to and mail in OD / Para / Optician / Staff / Student

HOTEL INFORMATION
Golden Nugget Biloxi Hotel and Casino, MS
You must reserve your room by May 12, 2015
Group Code: S156119
Room Reservations: 1-228-435-5400
Room rates with group code:
$88 Thurs / $179 Fri / $179 Sat
2015 Summer Convention
June 11-14, 2015
OD/PARA REGISTRATION PACKET
MISSISSIPPI OPTOMETRIC ASSOCIATION
141 Executive Drive, Suite 5
Madison, MS 39110
The Golden Nugget Biloxi Hotel & Casino, Biloxi, MS
151 Beach Blvd, Biloxi, MS 39530
MOA OD-PARA PACKET DRAFT 3.indd 1
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Mississippi Optometric Association Summer Convention
June 11 – June 14, 2015
Golden Nugget Biloxi Hotel & Casino, Biloxi, MS
AGENDA
(Subject to Change)
Thursday, June 11
2:00 – 5:00 p.m.................................... MOA Board of Directors Meeting
6:00 – 7:30 p.m.................................... Welcome Reception in honor of the inaugural Leadership Optometry Class
Friday, June 12
7:15 – 8:00 a.m.................................... Registration and Continental Breakfast
Fri. Instructor(OD)............................ Leo Semes, O.D.
8:00 – 9:45 a.m.................................... (2 hrs – COPE - OD) Greatest Retina Grand Rounds Course Ever
10:00 – 11:00 a.m................................ (1 hr – COPE - OD) Blood Flow in Glaucoma – New Perspectives
11:00 a.m. – 12:00 p.m....................... (1 hr – COPE - OD) AMD and AREDS Too
Noon – 1:00 p.m................................. Lunch On Your Own
1:00 – 5:00 p.m.................................... Optician’s Track, Part I – Jerry Ann Himes, FANO, ABOM, NCLE
.............................................................. (4 hrs) Optical Boot Camp, Part 1 - ABO credit
6:00 – 8:30 p.m.................................... Exhibit Hall & Reception
Saturday, June 13
7:30 – 8:30 a.m.................................... Registration and Membership Breakfast for ODs
7:30 – 8:30 a.m.................................... Registration and Continental Breakfast for Para/Staff/Opticians
8:00 a.m. – 12 p.m.............................. Optician’s Track, Part II – Jerry Ann Himes, FANO, ABOM, NCLE
..........................................................(4 hrs) Optical Boot Camp, Part 2 - ABO credit
Sat. Instructor (OD)........................... Blair Lonsberry, O.D.
8:30 – 10:15 a.m.................................. (2 hrs – COPE - OD) Anterior Segment Grand Rounds
10:30 – 11:30 a.m................................ (1 hr – COPE - OD) Eyelid Lumps and Bumps
11:30 a.m. – 12:30 p.m....................... (1 hr – COPE – OD) Diagnosing and Managing Ocular Emergencies
12:15 p.m. – until................................ MOA Annual Golf Tournament at Shell Landing Golf Club
1:30 – 3:00 p.m.................................... Biloxi Shrimping Trip (Reservation required, limited space)
3:30 – 5:00 p.m.................................... Biloxi Shrimping Trip (Reservation required, limited space)
Sunday, June 14
8:15 – 8:45 a.m.................................... Continental Breakfast
8:45 – 10:35 a.m.................................. Blair Lonsberry, O.D.
..........................................................(2 hrs – COPE - OD) Interactive Grand Rounds
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ATTENTION: Early registration deadline is May 15, 2015
*Those who register after the May 15th date will be charged an additional $40.*
Registration Information
1) Safety Codes
The attendee assumes full responsibility for complying with city and hotel regulations concerning fire, safety and
health.
2) Liability
Management will employ reasonable precautions for safe-guarding the attendee’s property. Neither the
Mississippi Optometric Association nor the Golden Nugget Biloxi Hotel & Casino will be liable for the loss or
damage to property of the attendee or his/her representatives from theft, fire, accident, loss in transit or other
causes. Injury to persons, loss or damage to property shall be the Mississippi Optometric Association’s or the
Golden Nugget Biloxi Hotel & Casino’s liability only in cases of negligence.
3) Admission
Exhibit hall admission is by official badge only. Attendees not wearing and unable to produce the original badge
immediately upon request will be asked to leave the event.
4) Refund Policy
All refund requests must be made in writing and may be emailed to: [email protected]; faxed to (601)
853-4408; or mailed to the following address: 141 Executive Drive, Suite 5, Madison MS, 39110.
Refunds will be given based on the following:
• 30 days prior to the event, full refund minus $25 processing fee
• 20 days prior to the event, 50 percent refund
• 10 days prior to the event, 25 percent refund
• Less than 5 days prior to the event, no refunds can be made.
Refund amounts also may be applied to alternate MOA events or dues statements during the 2015 calendar year. Appeals for extenuating
circumstances may be made to the Executive Director and/or the MOA Board of Directors.
Save the Date 2015
Saturday, Aug. 8: Come to Jackson, MS for a quick review of the ICD10 codes with Dr. Peter Cass of Optometric Business Solutions.
Thursday-Sunday, Oct. 1 - 4: Fall Conference and Vision Exposition
at the Hilton of Jackson. At least 20 hours of COPE approved CE
offered. This is the 60th anniversary of the MOA Fall Conference!
4/6/15 6:47 AM
PARA REGISTRATION
Mississippi Optometric Association Summer Convention
(Available to MOA/AOA Members Only)
June 11 – June 14, 2015
Golden Nugget Biloxi Hotel & Casino, Biloxi, MS
Name: ____________________________________________________________________________________________
Address____________________________________________________________________________________________
City, State, Zip
____________________________________________________________________________________________
Phone
_________________________________________Email ___________________________________________
SPEAKERS
**This is a benefit available to MOA member staff only. Staff is not required to be an MPA member, but the registering OD must be an MOA/AOA member.
# of Paraoptometrics at $200/each
#of Opticians at $200/each
# of Staff at $200/each
Before May 15th After May 15th
_________
_________
_________
__________
__________
__________
Name for badge: __________________________________________________________ Name for badge: __________________________________________________________ Name for badge: __________________________________________________________ Name for badge: __________________________________________________________ Name for badge: __________________________________________________________ Certification Level: _________
Certification Level: _________
Certification Level: _________
Certification Level: _________
Certification Level: _________
Lonsberry
Registration Extras
q
q
q
q
q
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MOA Golf Championship.................................................................................................................................# at $80/each _____________
Name of player(s) and handicap:
__________________________________________________ ______________________
Thursday Welcome Reception, spouse/guest registration.............................................................................# at $25/each _____________
Thursday Welcome Reception, child registration (Age 5-12).......................................................................# at $10/each _____________
Friday Exhibit Hall, spouse/guest registration................................................................................................# at $40/each _____________
Friday Exhibit Hall, child registration (Age 5-12)..........................................................................................# at $10/each _____________
Saturday Biloxi Shrimping Tour........................................................................................................................# at $15/each _____________
Dr. Blair Lonsberry, OD, obtained his Optometry degree from the University
of Waterloo in 1996 after completing a Master of Science in Physiology from the
University of Manitoba. He completed his residency in Primary Care Optometry
from the Illinois College of Optometry in 1997, then joined the faculty at Southern
College of Optometry in Memphis, TN. During his time at SCO, he completed a
Masters in Education degree with an emphasis in adult learning.
Currently, Dr. Lonsberry is a Full Professor and the Clinic Director for the Pacific
EyeClinic in Portland, Oregon. Dr. Lonsberry is a Diplomate of the American
Board of Optometry, a Fellow of the American Academy of Optometry, the
Optometric Retinal Society, and the Optometric Glaucoma Society, and is on the
executive board of the Ocular Surface Society of Optometry.
Leo P. Semes, OD, is Professor of Optometry at the UAB School of Optometry. He
earned his OD from PCO and completed residency at The Eye Institute of PCO.
Dr. Semes has authored over 220 scientific articles, book chapters and posters. He
is a fellow of the American Academy of Optometry, as well as an active member of
the AOA, chairing the Nutrition and Health Committee. Dr. Semes is a founding
member of the Optometric Glaucoma Society and a founding fellow of the
Optometric Retina Society.
Payment Options
We want to make it as easy as possible to take care of registration payment. Choose the method that works best for you.
qPlease make checks payable to MOA and mail your payment, along with the completed registration form to:
MOA, 141 Executive Drive, Suite 5, Madison, MS 39110
qSelect an online payment service which allows you to make a safe, secure, and reliable payment. Additionally,
your confirmation will be available for immediate viewing online at www.mseyes.com
qComplete the registration form in its entirety, including the portion of this page below, and mail or fax your
payment to MOA, 141 Executive Drive, Suite 5, Madison, MS 39110 | Fax (601-) 853-4408
Account Type: q Visa
q
MasterCard
q
AMEX
q
Semes
Jerry Himes, FANO, ABOM, NCLE has 47 years of experience in all phases of the
optical industry. For the past 18 years she has been employed by Carl Zeiss Vision/
AO Sola Optical. She is on Carl Zeiss Vision speaker’s bureau, and currently the
territory manager for Arkansas, Mississippi, Tennessee, and Louisiana. She is the
director for the Optician Association of Arkansas, Secretary of the Arkansas State
Board of Opticians and Chairman of the NCSORB.
Discover
Cardholder Name __________________________________________________________________________
Cardholder Sig.
__________________________________________________________________________
Account Number __________________________________________________________________________
Expiration Date
__________________________
Billing Address
_______________________________________
Phone# _______________________
City, State, Zip
_______________________________________
Email _________________________
Amount to be charged: ____________________________________
Date __________________________
MOA OD-PARA PACKET DRAFT 3.indd 3
CVV2 _________________________
Himes
4/6/15 6:47 AM
CONFERENCE NOTES
Important Dates for ODs
May 12: .................. Deadline to reserve rooms at the Golden Nugget Biloxi Hotel & Casino
May 15: .................. Deadline to register for Convention Early Bird Fee
................................ (Applications must be postmarked or faxed no later than May 15, 2015)
June 11: ................. Board of Directors meeting begins at 2:00 p.m.
June 11: ................. Welcome Reception in honor of the inaugural Leadership Optometry class
June 12: ................. Exhibit Hall and Reception – 6:00 – 8:30 p.m.
June 13: ................. Membership breakfast. Vote will be held for 2016 officer positions.
June 13: ................. MOA Golf Championship at Shell Landing Golf Club
June 13: ................. Biloxi Shrimping Boat & Coast Tour (Reservation required)
MOA Exhibit Hall and Reception with MOA Talent Show
Join the Mississippi Optometric Association for an evening filled with exhibitors, fun, food, and the first ever
MOA Summer Convention Talent Show! 6:00 - 8:30 p.m. Casual attire. Entries to the talent show are encouraged (limited space, up to 5 groups accepted). Come show off your talent, whether it be magic tricks, juggling,
extreme hula hooping, martial arts, or miming! Call the MOA office if you would like to perform but need ideas
for a “talent” – we can help you out.
Biloxi Shrimping Trip (info provided by www.biloxishrimpingtrip.com)
Welcome to the Mississippi Gulf Coast! The pride and heritage of Biloxi comes alive aboard this unique and
interesting cruise. The Biloxi Shrimping Trip exposes our guests to the spectacular world of sea life - caught on a
real shrimping expedition. Learn everything you ever wanted to know about catching, cooking, and eating this
delicious Southern delicacy, Mississippi Gulf Coast Style. Climb aboard the Sailfish and take a 70-minute peek
into how the journey begins for a shrimp and how it ends up on your plate. The Biloxi Shrimping Trip has been
entertaining visitors worldwide since 1955. This 70-minute Living Marine Adventure Cruise is navigated in the
calm, protected waters between Deer Island and the Biloxi shoreline for your comfort.
Back for 2015: Optical Boot Camp for Paraoptometrics, Opticians, and Office Staff
OD REGISTRATION
If you have questions about your membership classification, please call the MOA office at (601) 853-3942.
Name: ____________________________________________________________________________________________
Address____________________________________________________________________________________________
City, State, Zip
____________________________________________________________________________________________
Phone
_________________________________________Email ___________________________________________
Main Registration Options
MOA MEMBER: Dues Current
MOA Member: Graduated in 2015, Student, or
Retired/Life NOT seeking CE credit
MOA Member: 2014 Grad, Partial Practice, or
Retired/Life seeking CE credit
Out of State OD/AOA Member, AOA ID#___________
Non Member of MOA/AOA
Before May 15th After May 15th
q $295
q
FREE
FREE
q
q
q
$148
$295
$395
q
q
q
$345
$198
$345
$445
Registration Extras
q
q
q
q
q
q
MOA Golf Championship.................................................................................................................................# at $80/each _____________
Name of player(s) and handicap:
__________________________________________________ ______________________
Thursday Welcome Reception, spouse/guest registration.............................................................................# at $25/each _____________
Thursday Welcome Reception, child registration (Age 5-12).......................................................................# at $10/each _____________
Friday Exhibit Hall, spouse/guest registration................................................................................................# at $40/each _____________
Friday Exhibit Hall, child registration (Age 5-12)..........................................................................................# at $10/each _____________
Saturday Biloxi Shrimping Tour........................................................................................................................# at $15/each _____________
Payment Options
We want to make it as easy as possible to take care of registration payment. Choose the method that works best for you.
This fun and interactive session will provide every level of optical personnel with all of the skills and information
they need to successfully assist patients in an optometric practice. This is an essential course for beginning dispensers, or those in the business that could use a refresher. The hands-on workshop from last year will be back,
to teach adjustments, fitting and dispensing. This course is not just for opticians – all areas of a practice need
this basic training! It is useful for all optometric staff members. There is great value to be had in staff trained to
understand a patient’s problem and how to fix it. You will see the value of this course once the first happy patient
refers their family and friends to your practice due to an educated staff that took care of all their eyeglass needs.
This course assists with preparation for CPOA and ABOC testing. Courses are ABO and CPC approved.
qPlease make checks payable to MOA and mail your payment, along with the completed registration form to:
2015 MOA Golf Championship
Cardholder Name __________________________________________________________________________
Saturday, June 13, 2015, at Shell Landing Golf Club in Gautier, MS
Shell Landing is 12.4 miles (roughly 20 minutes) from the convention location
$80 Entry Fee for ODs; Noon-5:00 p.m.
Deadline to register for the MOA 2015 Golf Championship is May 15, 2015
Exemplary personal service, five sets of tees, and immaculate course conditioning make a visit to Shell Landing
a rewarding, enjoyable experience for golfers who demand the best. A beautiful clubhouse and deck offer every
amenity. Shell Landing features a complete 15 acre practice facility, locker rooms, storage, and pro-line rental
clubs are available.
MOA OD-PARA PACKET DRAFT 3.indd 4
MOA, 141 Executive Drive, Suite 5, Madison, MS 39110
qSelect an online payment service which allows you to make a safe, secure, and reliable payment. Additionally,
your confirmation will be available for immediate viewing online at www.mseyes.com
qComplete the registration form in its entirety, including the portion of this page below, and mail or fax your
payment to MOA, 141 Executive Drive, Suite 5, Madison, MS 39110 | Fax (601-) 853-4408
Account Type: q Visa
Cardholder Sig.
q
MasterCard
q
AMEX
q
Discover
__________________________________________________________________________
Account Number __________________________________________________________________________
Expiration Date
__________________________
CVV2 _________________________
Billing Address
_______________________________________
Phone# _______________________
City, State, Zip
_______________________________________
Email _________________________
Amount to be charged: ____________________________________
Date __________________________
4/6/15 6:47 AM