Pediatric Gynecology & Child Abuse Update

Department of Professional Education Behavioral Health Issues and Therapies: Stayin' Alive with Meds, Music, Art and Animals Wednesday, September 22, 2010 Crowne Plaza Anaheim 12021 Harbor Blvd, Garden Grove, Ca Self-parking is free Registration/Continental Breakfast/Exhibitor Viewing: 7:15am - 7:50am Program: 8:00am – 3:45pm TOPICS & SPEAKERS: Depression and Anxiety Update# Michael Hanna, PhD, Kaiser Permanente, Fontana Medication Treatment Update for Depression and Anxiety# Betty Haller, PharmD Suicide Prevention# Veronica Scarpelli, American Foundation for Suicide Prevention, Greater Los Angeles Music and Art Therapies Lisa Lynne, Founder of “Hands-On-Harps” interactive music program Erica Curtis, MFT, ATR-BC, Registered Board Certified Art Therapist Animal Therapy: Dogs at Work Dondi Austin, CNM, Kaiser Permanente, Downey

REGISTRATION FEES (Includes continental breakfast, lunch and CEUs) Website: http://www.kpsymposia.com $75.00 fee on the website by September 9th @ 9pm $100.00 fee on the website between Sept. 9th @ 9:01pm – Sept. 16th @ 9:00pm

Mail: $85.00 if registration is postmarked by September 9th $110.00 if registration is postmarked between Sept. 10th and Sept. 15th Do not mail a registration after Sept 15th. Register on the website or onsite. Onsite: $125.00

Refunds will be granted until Sept. 15; no refunds after that date. Check payment will be refunded (less the $10 processing fee) in the form of a voucher for another symposium. Website registrations will be refunded to the credit card. E-mail [email protected] to request a refund. If symposium is canceled, the above refund policy will be enforced. Kaiser Permanente Professional Education (626) 564-3082, tie 338 Course Description: Course is designed to provide updates on health care issues relevant to clinical practice and investigate aspects of other related disciplines that enhance the understanding or practice of social work.

Continuing Education Credits Nurses: Provider approved by the California Board of Registered Nursing, Provider Number CEP751 for 7 contact hours. Certified Nurse-Midwives: ACNM specialty credit will be applied for. Physician Assistants : This program is not yet approved for CME credit. Conference organizers plan to request 6 hours of AAPA Category I CME credit from the Physician Assistant Review Panel. Total # of approved credits yet to be determined. LCSWs & MFTs: Course meets the qualifications for 6 hours of continuing education credit for LCSWs and MFTs as required by the California Board of Behavioral Sciences. Provider #PCE 1763. Professional Education Behavioral Health Issues and Therapies: Stayin' Alive with Meds, Music, Art and Animals Wednesday, September 22, 2010 Crowne Plaza Anaheim All the requested information below is required; please fill the form out completely. REGISTRATION INFORMATION: Registrations by mail must be accompanied by payment. Registration via mail is an additional $10 for processing. See previous page for exact amount. No fax registrations accepted  We discourage sending a registration via interoffice mail. Please make checks payable to Kaiser Permanente US Mail: KP Professional Education, 100 S. Los Robles Ave, #501, Pasadena, CA 91101 If registration fee is not received by September 20th, payment required on-site. Please see previous page for refund policy.

FIRST & LAST NAME

Home address

City, State & Zip

E-Mail Address A valid e-mail address is required to receive the registration confirmation/receipt, link to handouts & evaluation License # Daytime Phone # Facility name Department

Employer:  Kaiser Permanente  Community Colleague/Non-KP

Check your license type: CNM NP PA RN  Other ______

Lunch Choice  Chicken Entrée  Vegetarian Entrée

CREDIT CARD FORM ONLY Amex, Visa, MasterCard accepted

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