20Th Annual Medical Staff Symposium

20th Annual Medical Staff Symposium

Building Our Community of Excellence Together Welcome

TWENTY YEARS AGO, endeavoring to further strengthen the esprit de corps at Beaumont, Troy, medical staff presidentKirit Vora decided to bring together not only physicians and administrators, but also their families for an off-site weekend of learning and relationship building. The conference was strong and the golf was competitive, but nothing compared to the laughter of the children. While some faces have changed and we have been joined by colleagues from 7 additional hospitals, the format remains the same. As we relentlessly strive to provide the best possible health care for our communities, a few days to recharge our batteries in a beautiful environment is just what the doctor ordered. Dr. Vora’s prescience is now self evident and all are welcome to take advantage of his wonderful gift.

Symposium Planning Committee

David Forst, M.D. Symposium Director Parvez Khan, M.D. Professor, Internal Medicine, Oakland University William Hematology & Oncology, Beaumont, Dearborn; Chief of Staff, Beaumont (OUWB) School of Medicine; Cardiovascular Beaumont, Dearborn Medicine, Beaumont, Royal Oak, Troy; Medical Staff President, Beaumont, Troy

Kassem Charara, M.D. Peggy Nowak, M.D. Surgical Services, Beaumont, Taylor; Chief of Staff, Beaumont, Associate Professor, Department of Surgery, OUWB School of Taylor; Assistant Clinical Professor, Department of Surgery, Medicine; Surgical Services, Beaumont, Royal Oak; Medical Wayne State University Staff President, Beaumont, Royal Oak

Raimundo Pastor, D.O. George Ghanem, M.D. Surgical Services, Beaumont, Farmington Hills; Assistant Clinical Assistant Professor, Internal Medicine, OUWB School of Medicine; Professor of Surgery, Michigan State University College of Cardiovascular Medicine, Beaumont, Grosse Pointe; Medical Osteopathic Medicine; Medical Staff President, Beaumont, Staff President, Beaumont Hospital, Grosse Pointe Farmington Hills

Ashok Jain, M.D. Jill Schoenherr Diagnostic Radiology, Beaumont, Wayne; Chief of Staff, Senior Executive Administrative Assistant & Conference/ Beaumont Hospital, Wayne Event Planner, Beaumont, Troy

June 22-24, 2017 • Boyne Mountain • Boyne Falls, MI CME Overview

Symposium/Event Overview CME Accreditation and Credit Designation The Medical Staffs of Beaumont Health are hosting a weekend William Beaumont Hospital is accredited by the Accreditation symposium at Boyne Mountain beginning Thursday evening, Council for Continuing Medical Education (ACCME) to provide June 22, to promote the continuing education of the continuing medical education for physicians. Beaumont Medical Staff. In addition to the presentation of William Beaumont Hospital designates this live activity for a interesting medical topics, social activities are planned. maximum of 8.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of Educational Conference their participation in the activity. th The 20 Annual Symposium is your source for cutting- Application for CME credit has been filed with the American edge information, best practices and national guidelines Academy of Family Physicians. Determination of credit is that cover a wide variety of medical specialties and disease pending. management. Non-physician professionals should check with their Who Should Attend individual credentialing bodies to confirm that participation in this CME activity will be approved for credit. CME credits Medical Staff members and leaders of Beaumont Health. can be used to meet the continuing education requirements needed for Michigan physician assistant and nursing Conference Registration relicensure without limitation. See enclosed registration form for various pricing levels. This activity is eligible for Call, fax, or mail registration: meaningful participation (MP) Phone: 248-964-1063 credits. MP Questions? Contact Fax: 248-964-8842 Deirdre Pitts, 248-370-2741 Mail: Beaumont, Troy/Administration 44201 Dequindre Rd. Faculty Disclosure Troy, MI 48085 All speakers and members of the planning committee have For questions please contact Jill Schoenherr at been asked to disclose any significant relationships they may [email protected] have with commercial companies. The presence or absence of relationships will be disclosed at the time of the meeting. For additional event information, please visit http://beaumont.cloud-cme.com/medstaffconf Global and Educational Objectives Lodging By attending the educational sessions, the participants should be better able to: A block of rooms has been reserved at Boyne Mountain. Please call, mail or fax your reservation request using the 1. Describe current approaches and strategies to diagnose enclosed registration form. Please be sure to mention and treat Type II diabetes, ischemic heart disease, “Beaumont Health” when reserving your overnight atherosclerosis, and uterine and breast cancers. accommodations in order to receive our negotiated rate. 2. Differentiate surgical interventions to optimize clinical Call, fax, mail or go online for your overnight accommodation outcomes and minimize cost. requests: Phone: 800-462-6963 3. Discuss current issues and pressures impacting our Fax: 231-549-6844 healthcare environment including patient and Mail: Boyne Mountain family-centered care, MACRA, value-based reimbursement, Central Reservations Dept and provider burnout. PO Box 19 Boyne Falls MI 49713 Evaluation Form Website: boyne.com All participants wishing to receive CME credit for these Use online code: 1063NB sessions will be required to complete an online ”CME Evaluation Form”.

3 Faculty Speakers

Paul Misch, M.D. Michael Brennan, D.O. Chairman & Professor, Family Medicine & Community Health, Assistant Professor, Internal Medicine, OUWB School of Medicine; OUWB School of Medicine; Chairman, Family Medicine & Internal Medicine, Beaumont Health, Grosse Pointe Community Health, Beaumont, Grosse Pointe, Royal Oak, Troy; Chief, Family Medicine & Community Health, Beaumont, Troy

Peggy Nowak, M.D. Richard Easton, M.D. Associate Professor, Department of Surgery, OUWB School of Assistant Professor, Orthopaedic Surgery, OUWB School of Medicine; Surgical Services, Beaumont, Royal Oak; Medical Medicine; Surgical Services, Beaumont, Royal Oak, Troy Staff President, Beaumont, Royal Oak

Gilbert Raff, M.D. John Fox Professor, Internal Medicine, OUWB School of Medicine; President & Chief Executive Officer, Beaumont Health Director Cardiac MRI/CT, Beaumont, Royal Oak

J. Anthony Rakowski, D.O. Barry Franklin, Ph.D. Clinical Assistant Professor, Michigan State University College Professor, Internal Medicine, OUWB School of Medicine; Director, of Human Medicine; Obstetrics & Gynecology, Beaumont Cardiovascular Rehabilitation, Beaumont, Royal Oak Dearborn, Troy

Lori Joy Gallardo, M.D. Arthur Riba, M.D. Assistant Professor, Diagnostic Radiology & Molecular Imaging, Associate Director, Cardiovascular Disease Fellowship Program, OUWB School of Medicine; Diagnostic Radiology, Beaumont Beaumont, Dearborn; Medical Director, Clinical Documentation Grosse Pointe, Royal Oak, Troy Improvement Program, Beaumont Health

Joe Williams, D.O. Medical Director, Beaumont Health ReNew Weight Management Susan Grant, DNP, RN, FAAN, NEA-BC Program; Family Medicine, Beaumont, Farmington Hills; Clinical Executive Vice President & Chief Nursing Officer, Beaumont Health Assistant Professor, Michigan State University College of Osteopathic Medicine; Advisor, Exercise Science Program, Eastern Michigan University

Pablo Ysunza, Ph.D. Terry Kowalenko, M.D. Professor, Physical Medicine and Rehabilitation, OUWB School of Chairman & Professor, Emergency Medicine, OUWB School of Medicine; Coordinator of Speech Services, Ian Jackson Craniofacial Medicine; System Chairman, Emergency Medicine, Beaumont, and Cleft Palate Clinic, Neuroscience Program, Beaumont, Royal Grosse Pointe, Royal Oak, Troy Oak; Physical Medicine and Rehabilitation Beaumont, Royal Oak

4 Thursday, June 22 Welcome Reception 6:30 to 8 p.m. Friday, June 23 Saturday, June 24

6:30 to 8:30 a.m. Complimentary Buffet Breakfast 6:30 to 8:30 a.m. Complimentary Buffet Breakfast

8:30 a.m. to 9:30 p.m. Optional Activities* 9 a.m. to 9:30 p.m. Optional Activities*

Core Educational Symposium Core Educational Symposium

7:30 a.m. Welcome & Announcements 7:30 a.m. Welcome & Announcements

7:45 to 8:15 a.m. Metabolic Syndrome: Beyond 7:45 to 8:15 a.m. The Appropriate Use of Breast Counting Calories Imaging Joe Williams, D.O. Lori Joy Gallardo, M.D.

8:15 to 8:45 a.m. Diabetes: What’s New in Type 2 8:15 to 8:45 a.m. Saving President Reagan Michael Brennan, D.O. Terry Kowalenko, M.D.

8:45 to 9:15 a.m. Anti-Aging Benefits of Regular 8:45 to 9:15 a.m. Sentinel Flow Mapping: Optimizing Exercise and Increased the Treatment of Uterine Cancer Cardiorespiratory Fitness J. Anthony Rakowski, D.O. Barry Franklin, Ph.D. 9:15 to 9:30 a.m. BREAK 9:15 to 9:30 a.m. BREAK 9:30 to 10 a.m. Documenting for Success 9:30 to 10 a.m. Spinal Surgery: Keeping the Cutting Arthur Riba, M.D. Edge Affordable Richard Easton, M.D. 10 to 10:30 a.m. Medicine in the Movies Pablo Ysunza, Ph.D. 10 to 10:30 a.m. CT Coronary Angiography: Changing the Chest Pain Paradigm 10:30 to 11 a.m. Physician Burnout: Keeping the Gilbert Raff, M.D. Flame Alive Peggy Nowak, M.D. 10:30 to 11 a.m. MACRA & Physician Payment Reform – Get ready ’cause here it comes! 11 a.m. to 12 p.m. Patient & Family Centered Care Paul Misch, M.D. Susan Grant, DNP, RN, FAAN, NEA-BC

11 a.m. to 12 p.m. Navigating the Healthcare Tsunami 12 to 1 p.m. Complimentary Buffet Luncheon Together John Fox 6:15 to 9:30 p.m. Cocktails, Dinner & Team Trivia*

12 to 1 p.m. Complimentary Buffet Luncheon

6 to 8 p.m. Family BBQ*

8 to 9:30 p.m. Family Olympics*

*Please see pages 6 and 7 for information about Beaumont For CME questions contact Jessica Rice at 248-551-0748 or Sponsored Optional Activities. [email protected]

Agenda and amount of CME credits available are subject to change.

5 Friday, June 23 Beaumont Sponsored Optional Activities

8:30 to 11:30 a.m. ZIPLINE ADVENTURE TOUR 12:50 p.m. GOLF ON THE “ALPINE” The Zipline Adventure Tour features a series of 10 lines that Home of the “Tournament of Champions,” this course travel up to 4300 feet, 20-25 mph, up to 50 feet in the air and weaves down the mountainside toward spectacular Deer 780 feet in length! The adventure begins at the top of the Lake. Stunning vistas with strategically placed water hazards mountain and routes you through trees across the slopes of and bunkers make for a thrilling round. Awards will be given Boyne Mountain. A liability waiver is required to be signed by for the longest drive & closest to the pin. We have secured all participants and a parent/guardian signature is required enough tee times for 16 golfers. for those riders under the age of 18. This activity is suitable $83 per person for individuals 10+ years old and 60+ pounds and can 6 to 8 p.m. FAMILY BBQ accommodate a maximum of 12 participants. Availability will Bounce houses, glitter tattoos and other interactive activities be filled on a first-come first-served basis. are planned for the kids. Casual dress and a cash bar. $55 per person $30 per person (13 years old and older) 9:30 to 10:30 a.m. STUFF A FRIEND $15 per child (4-12 years old) Much like Build a Bear; each kit includes an unstuffed animal N/C (children under 4 years old) of your choice, fluff for stuffing your plush friend, sound 8 to 9:30 p.m. FAMILY OLYMPICS modules, birth certificate and white t-shirts with fabric paint. Show your team spirit in the Family Olympics with zany This activity is suitable for children 3+ years old. games and relays. There is no charge for this activity and $10 per person participants of all ages are encouraged to participate! 10 to 11:30 a.m. MONSTER RC TRUCKS If you haven’t been to the Symposium, this is the activity RC trucks battle it out in a 20’ x 40’ inflatable track with of “the weekend” that is most remembered year after year. obstacles, ramps and hills for added fun! Race against If you’re debating about participating we suggest you just your friends and show them who’s boss! This activity go for it! Please be sure to fill out the optional activities will be conducted in heats and each child will compete brochure with the name of each participant and their in approximately 3-5 heats depending upon how many t-shirt size. Our t-shirt order MUST be placed on Friday, children register for the activity. This activity is suitable for June 9. T-shirts will be guaranteed for all registrations children 8+ years old and can accommodate a maximum of received by the close of business on Thursday, June 8. 15 kids. Availability will be filled on a first-come first-served basis. $10 per person

1 to 4 p.m. RAFTING ON THE JORDAN RIVER This 1½ hour rafting trip will take you through the pristine Miscellaneous Information scenery of the Jordan River and is suitable for individuals 5+ years old. Rafts can accommodate 8-10 people. Bathing Preregistered Activities suits or clothes/shoes that can get wet are suggested. It is very important to register for activities in advance as the staff at Boyne must prepare for the number of Sunscreen, bug spray and towels are also recommended. participants a few days prior to the conference. Due Lifejackets are required and will be provided. This activity can to space constraints and advance preparations by accommodate a maximum of 40 participants. Availability will Boyne we cannot guarantee that on-site registration/ be filled on a first-come first-served basis. Rafting will take participation will be available. place unless there is severe weather in the area. Age Restrictions $20 per person (10+ years old) If you have more than one child and want to keep them $10 per child (5-9 years old) together you should register all of your children for the activity that is most suited for the youngest child. Younger children will not be able to partake in activities that are above their intended age bracket.

6 Saturday, June 24 Beaumont Sponsored Optional Activities

9:30 to 10:30 a.m. KIDS OLYMPIC CHALLENGE 6 to 9:30 p.m. MEXICAN FIESTA & PAINTBALL The Boyne Staff will lead your kids through a crazy morning This is your chance to don some camo, load up on ammo of events. These relay races are sure to get everyone and have some fun! Boyne Mountain has joined forces laughing. This activity is suitable for children 6+ years old. with T.C. Paintball — northern Michigan’s largest, most $5 per person knowledgeable paintball experts. This activity is suitable for individuals 10+ years old. A liability waiver must be signed 10 to 10:45 a.m. KIDS SCAVENGER HUNT by all participants. For those under age 18, a parent/guardian We’ve hidden some treats, toys and other fun treasurers for signature is required. the little ones to find. This activity is suitable for children $45 per person 3-6 years old only. $10 per person 6:15 to 9:30 p.m. COCKTAIL RECEPTION, DINNER & TEAM TRIVIA 11 to 11:45 a.m. MAKE YOUR OWN PIZZA Send your kids to the planned activities for an evening of fun Cheese, pepperoni, sauce and all the rest of the fixins’ will and join your colleagues for a cocktail reception followed by be available to make your own personal-size pizza and put a cordial sit down dinner. The evening will be highlighted by your own creative twist on it! Boxes will be provided to take a special presentation to Dr. Kirit Vora, Symposium Founder, your creation to lunch with the rest of the group. A short as well as the very popular Team Trivia Competition. demonstration will be provided by the chef at the start of the Winners will receive prizes along with bragging rights. The activity. This activity is suitable for kids over 5 year old and conference registration fee includes 2 complimentary can accommodate a maximum of 15 participants. Availability tickets. and will be filled on a first-come first served basis. $50 per person $10 per person

1:30 to 2:30 p.m. BLACK STAR FARMS WINE TASTING Black Star Farms is a unique wine & culinary destination in the heart of Traverse City’s wine country. Kim Zacharias from BOYNE Additional Services Black Star Farms will join us at Boyne to introduce some of (advance reservations required) their award winning wines. Fritz’s Adventure Camp: Open daily for children $20 per person 5-12 years of age. The mission at Fritz’s Adventure Camp is to develop and promote an active lifestyle in an 6 to 9:30 p.m. DINNER & A MOVIE educationally friendly environment. Campers experience Chicken fingers, chips & milk/juice will be served followed a variety of activities including at least one and a half by “make your own sundae” and a kid-friendly movie. hours of aquatic thrills at Avalanche Bay, Michigan’s This activity is suitable for children 3-6 years old. largest Indoor waterpark, as well as nature hikes, games, $25 per child and crafts. During summer months, activities are often based on rotating weekly themes. 6 to 9:30 p.m. AVALANCHE BAY MEXICAN FIESTA Avalanche Bay Splash Camp: Open daily for children A Mexican buffet will be provided to nourish the body before 6-12 years of age. Supervised activities include: waterpark the kids are let loose in Avalanche Bay Indoor Waterpark! play, arts and crafts, games & lots of fun. Full-day, half-day This activity is suitable for children 7+ years old. and night time rates available. Items to bring to camp: $30 per child bathing suit, change of clothes and shoes.

Day Care Children’s Playcare: Certified and highly trained instructors will care for children ages 3 months -5 years. In-room babysitting services are also available. Full-day, half-day and hourly rates available.

For more information, visit: boyne.com

7 NON-PROFIT U.S. POSTAGE PAID ROYAL OAK, MI Medical Administration PERMIT #404 44201 Dequindre Road Troy, MI 48085-1198

248-964-1063

20th Annual Medical Staff Symposium

Building Our Community of Excellence Together

June 22-24, 2017 • Boyne Mountain • Boyne Falls, MI

• Networking & Education • • Complimentary Welcome Reception – Thursday • • Complimentary Breakfast – Friday & Saturday • • Complimentary Lunch – Friday & Saturday • • Kids & Adults Activities – Friday & Saturday • • Family Olympics – Friday • • Adults Dinner & Team Trivia – Saturday • • Kids Dinner & Activities – Saturday •

20th Annual Medical Staff Symposium Registration

Registration Options

MAIL: Beaumont Hospital – Troy QUESTIONS? 44201 Dequindre Road PHONE: 248‐964‐1063 Administration/Jill Schoenherr EMAIL: [email protected] Troy, MI 48085 WEBSITE: http://beaumont.cloud‐cme.com/medstaffconf FAX: 248‐964‐8842 (please fax both sides of the registration forms)

Main Contact

First/Last Name Credentials

First Name (as preferred on name tag) Beaumont Hospital Affiliation

Street Address City, Zip

Phone # Fax #

Email Address

Family Members/Additional Guests (If registering 9+ guests please provide the below information on a separate sheet of paper)

Additional Family/Guest Names Age Dietary restrictions Additional Family/Guest Names Age Dietary restrictions 1 5

2 6

3 7

4 8

9 10

If you are registering for 10 or more guests please provide the above information on a separate sheet of paper

Registration Inclusions

The full 2‐day Educational Symposium registration fee includes:  8.0 AMA PRA Category 1 credits or 8.0 AAFP credits  Family breakfast and lunch, Saturday  Family Welcome receptions, Thursday  Family Olympics, Friday  Family breakfast and lunch, Friday  Reception, dinner and team trivia, Saturday

CANCELLATION POLICY: CANCELLATION POLICY: Cancellations must be received by Friday, June 9. Due to contractual obligations to Boyne Mountain and other vendors we will not be able to honor refunds for no‐shows, cancellations or changes after June 9 2‐Day Registration

Physician or Administrator Resident/Fellow/Mid‐Level Provider Medical Student $150 per person/adult $75 per person/adult $50 per student $50 per child 13 years of age & older $25 per child 13 years of age & older

Physician or Administrator Resident/Fellow/Mid‐Level Provider Medical Student _____ # of adults @ $150 per person _____ # of adults @ $75 per person _____ # of students @ $50

_____ # of children 13 years of age & older _____ # of children 13 years of age & older @ $50 per child @ $25 per child

Registration Total ______(Please carry this amount down to the Conference Registration Total below)

1‐Day Registration Fees

Physician or Administrator: Resident/Fellow/Mid‐Level Provider: Medical Student: $75 per person/adult $50 per person/adult $35 per Student $35 per guest 13 years of age & older $15 per guest 13 years of age & older

Physician or Administrator: Resident/Fellow/Mid‐Level Provider: Medical Student _____ # of adults @ $75 per person _____ # of adults @ $50 per person _____ # of students @ $35

_____ # of children 13 years of age & older _____ # of children 13 years of age & older @ $35 per child @ $15 per child

Registration Total ______(Please carry this amount down to the Conference Registration Total below)

Payment Method

    Check payable to: WBH, Troy Medical Staff Fund Credit Card: AMX MC Visa

Account #:  Exp. Date:

Cardholder Name: ______Signature: ______

Billing Address: ______

Conference Registration Total $

CANCELLATION POLICY: CANCELLATION POLICY: Cancellations must be Total from Optional Activities Form $ received by Friday, June 9. Due to contractual obligations to Boyne Mountain and other vendors we will not be able to honor refunds for no‐shows, Total Paid $ cancellations or changes after June 9

20th Annual Medical Staff Symposium Optional Activities Registration

Main Contact

First Name Last Name

Daily Optional Activities In registering for optional activities it is important that you include each participants name

THURSDAY, JUNE 22 10 to 11:30 a.m. Monster RC Trucks 6 to 8 p.m. Family BBQ 6:30 to 8 p.m. Welcome Reception _____ # of Kids @ $10/pp _____ # of Participants 13+ years old @ $30/pp _____ # of Adults This activity is suitable for kids 8+ years old and can _____ # of Kids 4 – 12 years old @ $15/pp accommodate a maximum of 15 participants and _____ # of Kids 5+ years old _____ # of Kids under 4 years old @ N/C will be served on a first‐come first‐served basis _____ # of Kids under 5 years old BBQ Total $______Monster Trucks Total $______Participants: Participants:

Participants:

12 to 1 p.m. Lunch Buffet _____ # of Adults FRIDAY, JUNE 23 + 6:30 to 8:30 a.m. Breakfast Buffet _____ # of Kids 5+ years old 8 to 9:30 p.m. Family Olympics _____ # of Kids under 5 years old _____ # of Adults T‐shirts: Adult: XS to 2XL

_____ # of Children 5+ years old Participants: Child: XS to XL _____ # of Children under 5 years old T‐shirts MUST be ordered on Friday, June 9. Shirts will be guaranteed for all re gistrations received by Participants: the close of business on Thursday, June 8

Participant Shirt size

12:50 p.m. Golf on the “Alpine” 1. _____ # of Participants @ $83/pp 2. * This activity can accommodate a maximum of 16 8:30 to 11:30 a.m. Zipline Adventure Tour participants and will be served on a first‐come first‐ 3. served basis _____ # of Participants @ $55/pp 4. This activity is suitable for individuals 10+ years old Golf Total $______and 60+ lbs. and can accommodate a maximum of 12 participants and will be served on a first‐come Participants: 5. first‐served basis 6. Zipline Total $______** 7. Participants: 1 to 4 p.m. Rafting on the Jordan River _____ # of Participants 10+ years old @ $20/pp 8. _____ # of Kids 5 – 9 years old @ $10/pp This activity is suitable for individuals 5+ years old 9. 9:30 to 10:30 a.m. Stuff a Friend and can accommodate a maximum of 40 participants and will be served on a first‐come first‐ 10. _____ # of Kids @ $10/pp served basis Advance registration is highly recommended for all This activity is suitable for kids 3+ years old Rafting Total $______activities. Due to space constraints and limited Stuff a Friend Total $______Participants: availability we are unable to guarantee onsite registration for any activities. Participants: See reverse for Saturday Activities SATURDAY, JUNE 24 11 to 11:45 a.m. Make Your Own Pizza 6 to 9:30 p.m. Avalanche Bay Mexican Fiesta 6:30 to 8:30 a.m. Breakfast Buffet _____ # of Kids @ $5/pp _____ # of Kids @ $30/pp _____ # of Adults This activity is suitable for kids 5+ years old and can _____ # of Kids 5+ years old accommodate 15 participants and will be served on This activity is suitable for kids 7+ old a first‐come first‐served base _____ # of Kids under 5 years old Avalanche Bay Total $______Pizza Total $______Participants: Participants: Participants:

% 12 to 1 p.m. Lunch Buffet 6 to 9:30 p.m. Mexican Fiesta & Paintball _____ # of Adults _____ # of Kids @ $45/pp _____ # of Kids 5+ years old 9:30 to 10:30 a.m. Kids Olympic Challenge This activity is suitable for kids 10+ old _____ # of Kids under 5 years old _____ # of Kids @ $5/pp Paintball Total $______Participants: This activity is suitable for kids 6+ years old Participants: Olympics Total $______

Participants:

6:15 to 9:30 p.m. Reception, Dinner & Team 10 to 10:45 a.m. Kids Scavenger Hunt 1:30 to 2:30 p.m. Black Star Farms Wine Trivia Tasting Registration fee includes 2 complimentary tickets. _____ # of Kids @ $10/pp Additional tickets available at $50/pp _____ # of Adults @ $20/pp This activity is suitable for kids 3‐6 years old _____ # of Complimentary tickets @ N/C Wine Tasting Total $______Scavenger Hunt Total $______# of Additional tickets @ $50/pp Participants: Participants: Dinner Total $______

Participants:

6 to 9:30 p.m. Dinner & A Movie _____ # of Kids @ $25/pp This activity is suitable for kids 3 ‐ 6 years old

Dinner & a Movie Total $______

Participants:

Optional Activities Grand Total $______Please carry this total to the Conference Registration page FINE PRINT: Advance registration is highly recommended for all activities. Due to space constraints and limited availability we are unable to guarantee onsite registration for any of the above listed activities. If you have more than 1 child and want to keep them together, you must register all of your children for the activity that is most suited for the youngest child. Younger children will not be able to partake in activities that are above their intended age bracket. * Zipline Adventure Tour – For safety reasons, participants under 60 pounds are not permitted on the zipline. ** Rafting on the Jordan River ‐ This activity can only accommodate a maximum of 40 people (first‐come first‐served). + Family Olympics – T‐shirts will be guaranteed if your registration is received by the close of business on Thursday, June 8. % Paintball & Pizza Party – Parents will be required to complete a signed liability form. Children must be 10 years of age and older.

Reservations must be made utilizing this form and be received by May 30, 2017. Reservation requests received after this date will be taken on a space available basis at current room rates. When making travel arrangements, please note the check-in and check-out times are on the second page with the room descriptions. Check in and check out takes place at the Mountain Grand Lodge Front Desk for all room types.

Accommodations: Please indicate your 1st and 2nd lodging preference below. If room type requested is not available, the next available room type and rate will be confirmed. We cannot guarantee specific rooms/units. All rooms are non smoking.

ACCOMMODATIONS ROOM TYPE ROOM RATES INDICATE 1ST & 2ND CHOICE

Mountain Grand Lodge - Parlor/Queen/King $167.00 Mountain Grand Lodge - 1 Bedroom Suite $242.00 Mountain Grand Lodge - 2 Bedroom Suite $309.00 Mountain Grand Lodge - 3 Bedroom Suite $309.00 Disciples Ridge - 2 Bedroom $301.00 Rates are based on the European Plan which includes lodging only. Rates are per room per night. Rates and a 9% Resort Services Fee are subject to a 6% Michigan State Sales and Use Tax. Rates are also subject to a 5% Local Lodging Assessment. Boyne Mountain Resort has a two-night minimum on weekends (Friday and Saturday night). PLEASE PRINT

ARRIVAL DAY/DATE:

DEPARTURE DAY/DATE:

Reservations can be made by SHARE WITH:

calling, on-line, mail or fax NUMBER OF ADULTS IN PARTY: BOYNE NUMBER OF CHILDREN IN PARTY: Central Reservations Department AGES OF CHILDREN 18 & UNDER: P.O. Box 19 NAME: Boyne Falls, MI 49713 COMPANY: Phone: 1.800.462.6963 ADDRESS: Fax: 231.549.6844 CITY: STATE: ZIP:

On-Line: www.boyne.com PHONE / BUSINESS: Booking Code: 1063NB PHONE / HOME: *E-MAIL ADDRESS:

Deposits: A deposit equal to the first night's lodging *Room confirmations will be e-mailed within 48 hours of receipt of reservation. is required with each reservation. Please make check BOYNE REWARDS #: or money order payable to Boyne USA Resorts or include a credit card number. The card will be charged **SPECIAL REQUESTS: upon receipt of form. Do not send cash. **BOYNE does its best to accommodate requests, but cannot guarantee them. PAYMENT METHOD Cancellation Policy: Cancellation and changes CHECK ENCLOSED $ affecting arrival/ departure dates must be made 7 days prior to arrival date in order to receive refund of American Express Visa MasterCard Discover deposit, less a $10.00 administrative fee. CREDIT CARD # Expiration Date

SIGNATURE: Security Code Tax exempt individuals: Please present the state tax exempt form 3372 at check in. NOTE: All reservations must be guaranteed by check or credit card deposit. Personal funds are not exempt from state tax or local Credit card imprint is required at check-in for all guests. assessments. BOYNE MOUNTAIN ROOM DESCRIPTIONS

Parlor One queen bed, one sofa bed, bathroom with tub, wet bar (microwave/mini fridge) and electric fireplace. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

Queen Two queens, bathroom (shower only) and wet bar (mini fridge). The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

King One king bed, bathroom (shower), in room whirlpool tub, wet bar (mini fridge), and electric fireplace. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

One Bedroom Suite One bedroom suite with one king or two queens in bedroom upstairs with bathroom (shower) and in room whirlpool tub, one sofa bed in living room, bathroom (with tub), wet bar (mini fridge), electric fireplace and balcony. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

Two Bedroom Suite Two bedroom suite with one king in master bedroom, two queen beds in second bedroom, and bath (tub) all upstairs with one sofa bed in living room, bath (shower), kitchen with table and four chairs, and electric fireplace. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

Three Bedroom Suite Three bedroom suite with one king in master bedroom, one queen in second bedroom, two sets of bunk beds in third bedroom all upstairs, one sofa bed in living room, two full baths (tub upstairs, shower downstairs), full kitchen with table and four chairs, electric fireplace and balcony. The Mountain Grand Lodge observes a 5:00pm check-in and 11:00am check-out.

Disciples Ridge Two Bedroom w/ Loft Condominium Sleeps maximum of ten with one king bedroom, two queen beds in 2nd bedroom, two queen beds in loft, sofa sleeper in living area, full kitchen and living area with gas fireplace. These units observe a 5:00pm check-in and 11:00am check-out.