PENS National Conference16 Registration

REGISTRATION BROCHURE

2016 NATIONAL CONFERENCE

THE SKY’S THE LIMIT: TRANSFORMING OUR FUTURE

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REGISTRATION BROCHURE

Purpose

Accreditation

The Pediatric Endocrinology Nursing Society (PENS) is committed to the advancement of the art and science of pediatric endocrinology nursing. This includes the establishment and continued development of standards of practice, the enhancement of nursing research, the advancement of clinical expertise and the promotion of recognition of excellence in nursing practice.

Application has been made to the Greater Kansas City Chapter of the American Society for Pain Management Nursing, an approved provider of continuing nursing education by the Kansas State Board of Nursing. Kansas State Board of Nursing provider number LT0279-0412.

Program Description The Annual Conference provides a forum for educational opportunities as well as a chance to interact with colleagues and experts in the field of pediatric endocrinology. The faculty will present information on a variety of pediatric endocrine disorders, as well as topics of general interest to nurses and other health care professionals. Teaching methods will include lectures, interactive sessions, discussions, workshops and poster sessions.

Application has also been made to the Kansas Board of Pharmacy, an approved provider of continuing pharmacology hours. In order to receive contact hours for this conference, participants must complete the online evaluation.

Networking

The conference is designed for nurses and other health care professionals interested in recent developments in the field of pediatric endocrinology nursing, including pediatric diabetes.

One of the key benefits of attending the PENS Conference is the opportunity to develop and continue relationships with your colleagues through networking. Networking offers many tangible benefits to conference participants, including, but not limited to, validating your experience in providing nursing care and developing a better understanding of your practice and your role in care delivery by learning from others are dealing with similar circumstances, solving the same problems and confronting the same issues. Take advantage of this national gathering of pediatric endocrinology nurses to learn more about national issues and trends.

Program Goals

Message Board

It is PENS’ goal to promote high quality endocrinology nursing practice through this educational offering.

Conference participants receive the latest information in basic to advanced practice, experience and research as demonstrated by pediatric endocrinologists and pediatric endocrinology nurses.

PENS will provide a message board to facilitate networking.

Bring with you to the 2016 National Conference job openings, questions and ideas to post for response by your PENS colleagues. If you have a special interest, arrange to meet others with that same interest.

Target Audience

Program Objectives  Develop new skills to improve educational and patient outcomes  Provide educational opportunities in pediatric endocrinology for nurses and others with expertise in the area  Promote the pursuit of nursing practice and research through a research presentation and poster session  Provide educational opportunities in the management and treatment of selected endocrine disorders  Provide direction for understanding health care changes  Objectives for each session are listed within the schedule

Posters PENS is providing a venue for meeting attendees to view and discuss participants’ poster presentations on Friday evening.

Visit with the poster presenters and learn about current research that will affect your clinical practice!

PENS Conference Planning Committee Meg Keil, PhD, CRNP, Chair Rebecca Crespi, RN, MSN, CPNP Cathy Metzinger, AAS, RN, CDE Tamara Nenadovich, RN Maryann Johnson, BSN, RN, Board Liaison

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THE SKY’S THE LIMIT: TRANSFORMING OUR FUTURE REGISTRATION BROCHURE

HOTEL INFORMATION Registration Information Early Registration: On or before March 22, 2016 Regular Registration: March 22 - April 27, 2016 Onsite Registration: After April 27, 2016

Denver Marriott City Center  1701 California St. Denver, CO 80202

You will receive a confirmation letter approximately two weeks after receipt of your registration form. Confirmation letters will not be sent after April 27, 2016.

Payment must accompany the registration form. Registration forms received without payment will not be processed until payment is received.

Registration fees include the educational program, networking events, and all meal functions.

Cancellation & Transfers Cancellations and transfers must be requested in writing and postmarked, faxed or emailed by April 27, 2016. Refunds will be issued following the conference.

A $50 administrative fee will be assessed. Cancellation requests must include the reason for the cancellation. If you transfer your registration to another person, please include a completed registration form for that person with your written request. Requests for cancellation postmarked, emailed or faxed after April 27, 2016, are not refundable.

Towering above the Mile High City, Denver Marriott City Center exceeds expectations with exceptional service and thoughtful amenities in a convenient location. This downtown Denver hotel boasts breathtaking views of the Rocky Mountains and city skyline and is near the Colorado Convention Center, 16th Street Mall, Coors Field, Pepsi Center, Sports Authority Field and Denver Art Museum. With farm-to-table dining at Prospect’s Urban Kitchen and Bar, a state-of-the-art fitness center, indoor pool and deluxe guest rooms with high-speed Wi-Fi and plush bedding, we make it easy for business and leisure travelers to relax and breathe in the fresh mountain air in style. Thrive during your stay at Denver Marriott City Center while tapping into all of downtown Denver’s high energy. Used with permission from the Denver Marriott City Center.

To prevent attendees from having to stay at an overflow hotel, participants will need to register for the conference to receive the hotel reservation link, which is provided on the confirmation page when registering online. If you register using the PDF form, once your completed form is received and processed, you will be sent a confirmation email with the link to make your hotel reservation.

Room rate: $164 plus tax per night single/double occupancy including guest room internet and complimentary fitness center access.

Reservation deadline: Book by Tuesday, April 19, 2016 to receive group room rate.

Please note if your conference registration is submitted after April 19, 2016 this does not guarantee the group rate at the hotel. To ensure you receive the group rate, please turn in your registration before April 19, 2016.

TRANSPORTATION INFORMATION The Denver Marriott City Center is located 26 miles from the Denver International Airport.

Taxi – Taxis are approximately $60.00 one-way.

RTD Commuter Rail – In April 2016 Denver RTD will open a new rail line from the Denver International Airport to Union Station in Downtown Denver. Union Station is located approximately 10 blocks from the Denver Marriott City Center and just one block from the FREE 16th St. Mall Shuttle that will drop you off 1 block from the Marriott. One way service on the RTD Rail will be $9.00 one way. For more information on the RTD Rail and rate information please visit their website at www.rtd-denver.com.

Shuttle Service – Super Shuttle is offering PENS Attendees a discount on round-trip service from the Denver International Airport. The special PENS rate is $38 and reservations are required. To make reservations online please visit https://reservations.supershuttle.com and use the Code: JTY9C.

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REGISTRATION BROCHURE CONFERENCE PROGRAM SCHEDULE

Thursday, May 12, 2016 8:00 a.m. - 5:00 p.m.

H.A.N.D.S. SM Pre-Conference Workshop

This workshop requires separate registration and additional fee. If the workshop does not achieve minimum registration, it is subject to cancellation. If cancelled, registration fees will be refunded in full.

 Summarize current knowledge and guidelines related to diabetes and diabetes management at school.  Identify the school nurse’s role in developing and maintaining a student’s individualized healthcare plan for safe, effective diabetes management at school.  Describe the management of hypoglycemia and hyperglycemia at school.

H.A.N.D.S.SM is a one-day educational program developed by the National Association of School Nurses (NASN). Course materials include a H.A.N.D.S.SM Participant Manual and numerous resources to support school nursing practice as it relates to diabetes management in school-aged pupils. The NASN-approved education program is available here. A completed evaluation and full day attendance are required to receive 6.5 CE contact hours.

4:30 - 5:30 p.m.

New Member & Past Presidents Reception

5:30 - 7:30 p.m.

Welcome Reception in Exhibit Hall

7:30 - 10:30 p.m.

Evening Event at the Denver Athletic Club -- Sponsored by Lilly Join your PENS colleagues for a truly unique Denver dining experience. Enjoy Denver Athletic Club’s rooftop deck with a view of the Rocky Mountains, downtown Denver like you’ve never seen before and crisp mountain air. You will enjoy one-of-a-kind Denver bites, local brews and local wines while networking and relaxing under the stars.

Friday, May 13, 2016 7:00 - 7:45 a.m.

Breakfast

7:45 - 8:00 a.m.

Welcoming and Opening Remarks Maryann Johnson, BSN, RN, PENS President

8:00 – 9:00 a.m

Opening Keynote Address: Compassionate Care of Those Who Suffer from Addictive Disorders Donna White RN, PhD, CS, CADAC  Define types of addictive disorders.  Discuss principles of addictive treatment.  Describe types of intervention and treatment.

9:00 – 10:00 a.m.

GENERAL SESSION 1: Metabolic Effects of Growth Hormone (GH)

 Describe the effects of GH on the metabolism of glucose, protein and fat under normal and pathologic conditions.  Explain the difference between the metabolic effects of GH deficiency or excess from those of IGF-I deficiency or excess.  Discuss how to apply this information in counselling and management of patients on GH therapy.

10:00 -10:30 a.m.

10:30 – 11:30 a.m.

Mark Sperling, MD

Break in Exhibit Hall GENERAL SESSION 2: Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children

 Identify which babies to screen for hypoglycemia.  Describe how to investigate a baby with suspected hypoglycemia.  Explain the treatment of neonatal hypoglycemia.

Paul Thornton, MD

11:30 a.m. - 12:30 p.m. GENERAL SESSION 3: Hypogonadism in Adolescents: Approach to Treatment and Transition to Adult Care  Describe the variation in pubertal timing.  Identify ways to implement a more patient centered approach to adolescents with pubertal disorder.  Analyze what steps can be taken to enhance/improve transitional care in their practice.

Andrew Dwyer, PhD, FNP-BC

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THE SKY’S THE LIMIT: TRANSFORMING OUR FUTURE REGISTRATION BROCHURE CONFERENCE PROGRAM SCHEDULE 12:30 – 2:00 p.m.

2:00 – 3:00 p.m.

Luncheon with Exhibitors Concurrent Session 1A: Islet Cell Transplantation

 Define islet allo-transplantation.  Describe specific indications for islet allo-transplantation.  Discuss the limitations to islet allo-transplantation and the future directions of research.

2:00 – 3:00 p.m.

Concurrent Session 1B: Updates in Endocrine Pharmacology for the APN

 Discuss advanced drug treatment plans for endocrine patients.  Describe drug therapies currently available for difficult diabetes cases.  Identify the benefits of new drugs on the horizon for both endocrine and diabetes patients.

2:00 – 3:00 p.m.

Concurrent Session 1C: Organized Approach to Pumping (with and without Continuous Glucose Monitoring System (CGMS)) and Pump Data Analysis Workshop

 Describe the four (4) step approach to pump training.  Identify the timing of when to add the CGMS.  Recognize trends in pump and CGMS downloads.

3:00 – 3:30 p.m.

3:30 – 4:30 p.m.

Concurrent Session 2A: Pediatric Thyroid Nodules and Differentiated Thyroid Cancer: Exploring the New Management Guidelines

Concurrent Session 2B: Cystic Fibrosis-Related Diabetes (CFRD)

 Describe pathophysiology and diagnosis of Cystic Fibrosis-Related Diabetes (CFRD).  Explain management goals of CFRD.  Discuss collaboration between Endocrine, Pulmonary, Gastroenterology, and Psychology services.

3:30 – 4:30 p.m.

Concurrent Session 2C: Beyond the ‘mones: The Art of Transgender Care with Youth

 Describe a welcoming approach to transgender and gender expansive youth.  Identify the ways in which transgender youth express themselves in their transition.  Discuss ways to support and affirm a young person and their adult caregivers as they transition.

3:30 – 4:30 p.m.

Concurrent Session 2D: Linear Growth Assessment: Evaluation, Causes and Treatment of Growth Failure

 Describe the steps in accurate growth assessment.  List the causes of growth failure.  Explain the treatment of growth disorders.

4:30 – 5:30 p.m.

Concurrent Session 3A: Testotoxi-WHAT? Overview of Diagnosis and Treatment of Testotoxicosis

 Identify the diagnostic criteria for testotoxicosis.  Explain the difference in diagnosis of central precocious puberty from adrenal issues.  Discuss various drug therapies for testotoxicosis and potentially the treatment for central precocious puberty.

4:30 – 5:30 p.m.

Gregory P. Forlenza, MD, MCR PHARM/ADV Dana Greer, APRN, CPNP, CDE DM/BAS

Mako E. Sather, RN, MSN, CPNP

Break in Exhibit Hall

 Describe the importance of the inaugural pediatric specific American Thyroid Association (ATA) management guidelines and how these guidelines may impact healthcare delivery.  Identify key features of clinical presentation of pediatric thyroid nodules and differentiated thyroid cancer.  Describe the treatment and long-term outcomes of children with papillary thyroid cancer (PTC).

3:30 – 4:30 p.m.

DM/ADV

Concurrent Session 3B: Septo Optic Dysplasia in Children

 Describe and define septo optic dysplasia.  Explain the difference between typical child development to that of children who are visually impaired.  Discuss pituitary hormone needs in children with septo optic dysplasia.

ENDO/ADV Sarah J. Bottomley, MSN, RN, CPNP; Angela R. Yarbrough, MSN, RN, FNP-BC DM/ADV Shayne Dougherty, MSN, CRNP ENDO/BAS Joanne M. Goodall, CRNP

ENDO/BAS Terri Lipman, PhD, CRNP, FAAN

ENDO/ADV Janet L. Moore, MSN, RN, CPNP ENDO/BAS Kathryn Clark, PPCNP-BC

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THE SKY’S THE LIMIT: TRANSFORMING OUR FUTURE REGISTRATION BROCHURE CONFERENCE PROGRAM SCHEDULE 4:30 – 5:30 p.m.

Concurrent Session 3C: The Path from Hormone Abnormality to Hypoglycemia

 Discuss the human body systems required for normal fasting adaptation.  Describe how hormone abnormalities can lead to hypoglycemia.  Discuss case studies of infants and children with hypoglycemia and determine which hormone(s) could be implicated as a cause of hypoglycemia.

DM/ADV Linda Steinkrauss, RN, MSN, CPNP

5:30 – 7:00 p.m.

Poster Reception in Exhibit Hall

7:30 - 10:30 p.m.

Evening Event at Lucky Strike Denver -- Sponsored by EMD Serono Get your dancing and bowling shoes ready for rocking good time at Lucky Strike Denver. With a tantalizing menu of chef driven cuisine, hand-crafted cocktails, and a live local DJ, Lucky Strike Denver breathes new life into the typical bowling experience with chic modern decor and a one-of-a-kind atmosphere.

Saturday, May 14, 2016 8:00 - 9:00 a.m

Awards Breakfast

9:00 - 10:00 a.m.

Keynote: Professional Development: From Here to There and in Between Cecily Betz, PhD, RN, FAAN

10:00 – 10:15 a.m.

Break

10:15 - 11:15 a.m.

GENERAL SESSION 4: Research Oral Presentations

 Development and Psychometric Testing of the Neonatal Growth Measurement Survey  Screening for Retinopathy in Children and Adolescents with Diabetes Mellitus (DM)  Development of a Pediatric Screening Tool for Diabetic Peripheral Neuropathy

Jan M. Foote, DNP, ARNP, CPNP; Erika McCann, RN, BS, BSN, MS; Joanne T. Moser, MSN, CRNP

11:15 a.m. - 12:15 p.m. GENERAL SESSION 5: Bionic Pancreas: From Dream to Realization  Identify the challenges that must be met to automate control of blood glucose levels in people with type 1 diabetes.  List the elements of an automated closed-loop bionic pancreas.  Describe the results of a recent clinical study of closed-loop blood glucose control using subcutaneous delivery of insulin and glucagon.

12:15 – 1:30 p.m.

1:30 – 2:30 p.m.

Membership Meeting/Lunch Concurrent Session 4A: Writing for Publication

 List the knowledge and skills necessary for writing for newsletters, journals, and other nursing related publications.  Identify a potential topic for publication based on your area of clinical expertise.  Identify potential organizational resources within the work setting that can be accessed to achieve your publication goal.

1:30 – 2:30 p.m.

Concurrent Session 4B: Endocrine Advanced Practice Nurse Case Studies

 Bone Disorder as a Result of Zolendronate Treatment for OI Gene Mutation  Vitamin D: How Much, How Often and What Formulation Works the Best?  Hyperinsulinism: Beyond the Naked Eye Update - a Rare Form of HI Found to Have Only Mutations in the Pancreatic Tissue 1:30 – 2:30 p.m.

Scott Scolnick, M.Ed.

Concurrent Session 4C: Diabetes Advanced Practice Nurse Case Studies

 Ten Dogs, An Elevated HbA1c and Severe Hypoglycemia: An Autoimmune Endocrine Story  Scaring the Dermatologist: A look at Xanthoma in Diabetes  Taking the Leap: A Patient’s Journey to Adult Care

ALL/BAS Cecily Betz, PhD, RN, FAAN

ENDO/ADV Wendy Schwarz, RN; Eileen Pyra, RN, MN; Vivian Enyo Dzata, MSN, CRNP DM/ADV Melissa Rearson, MSN, CRNP; Shari Liesch, APNP, CDE; Mandi Cafasso, DNP, RN, CNP

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THE SKY’S THE LIMIT: TRANSFORMING OUR FUTURE REGISTRATION BROCHURE CONFERENCE PROGRAM SCHEDULE 2:30 - 2:45 p.m.

2:45 – 3:45 p.m.

Break Concurrent Session 5A: Endocrinopathies Related to Cancer Therapy

 Describe the endocrine sequelae of childhood cancer therapies.  Discuss the common risk factors for developing endocrionpathy after cancer treatment.  Explain guidelines for monitoring, diagnosis and treatment.

2:45 – 3:45 p.m.

Concurrent Session 5B: Central Precocious Puberty: To Treat or Not to Treat and Other Clinical Dilemmas

 Describe potential pharmacologic options for treating patients with central precocious puberty and identify appropriate use of these medications.  Discuss current practice styles and potential ways to either maintain or change their current styles based on current research data.

2:45 – 3:45 p.m.

Concurrent Session 5C: Sweet Bouncing Baby on Insulin: Transient Neonatal Diabetes Mellitus

 Identify and define neonatal diabetes.  Describe the difference between transient neonatal diabetes vs. permanent neonatal diabetes.  Describe the complexity of transition to pump and use of diluted insulin.  Explain the barriers to transitioning this patient from hospital to home.  Discuss how to apply new knowledge to future care of new onset diabetes patient and family centered care.

2:45 – 4:15 p.m.

Concurrent Session 5D: Ready, Set, Research!

 Identify a clinical problem.  Investigate what is already known about this clinical problem.  Create an idea and form a research question to address the problem.  Design a research project.  Develop a plan on how to execute the project and obtain potential funding.

ENDO/ADV Angela R. Yarbrough, MSN, RN, FNP-BC; Sarah J. Bottomley, MSN, RN, CPNP ENDO/BAS Megan Lessig, MSN, CRNP

DM/ADV Shannon Abernethy, RN, CPN

ALL/BAS Carol Howe, PhD, RN, CDE; Sharron Close, PhD, MS, RN, CPNP-PC; Terri Lipman, PhD, CRNP, FAAN; Meg Keil, PhD, CRNP

4:30 – 5:30 p.m.

Committee Meetings:  Conference Planning Committee  Education Committee - open to new members  Nominating Committee  Research Committee - open to new members

7:30 - 10:30 p.m.

Evening Event -- Sponsored by Novo Nordisk Enjoy a fun, relaxing evening enjoying tasty eats, delicious drinks and one-of-a-kind entertainment – all without leaving the hotel! The music won’t stop until 10:30 pm and the food and bars will continue to flow. This event will have you dancing until your feet ache – luckily you will be just an elevator ride away!

Sunday, May 15, 2016 8:00 – 9:00 a.m.

Leadership Breakfast

9:00 - 10:00 a.m.

Keynote: Fundraising Best Practice Tips Tom Karlya, BA, Diabetes Dad

 Identify areas of fundraising not typically distinguished during the course of usual work-place activities.  Explain the strategy for fundraising that will establish projects and programs in the participants’ schools.  Discuss fundraising best-practices learned through both lecture and role playing exercises.

10:00 - 10:15 a.m.

Break

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THE SKY’S THE LIMIT: TRANSFORMING OUR FUTURE REGISTRATION BROCHURE CONFERENCE PROGRAM SCHEDULE 10:15 – 11:15 a.m.

Concurrent Session 6A: Pseudohypoparathyroidism: Case Presentation and Literature Review

 Identify signs and symptoms of pseudohypoparathyroidism.  Identify methods of properly diagnosing pseudohypoparathyroidism.  Explain the underlying genetics of pseudohypoparathyroidism.

10:15 – 11:15 a.m.

Concurrent Session 6B: Exploring the Benefits of Pump (& Sensor) Therapy When Steroids Are Needed

 Explain the differences between insulin action times for multiple daily injections (MDI) and insulin pump therapy.  Discuss sick care using separate basal pattern for illness, temporary basal, and sensor.  Explain the benefits to pump therapy as related to overall quality of life.

11:15 a.m. - 12:15 p.m. Concurrent Session 7A: Autoimmune Endocrine Disorders: Who and How to Evaluate - A Case Based Discussion  Describe the screening guidelines for autoimmune endocrine disorders in patients with type-1 diabetes, Down syndrome and Turner syndrome.  Identify clues in the history and physical examination that would lead to further testing for autoimmune endocrine disorders.  Discuss laboratory evaluation for autoimmune endocrine disorder.

11:15 a.m. - 12:15 p.m. Concurrent Session 7B: Thyroid Cancer: It’s Not Just for Adults  Describe the clinical presentation of thyroid cancer in children and young adults.  Discuss the clinical course and management of thyroid cancer in children.  Explain the follow-up management of thyroid cancer in children.

12:15 p.m.

Boxed Lunches

Level of Presentation:

ENDO/ADV=Advanced Endocrine

ENDO/BAS=Basic Endocrine

DM/ADV=Advanced Diabetes

DM/BAS=Basic Diabetes

PHARM/ADV=Advanced Pharmacology

ALL/BAS=All are invited

ENDO/ADV Aristides K. Maniatis, MD, FAAP DM/ADV Shari Liesch, BSN, APNP, CDE

ENDO/ADV Jennifer M. Barker, MD

ENDO/BAS Elaine Pottenger, MS, RN, CPNP, PMHS; Deborah Diotallevi, MS, RN, CPNP; Amelia DeRosa, BSN, RN, CPON

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REGISTRATION BROCHURE FACULTY LISTING Shannon Abernethy, RN, CPN Nurse Navigator Bon Secours Pediatric Endocrinology Richmond, VA

Jan M. Foote, DNP, ARNP, CPNP Pediatric Nurse Practitioner Blank Children’s Endocrinology Clinic Des Moines, IA

Janet L. Moore, MSN, RN, CPNP Pediatric Nurse Practitioner, Instructor of Pediatrics University of Toledo Sylvania, OH

Jennifer M. Barker, MD Associate Professor of Pediatrics University of Colorado Aurora, CO

Gregory P. Forlenza, MD, MCR Assistant Professor Barbara Davis Center - University of Colorado Denver Aurora, CO

Joanne T. Moser, MSN, CRNP Registered Nurse UPMC Children’s Hospital of Pittsburgh Pittsburgh, PA

Cecily Betz, PhD, RN, FAAN Professor of Nursing of Clinical Pediatrics Editor-in-Chief, Journal of Pediatric Nursing: Nursing Care of Children and Families University of Southern California, Keck School of Medicine, Department of Pediatrics Los Angeles, CA Sarah J. Bottomley, MSN, RN, CPNP Pediatric Nurse Practitioner U.T. MD Anderson Cancer Center Houston, TX Mandi Cafasso, DNP, RN, CNP Nurse Practitioner Cincinnati Children’s Hospital Medical Center Cincinnati, OH

Joanne M. Goodall, CRNP Nurse Practitioner Center for Adolescent and Young Adult Health - CHP Pittsburgh, PA Dana Greer, APRN, CPNP, CDE Pediatric Nurse Practitioner, Certified Diabetes Educator Oklahoma University (OU) Physicians-Tulsa Harold Hamm Diabetes & Endocrinology Clinic Tulsa, OK Carol Howe, PhD, RN, CDE Assistant Professor Harris College of Nursing and Health Sciences Texas Christian University Fort Worth, TX

Kathryn Clark, PPPCNP-BC Pediatric Nurse Practitioner University of Michigan Pediatric Endocrinology Tom Karlya, BA Vice President; Author/Creator of Ann Arbor, MI www.DiabetesDad.org Sharron Close, PhD, MS, RN, CPNP-PC Diabetes Research Institute Foundation Clinical Instructor Hollywood, FL Columbia University School of Nursing Chappaqua, NY Amelia DeRosa, BSN, RN, CPON Pediatric Long Term Follow Up Program Memorial Sloan Kettering Cancer Center New York, NY Deborah Diotallevi, MS, RN, CPNP, PMHS Pediatric Nurse Practitioner - Pediatric Long Term Follow Up Program Memorial Sloan Kettering Cancer Center New York, NY Shayne Dougherty, MSN, CRNP Endocrine Nurse Practitioner/Diabetes Specialist The Children’s Hospital of Philadelphia Doylestown, PA Andrew Dwyer, PhD, FNP-BC Chef de Projet University Hospital Lausanne Switzerland (CHUV) Lausanne, Switzerland Vivian Enyo Dzata Pediatric Enodcrine Nurse Practitioner Children’s Hospital of Philadelphia Philadelphia, PA

Meg Keil, PhD, CRNP Senior Nurse Practitioner-Research National Institute of Health Chevy Chase, MD Megan Lessig, MSN, CRNP Pediatric Endocrine Nurse Practitioner The Children’s Hospital of Philadelphia Cherry Hill, NJ

Elaine Pottenger, MS, RN, CPNP, PMHS Nurse Practitioner Memorial Sloan Kettering Cancer Center New York, NY Eileen Pyra, RN,MN Endocrine Clinical Nurse Specialist Alberta Children’s Hospital Calgary, AB, Canada Melissa Andrews Rearson, MSN/CRNP Pediatric Nurse Practitioner Children’s Hospital of Philadelphia/Division of Endocrinology & Diabetes Philadephia, PA Mako E. Sather, RN, MSN, CPNP Nurse Practitioner Rocky Mountain Pediatric Endocrinology Littleton, CO Wendy Schwarz, RN Clinical Resource Nurse Alberta Children’s Hospital Calgary, AB, Canada Scott Scolnick, M.Ed. Consultant - Bionic Pancreas Program Boston University Boston, MA Mark A. Sperling, MD Emeritus Professor of Pediatrics, University of Pittsburgh Professorial Lecturer, Dept. of Pediatrics, Icahn School of Medicine at Mt Sinai New York, NY

Shari Liesch, BSN, APNP, CDE Nurse Practitioner/Certified Diabetes Educator Linda Steinkrauss, RN, MSN, CPNP Children’s Hospital of Wisconsin Nurse Practitioner Neenah, WI A.I.duPont Hospital for Children Terri Lipman, PhD, CRNP, FAAN Newark, DE Assistant Dean for Community Engagement, Paul Thornton, MD Miriam Stirl Endowed Term Professor of Medical Director Diabetes and Endocrinology Nutrition, Professor of Nursing for Children Cook Children’s Medical Center University of Pennsylvania School of Nursing - Ft. Worth, TX Children’s Hospital of Philadelphia Donna White, RN, PhD, CS, CADAC Merion, PA Addiction Specialist Aristides K. Maniatis, MD, FAAP Lemuel Shattock Hospital Pediatric Endocrinologist Boston, MA Rocky Mountain Pediatric Endocrinology Angela R. Yarbrough, MSN, RN, FNP-BC Centennial, CO Family Nurse Practitioner Erika McCann, RN, BS, BSN, MS M.D. Anderson Cancer Center Registered Nurse Houston, TX UPMC Children’s Hospital of Pittsburgh Pittsburgh, PA

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REGISTRATION FORM PENS Executive Office, P.O. Box 14516, Lenexa, KS 66285-4516  Fax 913-895-4652  Register Online: www.pens.org Final registration deadline is April 27, 2016. If you are registering after April 8, please bring your completed paperwork and payment with you to the conference.

STEP ONE: Registration Information First Name M.I. Last Name Credentials (LIST 2 ONLY) Employer

 Home  Work Preferred Address – please indicate home or work City State Zip Country Daytime Telephone Number Fax Email Address

SPECIAL NEEDS

D. Spouse/Guest Registration

 I will need assistance:___________________________________________________ I have the following dietary requirements:  Gluten Free Diet  Vegetarian

 Vegan  Gluten Allergy  Other:____________________________ EMERGENCY CONTACT INFORMATION Name Relationship Phone Number

 This is my first PENS conference.  Do not provide my contact information on vendor lists or pre-registration attendee roster.

STEP TWO: Registration A. Pre-Conference Registration - H.A.N.D.S. SM Workshop Pre-Conference Workshop registrations do not include the Thursday New Member, Reception, Welcome Reception or Evening Event. If you would like to attend these events please register below.  Member (NASN or PENS) $95  Non-member $115 0 Section A Total: __________ B. Full Conference Registration

On or Between After 4/27

before 3/22 3/22 & 4/27 (on-site)

 Member  Non-Member

 $475  $600

 $550  $675

(only includes evening events of Thursday, Friday, and Saturday)

_____ Spouse/Guest $325 total for all three events.

$150 each for Thursday, Friday, or

Saturday.

My Guest will be attending the evening event on:

 Thursday  Friday  Saturday Guest Name(s): Section D Total: __________ E. RSVP! Please indicate which concurrent sessions you are interested in attending. Your assistance will help us assign each speaker to an appropriately sized room. Please check one session letter for each column.

Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Session 7  A  A  A  A  A  A A  B  B  B  B  B  B B  C  C  C  C  C C  D D

 $700  $825 0 Section B Total: __________

C. Single Day Registration Check desired day: Thursday Events Only  Member $200  Non-Member $325 New Member Reception, Welcome Reception and Evening Event only – does not include the Pre-Conference Workshop  Member $225  Non-Member $350 Friday  Member $225  Non-Member $350 Saturday  Member $100  Non-Member $225 Sunday 0 Section C Total: __________

Cancellations & Transfers Cancellations and transfers must be requested in writing and postmarked, faxed or emailed by April 27, 2016. Refunds will be issued following the conference. A $50 administrative fee will be assessed. Cancellation requests must include the reason for the cancellation. If you transfer your registration to another person, please include a completed registration form for that person with your written request. Requests for cancellation postmarked, emailed or faxed after April 8 are not refundable.

If you register after April 27, please bring your registration form and payment with you to the conference as it WILL NOT be processed at the PENS Executive Office after that date.

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2016 NATIONAL CONFERENCE

REGISTRATION FORM, continued STEP THREE: Total Fees Enclosed

 Check (made payable to PENS)

A. Pre-Conference Registration

$____________

 American Express  MasterCard  Visa  Discover

B. Full Conference Registration

$____________

C. Single Day Registration

$____________

D. Spouse/Guest Registration

$____________

0 TOTAL ENCLOSED: $____________ All fees must be paid in U.S. dollars, with checks drawn in U.S. funds on U.S. banks. Purchase orders are NOT accepted.

PENS Tax ID: 38-2757646

Register online at www.pens.org.

Card Number Expiration Date Cardholder Name Cardholder Signature

Final registration deadline is April 27, 2016 Please return this form with the TOTAL AMOUNT DUE to: Register online at: www.pens.org

By Mail: PENS P.O. Box 14516 Lenexa, KS 66285-4516

By Overnight Courier ONLY: PENS 18000 W. 105th St. Olathe, KS 66061

By Fax (with credit card information): 913-895-4652

Contact the PENS Executive Office for further information: 913-895-4628.