Registration Form 2009 ADHD Conference
Transcription
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 Yes No 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.