course MARCH 24 - 25, 2017 Duke Eye Center Durham, NC
