Mended Hearts 63rd Education and Training Conference Registration Packet June 24 – 27, 2015 Orlando, FL Mended Hearts welcomes you to sunny Orlando for the 63rd Annual Conference. Our goal this year was to focus on what we could offer, you, the attendee, to make this the most memorable event ever! We feel we have accomplished this with ample opportunities to network with other Mended Hearts members from across the country, participate in valuable workshops on chapter and member development, and hear the latest on heart related trends from cardiologists and healthcare team professionals. To make this an even more informative event, we will open the doors to the general public (at a nominal fee) for our first ever MHI Patient and Caregiver Symposium. Your registration fee covers your attendance to this priceless day. Speaking of registration fee, we have found a way to creatively offer you the lowest registration fee since 2005! Also, a special evening is being planned for the Farewell Dinner, with the installment of the 2015-2017 National Board of Directors. It is an event you will not want to miss! The Buena Vista Palace Hotel and Spa offers a premier meeting experience in the heart of the world famous Downtown Disney. Directly across the street from Downtown Disney, with a FREE shuttle to all Disney Theme Parks. Oh, and did I mention that we have arranged FREE transportation to and from the airport for those arriving on June 24th and departing on June 28th? Be sure to register your transportation through the Hello Florida link on the Mended Hearts website. I would like to extend a special welcome to the first time attendees. May this year be the first of many more conferences in your future! Don’t forget to sign up for the buddy program and connect with Mended Hearts members from across the country, even before the conference! I wish to extend a special “Thank You” to the conference committee, program committee, local volunteers and the great Mended Hearts Staff – my hat’s off to you for a job well done! Enjoy and learn, Marvin Keyser National Conference Chairman 1 Program All meetings are on the Convention Level unless otherwise noted. Wednesday, June 24, 2015 – Day 1 Begin/End Time Noon – 5:00 pm Function Attendee Arrival – Registration – Badge pick-up Meeting Room Events Center Noon – 5:00 pm Social time and Visit Exhibitors Exhibits Center 2:00 pm – 3:00 pm First Timers/Buddy Orientation Lynn Frierson, Conference Program Chair Mended Hearts, Inc. Board of Directors meeting All attendees are welcome to this open board meeting! Great Hall Center 3:15 pm - 5:15 pm 5:30 pm – 6:30 pm Welcome Reception and Entertainment Lobby Level Cloister North/ South Great Hall North 6:30 pm – 8:30 pm Welcome Dinner / Hats off to Our Heroes! Great Hall North 2 Thursday, June 25, 2015 – Day 2 Begin/End Time: 7:00 am – 7:30 am 8: 00 am – 9:15 am Function Meeting Room Morning Walk, Jim Oldfield, Walk Leader, Pontiac, Meet in Hotel Lobby Michigan Chapter 230 Coffee and Muffins Regional Meetings – Please attend your region’s individual program: Convention Center: Central Region Events Center A/B Mid-Atlantic Region Events Center C/D Midwest Region Events Center C1/D1 Northeast Region Events Center E/G1 Rocky Mountain Region Events Center F/G Southern Region Events Center H/I Southwest Region Lobby Level: Cloister North Western Region Lobby Level Cloister South 9:30 am –10:30 am Annual Meeting General Session Great Hall North 11:15 am – 1:15 pm Luncheon – “Living with Heart Failure” A joint program of Mended Hearts and American College of Cardiology CardioSmart Great Hall North 1:45 pm – 2:45 pm Two Concurrent Workshops A – Chapter Building/Member Recruiting & Engaging Ron Manriquez, Lakewood, California Chapter 149 Great Hall Center B – Ask the Pharmacist a Question / Medication Adherence Sarah Spinler, PharmD, Professor of Clinical Pharmacy Philadelphia College of Pharmacy, Philadelphia Scotland Orlando-based Pharmacy school students/Q & A 2:45 pm – 3:00 pm Break/Member Networking 3:00 pm – 4:00 pm Two Concurrent Workshops repeat 4:30 pm – 6:00 pm Event Center A – Chapter Building/Member Recruiting and Engaging Ron Manriquez, Lakewood, California Chapter 149 Great Hall Center B – Ask the Pharmacist a Question / Medication Adherence Sarah Spinler, PharmD, Professor of Clinical Pharmacy Philadelphia College of Pharmacy, Philadelphia Orlando Pharmacy program students Scotland Mended Hearts/Mended Little Hearts RD & ARD Training Session Regional Directors, MH & MLH Assistant Regional Directors Lynn Berringer, Vice President Patrick Farrant, Vice President-elect Great Hall West Dinner on Your Own 3 Friday, June 26, 2015 – Day 3 Begin/End Time: 7:00 am – 7:30 am Function Morning Walk, Jim Oldfield, Walk Leader, Pontiac, Michigan Chapter 230 Meeting Room Meet in Hotel Lobby 7:30 am – 8:15 am Coffee – Member Networking Events Center 8:30 am – 9:30 am MH & MLH General Session: Inspiring Volunteer Leadership! Pamela Landwirth, President, Give Kids the World Great Hall North/Center 9:30 am – 9:45 am Break Great Hall Assembly Center 9:45 am – 10:45 am General Session Great Hall North/Center C - Twenty Tried and True Ways to Spice Up Your Chapter! Cathy Byington, Midwest Regional Director/President, Sioux Falls, South Dakota Chapter 214 10:45 am – 11:00 am Break Great Hall Assembly Center 11:00 am – 11:45 am General Session: Great Hall North/Center D – Lifestyle Changes After a Heart Event Pradip Jamnadas, MD, MBBS, FACC, FSCAI, FCP, FACP Interventional Cardiologist, Cardiovascular Interventions, P.A. Orlando, Florida 11:45 am – 1:45 pm Lunch On Your Own 1:45 pm – 2:45 pm Two Concurrent Workshops E – Recruit, Train, Retain! Fredonia B Williams, Ed. D., National Visiting Chair, Huntsville, Alabama Chapter 260 Great Hall North F – Partnering with Hospitals to reduce Readmissions! Julie Lietaert, RN, and Joyce Reid, RN Cardiovascular Institute, Memorial Regional Hospital, Hollywood, Florida Great Hall Center 2:45 pm – 3:00 pm Break Great Hall Assembly Center 3:00 pm – 4:00 pm Two Concurrent Workshops repeat E – Recruit, Train, Retain! Fredonia B Williams, Ed.D., National Visiting Chair, Huntsville, Alabama Chapter 260 Great Hall North F – Partnering with Hospitals to reduce Readmissions! Julie Lietaert, RN, and Joyce Reid, RN Cardiovascular Institute, Memorial Regional Hospital, Hollywood, Florida Great Hall Center Dinner on Your Own 4 Saturday, June 27, 2015 – Day 4 Begin/End Time: 7:00 am – 8:30 am Function Invitation only: Corporate Advisory Council, Sponsors, Board Breakfast 7:00 am – 7:30 am Morning Walk, Jim Oldfield, Walk Leader, Pontiac, Michigan Meet in Hotel Lobby Chapter 230 8:30 am – 9:00 am Coffee – Member Networking Events Center 8:30 am – 9:00 am Symposium Registration & Packet Pick-up All Conference attendees complimentary; open to public Visit Exhibitors Great Hall Registration Booth 9:00 am – 2:15 pm Patient Symposium – see separate program for all conference attendees “Empowering Heart Patients and Caregivers” Great Hall North/Center 2:15 pm Symposium Adjournment 2:30 pm – 3:45 pm Newbie Graduation, Lynn Frierson, Program Chair Great Hall North/Center 5:30 pm – 6:30 pm Reception Great Hall North/Center 6:30 pm Awards Banquet & Board Installation Great Hall North/Center Saturday evening Conference Adjournment Oxford Sunday, June 28, 2015 Begin/End Time: 7:30 am – 9:00 am Function Breakfast meeting, 2015-17 Board of Directors only Meeting Room Lobby Level: Oxford 5 Symposium Empowering Heart Patients & Caregivers Saturday June 27, 2015 9:00 am – 2:15 pm (includes light lunch) Convention Level: Great Hall North/Center Buena Vista Palace Orlando, Florida 8:30 – 9:00 am - Coffee / Peer Networking 9:00 am – Welcome & Introductions, Fredonia B. Williams, Ed.D., Master of Ceremonies and Mended Hearts Southern Regional Director, Huntsville, AL 9:05 am- Managing Cholesterol and Lipids Ralph Vicari, MD, FACC, FNLA Vice President, Foundation of the National Lipid Association Associate Professor of Cardiovascular Medicine University of Central Florida College of Medicine Melbourne, FL Diplomate, American Board of Clinical Lipidology 9:30 am – Heart Failure Symptoms and Treatments 10:00 am – 10:30 am– Break & Visit Exhibits 10:30 am – Hypertension & Heart Disease Kim Allan Williams, Sr., MD, FACC President, American College of Cardiology James B. Herrick Professor and Chief of Cardiology Division, Rush University Medical Center, Chicago, IL Dr. Williams received his undergraduate degree at the University of Chicago, followed by medical school at the University of Chicago's Pritzker School of Medicine. He completed his internal medicine residency at Emory University, and overlapping fellowships in cardiology, clinical pharmacology, and nuclear medicine at the University of Chicago. He is board certified in internal medicine, cardiovascular diseases, nuclear medicine, nuclear cardiology and cardiovascular computed tomography. In 2013, Williams assumed the position of James B. Herrick Professor and chief of the division of cardiology at Rush University Medical Center in Chicago, IL. Williams has served on numerous committees and boards at the national level, including the American Society of Nuclear Cardiology (ASNC), the American Heart Association, the American Medical Association (AMA), the Certifying Board of Nuclear Cardiology, the Certifying Board of Cardiac Computed Tomography, the Society of Cardiovascular Computed Tomography and the Association of Black Cardiologists (ABC). 11:00 am – Latest Innovations & Therapies in Interventional Cardiology James C. Blankenship, MD, MSc, FSCAI President, The Society for Cardiovascular Angiography and Interventions, Director, Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania Dr. Blankenship is a practicing interventional cardiologist at Geisinger Medical Center and is the director of the Geisinger Cardiology Department and catheterization laboratories. He is an adjunct professor of medicine at Temple University Medical College and has authored or co-authored over 200 scientific abstracts and publications. 6 11:30 am – Coronary Artery Disease and Angina J. Jeffrey Marshall, MD, FACC, FSCAI Medical Director, Cardiac Catheterization Lab, Northeast Georgia Medical Center, Gainesville, GA. Dr. Marshall has achieved many distinctions and awards in his medical profession from cardiac research, to Editorin-Chief of "Seconds Count", an educational website for patients. He was the former President of SCAI (The Society for Cardiovascular Angiography and Interventions), and spearheaded the angioplasty and acute MI (STEMI) programs at Northeast Georgia Medical Center (NGMC). His clinical interests include peripheral, carotid and coronary interventional procedures and research in these areas. Dr. Marshall is board certified in Internal Medicine, Cardiovascular Disease, and Interventional Cardiology. 12:00 noon – Panel Discussion/ Q & A – All Experts & Audience 12:45 pm - Light Lunch/Peer-to-Peer Networking Gus Littlefield, President, Mended Hearts, Inc. “Stroke: The Reality” Video (12 minutes) 1:45 pm –Clinical Trial Opportunities – Does it Fit for Me? Kwabena Ayesu, MD, Internist, Central Florida Regional Hospital, Orlando, FL 2:15 pm –Closing Remarks Dr. Fredonia B Williams, Symposium Adjournment A special thank you to the following sponsors for making this conference symposium possible: GENERAL INFORMATION 2015 Mended Hearts Annual Education and Training Conference Orlando, FL June 24 – 27, 2015 Join Mended Hearts members from across the country in Orlando, FL for a week of education, networking and entertainment. You won’t want to miss this opportunity to connect with other chapter members from across the nation. We sincerely hope that this information is helpful to you in planning your trip to the 2015 Mended Hearts Annual Education and Training Conference. Hotel Reservations: Please contact the hotel directly regarding your hotel accommodations. The Mended Hearts negotiated room rate is: $134 Single/Double occupancy; $154 Triple occupancy; $174 Quadruple occupancy; plus the current rate of 12.5% for state and local taxes (subject to change). Guest room rates are also available three days pre and post the official event dates and based on availability. Reservations must be made by June 2, 2015 to secure the MHI room rate. Buena Vista Palace Hotel & Spa 1900 Buena Vista Drive Lake Buena Vista, FL 32830 407-827-2727 or 1-866-397-6516 (Refer to group name “Mended Hearts”) Check in time: 4:00 p.m. Check out time: 11:00 a.m. Hotel Parking: The Buena Vista Palace Hotel & Spa offers valet parking and is available at the hotel entrance. Self-parking: Complimentary Overnight Valet: $21 per day with in/out privileges. Parking is charged to guest room. Hotel Cancellations: Room cancellations should be made directly with the hotel within five days prior to your arrival date to avoid credit card charges. 1 On-Site Hotel Services: A daily hotel services charge of $21.95 plus tax is INCLUDED in the room rate. Hotel services include: Wired and wireless in-room AT&T® High Speed Internet. (In-room WebTV® not included.) Cyber Café (24 hour access) located on the 1st floor of the main building. Pool Ambassador, offering personalized pool amenities and services. Daily Membership to the Fitness Center (guest room key required for entry) and Spa, including unlimited use of Fitness Center Equipment, lockers, hot tubs, sauna and shower facilities. Minimum age for Spa guests is 18 years. (Membership does not include Spa treatments or services). Weekday New York Times Newspaper available in lounge. In room coffee and tea FREE Disney Bus Transportation – Daily to Disney ® Theme Parks. (Magic Kingdom, Epcot, Animal Kingdom, Hollywood Studio, Typhoon Lagoon and Blizzard Beach. Nightly Transportation to Downtown Disney Marketplace and Pleasure Island (Beginning At 6pm) Registration Fee: Registration must be received at the National office (postmarked or online) no later than May 1, 2015. Forms received prior to May 1, 2015 will receive the early bird rate of $210 per person, plus a $7 online registration fee. This includes: One lunch and two dinners (with receptions), registration fee for three days of sessions, take-home resources, and a tote bag filled with conference goodies. Late Convention Registration: An additional $50 fee for late registration will be charged for applications received after May 1, 2015. Meals: The hotel has been provided with heart-healthy guidelines for meal preparations and will offer healthy options when possible. Don’t forget to sign up for Farewell Dinner seating preferences at the registration table upon check-in! Attire: Business casual attire is best for conference events. For the special awards dinner, we suggest gentlemen wear a coat and tie, and ladies wear a dress or business attire. Be sure to remember comfortable walking shoes for touring Orlando. Bring your sunglasses and light backpacks for carrying sunscreen, bottled water and medications. MOST IMPORTANTLY – REMEMBER YOUR CAMERA! Weather in Orlando: Average June temperatures in Orlando: Average High Average Low 90°F 72°F 2 Note: Humidity in the month of June is high. Be sure to have bottled water with you at all times. June offers occasional showers, so please bring your umbrella. Fitness Stroll: No need to miss your regular morning walks! Join fellow Mended Hearts members, and walk with Jim Oldfield (Chapter 230, Pontiac, Michigan, Ironheart Foundation) for several organized walks throughout the week. Health Screenings: Health screenings will be available at no charge in the exhibit area. Scooters: Scooters will be available to rent. In order to provide the vendor an estimated head count, please be sure to indicate scooter needs on your registration form under the “Special Requests” section. Rental costs are $90 for 4 days (one-half the normal fee) and must be paid for in advance. Transportation to and from Orlando International Airport – 17 miles from hotel: Mended Heart is pleased to provide you with ground transportation between the Orlando International Airport and the Buena Vista Palace Resort and Spa. To book your ground transportation to and from the airport, copy and paste this link into your web browser: https://www.hello-usa.com/tickets/mh15/index.asp This website is designed to collect your flight information so we are better able to serve you upon arrival. Shuttle Services will run on the following days and times: June 24, 2015: June 28, 2015: 9:30 AM – 3:30 PM 7:00 AM - 1:00 PM Please provide your flight information no later than Sunday, June 7, 2015 to ensure that your transfers are arranged. Ground transportation will be provided on scheduled arrival and departure days only. If your itinerary differs from Mended Hearts’ arrival and departure dates, you will be responsible for arranging your own airport transportation. Taxis are readily available and cost approximately $45 one-way. 3 Mended Hearts Education and Training Annual Conference Buena Vista Palace Hotel & Spa June 24 – 27, 2015 REGISTRATION FORM Registration forms must be received no later than May 1st to avoid late fees. Registration is also available online at www.mendedhearts.org. ATTENDEE #1: LAST NAME FIRST NAME PREFERRED NAME (FOR NAME BADGE) CHAPTER# MI CHAPTER CITY, STATE MAILING ADDRESS CITY STATE HOME PHONE NUMBER ZIP CODE CELL PHONE NUMBER E-MAIL ADDRESS: YES NO FIRST-TIME ATTENDEE? YES NO INTERESTED IN FIRST-TIME ATTENDEE WORKSHOP? (See enclosed) YES NO INTERESTED IN BEING A BUDDY TO A FIRST-TIME ATTENDEE? (See enclosed) EMERGENCY CONTACT INFORMATION: LAST NAME HOME PHONE NUMBER FIRST NAME MI CELL PHONE NUMBER Please list any special dietary requests below: (PLEASE NOTE – This is to indicate serious, medical food allergies and dietary restrictions, not food preferences.) Are you interested in scooter rental information? *Rental costs are $90 for 4 days (one-half the normal fee) YES NO Please list any special medical conditions we need to be aware of: _________ Conference Registration Form Page 1 of 1 ATTENDEE #2: LAST NAME FIRST NAME PREFERRED NAME (FOR NAME BADGE) CHAPTER# MI CHAPTER CITY, STATE MAILING ADDRESS CITY STATE HOME PHONE NUMBER ZIP CODE CELL PHONE NUMBER E-MAIL ADDRESS: YES NO FIRST-TIME ATTENDEE? YES NO INTERESTED IN FIRST-TIME ATTENDEE WORKSHOP? (See enclosed) YES NO INTERESTED IN BEING A BUDDY TO A FIRST-TIME ATTENDEE? (See enclosed) EMERGENCY CONTACT INFORMATION: LAST NAME HOME PHONE NUMBER FIRST NAME MI CELL PHONE NUMBER Please list any special dietary requests below: (PLEASE NOTE – This is to indicate serious, medical food allergies and dietary restrictions, not food preferences.) Are you interested in scooter rental information?* *Rental costs are $90 for 4 days (one-half the normal fee) YES NO Please list any special medical conditions we need to be aware of: _________ Conference Registration Form Page 2 of 2 GUEST: LAST NAME FIRST NAME PREFERRED NAME (FOR NAME BADGE) CHAPTER# MI CHAPTER CITY, STATE MAILING ADDRESS CITY STATE HOME PHONE NUMBER ZIP CODE CELL PHONE NUMBER E-MAIL ADDRESS: YES NO FIRST-TIME ATTENDEE? YES NO INTERESTED IN FIRST-TIME ATTENDEE WORKSHOP? (See enclosed) YES NO INTERESTED IN BEING A BUDDY TO A FIRST-TIME ATTENDEE? (See enclosed) EMERGENCY CONTACT INFORMATION: LAST NAME HOME PHONE NUMBER FIRST NAME MI CELL PHONE NUMBER Please list any special dietary requests below: (PLEASE NOTE – This is to indicate serious, medical food allergies and dietary restrictions, not food preferences.) Are you interested in scooter rental information?* *Rental costs are $90 for 4 days (one-half the normal fee) YES NO Please list any special medical conditions we need to be aware of: Conference Registration Form Page 3 of 3 HOTEL INFORMATION: Please contact the hotel directly regarding your hotel accommodations. The Mended Hearts negotiated room rate is $134 single/double; $154 triple; $174 quadruple occupancy + 12.5% state/local tax. Guest room rates are also available three days pre and post the official event dates, based on availability. To receive the MHI negotiated rate, reservations must be made prior to June 2, 2015. Please be sure to refer to the group name “Mended Hearts” when making your reservation. For reservations, call Buena Vista Palace Hotel & Spa at 1-866-397-6516 or 407-827-2727. Reservations must be cancelled within 5 days prior to day of arrival to avoid credit card charges. REGISTRATION: Registration includes one luncheon, two receptions and dinner; as well as coffee social hours every morning. Registration must be received at the National office (postmarked or online) by May 1, 2015 to receive the early bird registration fee of $210, plus a $7 online processing fee. *An additional late fee of $50 per person will be charged for applications received after May 1, 2015: Attendee #1 Attendee #1 Attendee #2 Attendee #2 Guest X Guest Registration $210 ($217 online) per person X = _______ $50 per person late fee (if applicable) * = _______ TOTAL AMOUNT DUE: = ________ Please note: The conference committee has made every effort to keep costs as low and manageable as possible. CANCELLATION POLICY: 100% refundable if cancelled prior to May 1, 2015 50% refundable if cancelled between May 2 and June 1, 2015 Nonrefundable after June 2, 2015 without National President approval All refunds will be made in the manner payment was received. METHOD OF PAYMENT: 1. CHECK #_____________ AMOUNT: ___________ (Please make checks payable to The Mended Hearts, Inc. and noted for 2015 conference.) 2. CREDIT CARD INFORMATION: VISA exp. date MASTERCARD UPON RECEIPT OF THIS FORM, THE CARD NUMBER PROVIDED WILL BE CHARGED THE FULL AMOUNT. PLEASE SEE CANCELLATION POLICY ABOVE. NO REFUNDS WILL BE MADE AFTER JUNE 2, 2015, WITHOUT NATIONAL PRESIDENT APPROVAL. PLEASE RETURN TO NATIONAL OFFICE (POSTMARKED OR ONLINE) NO LATER THAN MAY 1, 2015 TO AVOID $50 LATE FEE. The Mended Hearts, Inc. 8150 N. Central Expressway, M2248 Dallas, TX 75206 1-888-HEART99 (1-888-432-7899) Online registration available at www.mendedhearts.org Conference Registration Form Page 4 of 4 Buddy / First Timer Session Registration Form ________ This is my first Mended Hearts Conference. I’m a “First Timer.” ________ Previously, I have attended at least one Mended Hearts Conference and I’m willing to be a “Buddy.” Sign up to be a “Buddy,” or a “First Timer.” You will be paired and can start to communicate and get to know one another before the conference begins. You will meet for the first time during the Buddy / First Timer Session. Our goal is to help you form a bond that will last far beyond this event. Enrollment form for Buddy and/or First Timer: Name:________________________________________________________________________ Address:______________________________________________________________________ City:________________________________State:_________________ Zip:________________ Home Phone #:__________________________ Cell Phone #:___________________________ Email Address:_________________________________________________________________ Chapter #__________________ Age: _________________ Gender: _____Male ____Female Profession:___________________________________ Retired:_______ Yes ______ No Date / Type of cardiac event:______________________________________________________ Special interests / hobbies:________________________________________________________ _____________________________________________________________________________ We hope you will join us! Please complete and return this form to: Mrs. Lynn Frierson 608 North Hills Drive Johnson City, TN 37604 The Buddy / First Timer Session Mended Hearts created the Buddy/First Timer System to help members attending the conference for the first time feel welcome, comfortable—and get the most out of their conference experience. Here’s how the program works: If you are a “first timer” or are a veteran who has attended a conference before and you are willing to be a “buddy,” then please return the completed registration form. Each first timer will be paired with a buddy, and the buddy will call and/or e-mail you prior to the event. Once your buddy has contacted you, you may ask questions, exchange ideas and get to know each other before arriving in Orlando . One of the first events on the conference schedule is a Buddy/First Timer session, where Buddies and First Timers meet in person. Your buddy will be there to answer questions and introduce you to people throughout the conference. Of course, you can ask questions of any conference committee member or staff, as well as your buddy. With your buddy smoothing the way, you can relax, have fun and enjoy the events. After all, it’s your conference! If you have any questions, please feel free to contact us at 423-282-6058, or by email at jlfrierson@chartertn.net. See you all in Orlando! Lynn Frierson MHI Education and Training Conference Information Technology Solutions June 24—27, 2015 This year’s annual event, the Mended Hearts Education and Training Buena Vista Palace Hotel & Spa 1900 Buena Vista Dr Lake Buena Vista, FL 32830 407-827-2727 or 1-866-397-6516 Conference, will be hosted by the Southern Region in Orlando, Florida! This year’s event brin gs members and leaders from across the country, and Opportunities for participation: Purchase an ad in the Con- ference Program Book Participate as an exhibitor Donate to send someone to conference Donate towards the Mended Little Hearts Bravery Bag program offers outstanding program s designed to help you tackle current issues and prepare for future chapter growth opportunities. The Executive Committee of the National Board of Directors encourages you to show your support by attending and contributing to the success of this event. A wealth of valuable learning materials and insight on the latest medical information will be offered for all to bring back and share with others. Mended Hearts, Inc. 8150 N. Central Expwy, M2248 Dallas, TX 75206 www.mendedhearts.org 1-888-HEART-99 Support Mended Little Hearts Bravery Bag Program This year, you can help families around the na on who have children in the hospital a er heart surgery or other procedures by dona ng to the Mended Little Hearts Bravery Bag Program. You can imagine the stress parents and caregivers feel as they sit by their child’s hospital bedside. Bravery Bags provide the family with items to ease their stay and let them know they are not alone. Dona ons for Mended LiƩle Hearts Bravery Bags may be sent to the Na onal office in denomina ons of $10, $20, $50, $100 or more. You can also help put a smile on a child’s face with our Buy One/Give One Bravery Lion. For only $20, you can purchase one of these adorable lions and one will be put in a Bravery Bag for a child in the hospital with a card with your name on it. “Buy One/Donate One” Bravery Lion A lis ng of members/chapters who donate items will be included in the conference program book. For ques ons, contact Jodi Lemacks, Na onal Director of Mended LiƩle Hearts at 804-419-7028. Zoey, age 3 weeks Exhibiting Opportunities: Your participation as an exhibitor will allow you to show off your chapter’s success as well as provide key visibility and interaction with attendees. You may elect to have drawings during exhibit hours with all proceeds returning to the you and/or your chapter. We encourage you to distribute handouts and give -a-ways during this time. Chapter Exhibit Table Price: $50 for the week Includes: One six-foot draped table Two chairs An opportunity to raffle an item as a fundraiser. Drawings must be held during exhibit hours. For additional exhibiting details contact: Exhibit Chairman: Frank Cecco Email: fjc1204@aol.com Telephone: 201-265-9296 Program Book Advertisement: Acknowledge and/or memorialize a special Mended Heart or family member by purchasing an ad in the 2015 Conference Program book. All ads will be in black and white, and may be purchased in a variety of sizes. Dimensions Black/White Cost Full Page (8 x 11) $300 1/2 Page (5.5 x 8.5) $150 1/4 Page (5.5 x 4.25) $100 1/8 Page (4.25 x 2.75) $50 Booster 30 characters, 1 line $20 We can build your ad from materials you supply. All directions should be clearly typed or sent in a text file, such as Microsoft Word. All supplied graphics and text should be of good quality so it will look its best when printed. We can enlarge or reduce the size of your original art as needed. However, the size of the original art should be as close as possible to the desired size in order to avoid any possible distortion. If you already have an ad that you would like to use, please send a quality printout on plain white paper, so we can scan the image. The following electronic files are preferred: TIFF, JPEG, PDF Program Book Advertisement Application: Ad size:_________________________________________________________________ Amount Enclosed:_________________________________________________________ Name:___________________________________________________________________ Contact:__________________________________________________________________ Address:__________________________________________________________________ City:_________________________State:______________________ Zip:______________ Chapter #_____________ Email:_______________________________________________ Contact Phone Number:_______________________________________________________ Completed application with camera-ready black and white ad, and check must be returned no later than May 1, 2015 to: Daniel Moravec 10778 E. Highway 84 Axtell, Texas 76624-1427 dmoravec@aol.com 254-863-5665 Orlando Tours Mended Hearts has arranged for a variety of tours while you visit Orlando. For a listing of all tours and sign up, go to https://www.hello-usa.com/tickets/mh15/index.asp Tours will operate rain or shine. Sign up must be completed NO LATER THAN June 7, 2015. Once you sign up for a tour, a confirmation will be emailed to you within 3 business days of completion. Tour confirmation is required to board buses and for admittance to all tours. Please refer to your tour confirmation email for more detailed information. Terms and Conditions In the event that a tour is cancelled, you will be notified and given the option to book another tour or receive a full refund. Hello Florida reserves the right to cancel any tour if the minimum required is not met by the deadline date of June 7, 2015. All Tours are refundable prior to June 7, 2015. Mended Hearts Symposium June 27, 2015 REGISTRATION FORM Buena Vista Palace Hotel & Spa Orlando, Florida ATTENDEE: LAST NAME FIRST NAME MHI Member Yes or No CHAPTER# MI CHAPTER CITY, STATE MAILING ADDRESS CITY STATE HOME PHONE NUMBER ZIP CODE CELL PHONE NUMBER E-MAIL ADDRESS: ______________________________________________________________ ARE YOU INTERESTED IN BECOMING A MENDED HEARTS MEMBER? Yes or Not at this time EMERGENCY CONTACT INFORMATION: LAST NAME FIRST NAME HOME PHONE NUMBER MI CELL PHONE NUMBER METHOD OF PAYMENT - $45 per Person 1. CHECK #_____________ AMOUNT: ___________ (Please make checks payable to The Mended Hearts, Inc. noted for 2015 SYMPOSIUM. 2. CREDIT CARD INFORMATION: VISA exp. date MASTERCARD UPON RECEIPT OF THIS FORM, THE CARD NUMBER PROVIDED WILL BE CHARGED THE FULL AMOUNT. The Mended Hearts, Inc. 8150 N. Central Expressway, M2248 Dallas, TX 75206 1-888-HEART99 (1-888-432-7899) Online registration available at www.mendedhearts.org Conference Registration Form Page 1 of 1
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