Registration Form 2009 ADHD Conference

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Registration Form 2009 ADHD Conference
Registration Form
2009 ADHD Conference
ADHD Health and Lifestyle:
Practical Research Based Information for the Medical Practitioner
October 17 & 18, 2009
The Montreal Hilton Bonaventure
900 de la Gauchetiere West, Montreal, Quebec, H5T 1E4
Name_____________________________________________Telephone______________________________
Mailing Address__________________________________________________________________________
City____________________________Province__________________Postal Code_____________________
Fax_____________________________E-mail Address___________________________________________
I would like to receive e-mail information on future conferences
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Please Indicate Your Role:
Pediatrician
Resident
Psychiatrist
Health Care Provider
Psychologist
Health Care Student
Family Physician
Industry
Social Worker
Media / Other
Please indicate which Workshop you would like to attend: (Choose One)
Please access www.caddra.ca for the complete conference timetable and full titles and abstracts of sessions.
Check
TDAH et le syndrome de Tourette (F)
October 17
10:45 - 12:00
Les tratements du TDAH: Que Réserve l'avenir? (F)
The Challenge to Meet the ADHD Students' Learning Needs (E)
ADHD and Iron (E)
Tools and Practical Advice for the Family Practitioner, Assessing and Treating ADHD
(English, with questions in French facilitated)
Please indicate which Plenary you would like to attend: (Choose One)
Check
October 17
13:30 - 14:45
ADHD and Anxiety (E)
TDAH et le sommeil (F)
Please indicate which Plenary you would like to attend: (Choose One)
Check
October 18
TDAH et l'anxiété (F)
08:00 – 09:15
ADHD and Sleep (E)
Please indicate which Workshop you would like to attend: (Choose One)
Check
ADHD and Tourette Syndrome (E)
October 18
ADHD Treatments: What Does the Future Hold? (E)
Outils et consils pratiques pour le médecin de famille, l'évaluation et le traitement du
11:00 – 12:15 TDAH (F) (with English questions facilitated)
TDAH et le fer (F)
Pourquoi est-ce un tel défi de répondre aux besoins d'apprentissage des élèves
atteints de TDAH? (F)
Please indicate which Meet the Experts Session you would like to attend: (Choose One)
Check
Behavioural Techniques for the Difficult Patient (discuss cases) (E&F)
October 18
Comorbid ADHD with Aspergers, Anxiety or TS (discuss cases) (E&F)
Patients with Difficult Sleep Issues (discuss cases) (E&F)
13:45 – 15:00 The User's Guide to the Brain: Tools that the Professional can
use when explaining ADHD to patients (E&F)
Treatment Resistant ADHD (E&F)
Date
Time
Oct 17 9:00 to 10:15
Presentation
Speaker(s)
Format
ADHD: Comprehensive, Psychosocial, Pharmacological and Combined Treatments (English)
Pelham
Plenary
Rostain
Workshops
10:45 to 12:00 TDAH et le syndrome de Tourette (French)
(choice of)
Les traitements du TDAH: Que réserve l'avenir? (French)
Weiss
The Challenge to Meet the ADHD Students' Learning Needs (English)
Toplak/Ghelani
ADHD and Iron (English)
Lecendreux
Tools and Practical Advice for the Family Practitioner, Assessing and Treating ADHD (E – Q&A facilitated in F)
Jain / Proulx
12:15 to 13:15 Lunch: "A.D.D. & Loving It?!" Sneak preview of a documentary by comedian/producer/director Rick Green
Rick Green
Film Event
ADHD and Anxiety (English)
13:30 to 14:45
(choice of)
TDAH et le sommeil (French)
Rostain
Plenary
15:15 to 16:30 Alternative Treatments (English)
Ratey
Plenary
TDAH et l'anxiété (French)
Rostain
Plenary
ADHD and Sleep (English)
Lecendreux
ADHD and Exercise (English)
Ratey
Plenary
Rostain
Workshops
Oct 18 08:00 to 9:15
(choice of)
9:30 to 10:45
11:00 to 12:15 ADHD and Tourette Syndrome (English)
(choice of)
ADHD Treatments: What does the Future Hold? (English)
Weiss
Outils et conseils pratiques pour le médecin de famille, l'évaluation et le traitement du TDAH
(F) - Q&A facilitated in E
Proulx / Jain
TDAH et le fer (French)
Lecendreux
Pourquoi est-ce un tel défi de répondre aux besoins d'apprentissage des élèves atteints de TDAH? (French)
Lafleur
12:30 to 13:30 Tour de LeMond - Athletes Greg LeMond and Jake Wetzel
13:45 to 15:00
(choice of)
Lecendreux
LeMond/Wetzel
Behavioural Techniques for the Difficult Patient (discuss cases) (English with facilitated questions in French)
Pelham
Comorbid ADHD with Aspergers, Anxiety or TS (discuss cases) (French & English)
Rostain
Patients with Difficult Sleep Issues (discuss cases) (French & English)
Lecendreux
The User's Guide to the Brain – Tools that the Professional can use when explaining ADHD to the patient.
(E - Q&A in F)
Ratey
Treatment Resistant ADHD (French & English)
Weiss
15:15 to 16:30 The Costs of ADHD to Society, Schools and Families (English)
Pelham
Lunch Event
Meet the
Experts
Plenary
CADDRA Complimentary Workshop (Non-Accredited):
(Please check appropriate session if you wish to attend)
French
English
October 17
How to Use the “Adult ADHD Challenge” Game as a Training Tool
17:00 – 18:30 This card game is designed to support comprehensive medical training on the diagnosis and
Refreshments
and hors
d'oeuvre will be
provided.
management of adults with ADHD. The game can be used by professionals from a variety of
disciplines, including: family physicians, psychiatrists, psychologists, and allied health
specializing in mental health, with cards adapted for each of these areas of practice.
This session will introduce you to the “Adult ADHD Challenge” , give you an understanding of
how this game is played, and train you as a facilitator to use the game as an effective adult
ADHD teaching tool to train health professionals. Copies of the “Adult ADHD Challenge” and
Licenses will be available at a reduced conference rate.
Conference fees: (Please Circle the Appropriate Fee)
Conference Fees (Canadian Funds)
Physicians, Psychiatrists,
Pediatricians, Psychologists,
Medical professionals
Residents, Students,
Allied Health
(documentation may be required)
By July 10, 2009
$409.00 + 20.45 GST = 429.45
$279.00 + 13.95 GST = 292.95
By September 15, 2009
$439.00 + 21.95 GST = 460.95
$309.00 + 15.45 GST = 324.45
After September 15 and on site
$469.00 = 23.45 GST = 492.45
$339.00 + 16.95 GST = 355.95
CADDRA Members receive a 10% discount
One Day Rate (Please Circle the Appropriate Fee)
Conference Fees (Canadian Funds)
ONE Day Only Rate (Circle One)
Physicians, Psychiatrists,
Pediatricians, Psychologists,
Medical professionals
Residents, Students,
Allied Health
(documentation may be required)
By July 10, 2009
$259.00 + 12.95 GST = 271.95
$149.00 + 7.45 GST = 156.45
By September 15, 2009
$279.00 + 13.95 GST = 292.95
$169.00 + 8.45 GST = 177.45
After September 15 and on site
$299.00 = 14.95 GST = 313.95
$189.00 = 9.45 GST = 198.45
October 17
October 18th
CADDRA Members receive a 10% discount
CADDRA Members Receive a 10% Discount on the Conference Fee.
Please note: You must be a physician, psychologist, resident or a certified health care provider to become a member
of CADDRA. Further information is available at www.caddra.ca
Check here if you are a registered member of CADDRA
CADDRA 2008 Guidelines – ENGLISH and FRENCH
To pre-order a copy of the CADDRA 2008 Canadian ADHD Practice Guidelines at a special conference cost of $26.25
each, inclusive of GST, (a savings of $13.00 shipping fee per copy), please fill out the information below.
CADDRA 2008 Canadian ADHD Practice Guidelines
Quantity
@ $26.25 each
Total
Amount
ENGLISH
FRENCH
If you have already registered as a member of CADDRA, you will automatically receive a copy of the
Guidelines in your Membership Package. Do not purchase them now! Guidelines are non refundable.
PAYMENT INFORMATION
Conference Fees: ___________________
Guidelines Order: ____________________
TOTAL BALANCE: ___________________
Credit Card Information:
VISA
MASTERCARD
Card Number: ____________________________________________ Expiry Date:______________
Name on Card: ____________________________________________________________________
Signature: ________________________________________________________________________
Refund and Cancellation Policy:
Should you need to cancel your registration, you must do so by e-mail to [email protected] before
October 1, 2009. Your tax receipt must be destroyed. Your registration fee, less a $50.00 handling charge, will
be refunded. After October 1, 2009, no refunds will be granted for withdrawal. However, the registrant may
secure a replacement to fill their spot.
Only forms accompanied by full payment will be processed. The cheque/money order must be
payable to CADDRA.
Send completed form and payment to:
CADDRA
40 Wynford Drive, Suite 304A,
Toronto, ON M3C 1J5
OR
Fax form with credit card information to: (416) 385-3232.

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