8th Annual - FORCE: Facing Our Risk of Cancer Empowered

8th Annual - FORCE: Facing Our Risk of Cancer Empowered

www.facingourrisk.org
8th Annual
Joining FORCEs Against Hereditary Cancer
Conference on Hereditary Breast and Ovarian Cancer
June 12-14, 2014
Philadelphia Marriott Downtown | Philadelphia, PA
conference@facingourrisk.org
www.facingourrisk.org/conference
Fighting Hereditary
Breast and Ovarian
Cancer
PROGRAM DESCRIPTION
Joining FORCEs Against Hereditary Cancer is an international conference designed
by and for people and families affected by hereditary cancer or a BRCA mutation. The
conference presents a wide range of topics and the latest research on these cancers.
Held in partnership with Penn Medicine’s Basser Research Center for BRCA (basser.org),
the conference will provide opportunities to enroll in research, including Basser-funded
studies. Attendees include people concerned about hereditary cancer: survivors, previvors,
people with a BRCA mutation or family history of cancer, patient advocates, researchers,
and health care providers who treat high-risk patients.
PROGRAM OBJECTIVES
This one-of-a-kind conference will provide:
Opportunities to learn the latest information about:
UÊ
>˜ViÀÊÀˆÃŽ]Êi>ÀÞÊ`iÌiV̈œ˜ÊEÊÀˆÃŽÊÀi`ÕV̈œ˜
UÊ,ˆÃŽ‡Ài`ÕVˆ˜}ÊÃÕÀ}iÀÞʜ«Ìˆœ˜Ã
UÊ,iVœ˜ÃÌÀÕV̈œ˜Êœ«Ìˆœ˜Ã
UÊ/Ài>̓i˜ÌÃÊvœÀÊ,
‡>ÃÜVˆ>Ìi`ÊV>˜ViÀÃÊ>˜`Ê
triple-negative breast cancers
UʜÜÊ̜Ê`ˆÃVÕÃÃÊV>˜ViÀÊÀˆÃŽÊ܈̅Êv>“ˆÞʓi“LiÀÃ
UÊ/…iʓi>˜ˆ˜}ʜvÊ}i˜ïVÊÌiÃÌÊÀiÃՏÌÃ
UʜÜÊiÝiÀVˆÃiÊ>˜`ʘÕÌÀˆÌˆœ˜ÊV>˜ÊœÜiÀÊ̅iÊÀˆÃŽÊvœÀÊ
developing cancer and improve survival
UÊiÀ̈ˆÌÞʜ«Ìˆœ˜ÃÊvœÀÊÃÕÀۈۜÀÃÊ>˜`Ê«ÀiۈۜÀÃ
UʜÜʈ˜Ìi}À>̈ÛiÊ>˜`ÊVœ“«i“i˜Ì>ÀÞʓi`ˆVˆ˜iÊV>˜Ê
improve your health and outlook
UÊ>˜>}ˆ˜}Ê̅iÊŜÀ̇Ê>˜`ʏœ˜}‡ÌiÀ“ÊivviVÌÃʜvÊi>ÀÞÊ
menopause
UÊ,
ʈ˜Ê“i˜
UÊiÀi`ˆÌ>ÀÞÊ«>˜VÀi>̈VÊV>˜ViÀ
Opportunities to learn skills for:
UÊ
œ«ˆ˜}Ê܈̅ʅiÀi`ˆÌ>ÀÞÊV>˜ViÀÊ`ˆ>}˜œÃˆÃʜÀÊÀˆÃŽ
UÊ>Žˆ˜}ÊÀˆÃŽ‡“>˜>}i“i˜ÌÊ`iVˆÃˆœ˜Ã
UÊ
œ«ˆ˜}Ê ÜˆÌ…Ê Lœ`ÞÊ ˆ“>}iÊ >˜`Ê ÃiÝÕ>ˆÌÞÊ ˆÃÃÕiÃÊ
arising after cancer or surgery
Opportunities to network and share experiences with other people who are high risk
or affected by a BRCA mutation
Opportunities to hear about and enroll in hereditary cancer research studies
Accommodations
Philadelphia Marriott Downtown
1201 Market Street
Philadelphia, Pennsylvania 19107
Phone: 800-320-5744
www.facingourrisk.org/conference/hotel
This Center City, Philadelphia, hotel is near downtown dining, shopping and
attractions. The Philadelphia Marriott Downtown commands a towering presence in
the heart of America’s original capital. Surrounded by rich revolutionary history and
culture, the hotel’s downtown location puts guests in close proximity to Independence
Hall and the Liberty Bell, both located within eight blocks. The property features a
fitness center and indoor pool. The hotel is just a few blocks from Reading Terminal
Market, a unique and extraordinary historic farmers market in Center City.
A room block has been reserved for our conference at a special price of $184.00
per night, single/double occupancy. To guarantee this rate, please book your room
before May 30, 2014.
For reservations, please call 800-320-5744 and mention that you will be attending
the FORCE Conference. Alternatively, you may book your room online at:
www.facingourrisk.org/conference/hotel
Agenda
Thursday | June 12
3:00 – 6:00 pm Registration
Friday | June 13
7:00 am – 8:50 am Registration and Networking Breakfast
9:00 am – 10:00 am General Session
Welcome/Opening remarks: Sue Friedman, DVM; Rebecca Sutphen, MD; Susan Domchek,
MD; Karen Hurley, PhD; Barbara Pfeiffer
10:05 am – 10:55 am Morning Break
11:00 am – 12:25 pm Concurrent Session I (choose one of the following)
Ê
UÊi˜ïVÃÊ£ä£\Ê,iLiVV>Ê-ÕÌ«…i˜]Ê
Ê
UÊ>ÃÌiV̜“ÞÊvœÀÊ/Ài>̓i˜ÌÊ>˜`Ê*ÀiÛi˜Ìˆœ˜\ÊÀˆÃ̈Ê՘Ž]Ê
Ê
UÊ iÜÊ/Ài>̓i˜ÌÃÊvœÀÊ"Û>Àˆ>˜Ê
>˜ViÀ\Ê,œLiÀÌÊÕÀ}iÀ]Ê
Ê
UÊ ÕÌÀˆÌˆœ˜ÊvœÀÊi>Ì…]Ê7i˜iÃÃ]ʜÀÊ,iVœÛiÀÞ\ʈÊ"À>ۈÌâ]Ê,
Ê
UÊ*ÀiÛi˜Ìˆ˜}Ê>˜`Ê/Ài>̈˜}Ê
>˜ViÀÃʈ˜Êi˜\Ê>VµÕiÞ˜Ê*œÜiÀÃ]ÊÊ
UÊ,iV>ˆ“ˆ˜}ʘ̈“>VÞ\ÊÊ*Àˆ“iÀÊvœÀÊ*ÀiۈۜÀÃÊ>˜`Ê-ÕÀۈۜÀÃ\Ê-ÕÃ>˜Êiœ}}‡-«>`Ì]ÊÊ
Ê
ÊÊÊ
, *]Ê*…ÆÊ->LˆÌ…>Ê*ˆ>ˆ‡Àˆi`“>˜]Ê*…]Ê
-7
Ê
UÊ9œÕ˜}Ê*ÀiۈۜÀýÊ7œÀŽÃ…œ«\ʈ˜`ÃiÞʜΈ˜Ã]Ê*…ÆʏˆÃœ˜Ê7iÀ˜iÀ‡ˆ˜]Ê*…
Ê
UÊ9œ}>\Ê>˜>ÊÕœ>˜Ê­Ã«>ViʈÃʏˆ“ˆÌi`Ê̜ÊÎäÊ«iœ«i®
Ê
12:30 pm – 1:35 pm Networking lunch - box lunch provided
1:40 pm – 3:05 pm Concurrent Session II (choose one of the following)
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
UÊÀi>ÃÌÊ,iVœ˜ÃÌÀÕV̈œ˜Ê"ÛiÀۈiÜ\Ê>̅ÞÊ-Ìiˆ}œ
UÊ"
]Ê
>˜ViÀ]Ê>˜`Ê9œÕÀÊi}>Ê,ˆ}…ÌÃ\ʘÞ>Ê*Àˆ˜Vi]Êõ°
UÊi˜Ê>ÌÌiÀÊ/œœÊ7œÀŽÃ…œ«\ÊÀˆÃ̈ÊÀ>ÛiÃ]Ê*…
UÊi˜œ«>ÕÃiÊ7ˆÌ…Ê>˜`Ê7ˆÌ…œÕÌʜÀ“œ˜iÃ\ʘ`ÀiÜÊ>՘ˆÌâ]Ê
UÊ iÌܜÀŽˆ˜}\Ê9œÕ˜}Ê*ÀiۈۜÀÃ\ʘ˜>ÊÕÜ>`>
UÊ-«œÕÃiÊ-Õ««œÀÌÊ>˜`Ê iÌܜÀŽˆ˜}\Ê,>V…iÊ-…>«ˆÀ>]ÊUÊ/…iÊ iÜÊ œÀ“>\Ê,iˆ˜Ûi˜Ìˆ˜}Ê9œÕÀÃivÊvÌiÀÊ/Ài>̓i˜ÌʜÀÊ-ÕÀ}iÀÞ\Ê>Ài˜ÊÕÀiÞ]Ê*…
UÊ1˜`iÀÃÌ>˜`ˆ˜}Ê,iÃi>ÀV…]Ê,ˆÃŽ]Ê>˜`Ê-Ì>̈Ã̈VÃ\Ê/>À>ÊÀˆiLi]Ê*
3:10 pm – 4:00 pm Afternoon Break
4:05 pm – 5:30 pm Concurrent Session III (choose one of the following)
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
UÊÀi>ÃÌÊ
>˜ViÀÊ-ÕÀÛiˆ>˜ViÊ>˜`Ê
…i“œ«ÀiÛi˜Ìˆœ˜\Ê,>V…iÊÀi“]ÊÆÊ>ÀÞÊ>Þ]Ê]Ê*…
UÊiÀ̈ˆÌÞÊ>˜`Ê*>Ài˜Ìˆ˜}Ê"«Ìˆœ˜ÃÊvœÀÊ*ÀiۈۜÀÃ\Ê
>ÀˆÃ>ÊÀ>Vˆ>]ÊÆÊ>ÕÀi˜Êœ…˜Ãœ˜]Ê
UÊiÌ̈˜}Ê7-ÊLœÕÌÊÝiÀVˆÃi\Ê>̅ÀޘÊ-V…“ˆÌâ]Ê*…
UʜÜÊ
œ˜ÃՓiÀÃÊ
>˜Ê“«>VÌÊ,iÃi>ÀV…Ê*ÀˆœÀˆÌˆiÃ\Ê
>À>Ê/i˜i˜L>Փ]Ê]Ê
Uʜ˜}Ê/iÀ“Ê
œ˜ÃiµÕi˜ViÃʜvÊi˜œ«>ÕÃi\Êi>ÀÌ]ʜ˜i]Ê>˜`Êi“œÀÞ\Ê
ÊÊÊ-ÕÃ>˜Êœ“V…iŽ]ÊÆÊ iˆÊ««iÀܘ]Ê
UÊ iÌܜÀŽˆ˜}\Ê*>Ài˜ÌÃʜvÊ,
Ê
…ˆ`Ài˜\Ê*>ՏÊÀi`œÜ]Ê*ÃÞÆÊ
ÊÊÊ<ˆÛ>ÊÀii˜‡Ài`œÜ]Ê-`
UÊ"Û>Àˆ>˜Ê
>˜ViÀÊiÌiV̈œ˜Ê>˜`Ê*ÀiÛi˜Ìˆœ˜\Ê œ>…Ê>Õvv]Ê
UÊ,iVœ˜ÃÌÀÕV̈œ˜Ê*>˜iÊ+ÊEÊÊ£\ʜÅÕ>Êiۈ˜i]ÊÆʈV…>iÊœV…]ÊÆʏˆÊ->`i}…ˆ]Ê
Saturday | June 14
7:30 am – 8:55 am
Ê
UʺÎÊ̅iÊÝ«iÀÌûÊ,œÕ˜`Ì>LiÊ>˜`Ê iÌܜÀŽˆ˜}ÊÀi>Žv>ÃÌ
9:00 am – 10:50 am General Session
Ê
UÊ7…>̽ÃÊ iÜʈ˜Ê"
Ê,iÃi>ÀV…\Ê-ÕiÊÀˆi`“>˜]Ê6]Ê>ÀŽÊÀii˜i]ÊÆÊ
Timothy Rebbeck, PhD; Susan Domchek, MD
11:00 am – 12:25 pm Concurrent Session IV (choose one of the following)
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
UÊ,
ÊEÊ/Àˆ«i‡ i}>̈ÛiÊÀi>ÃÌÊ
>˜ViÀ\Ê>À>Ê>ÝÜi]Ê]Ê*…
UÊi>ˆ˜}Ê܈̅Ê*…ÞÈV>Ê>˜`ʓœÌˆœ˜>ÊëiVÌÃʜvÊ
œ“«ˆV>̈œ˜ÃÊvÌiÀÊ-ÕÀ}iÀÞ\Ê
ÊÊÊ>Ài˜ÊÕÀiÞ]Ê*…ÆʈiiÌÊ-ˆ˜}…]Ê]Ê>̅ÀޘʜÀ>˜]Ê*/]Ê
/ʘ`ÀiÜÊňŽ>Àˆ]Ê
UÊ*>˜VÀi>̈VÊ
>˜ViÀÊiÌiV̈œ˜]Ê*ÀiÛi˜Ìˆœ˜]Ê>˜`Ê/Ài>̓i˜Ì\ʘˆÊ,ÕÃÌ}ˆ]Ê
UÊ*>̈i˜ÌÊ*œÜiÀi`Ê,iÃi>ÀV…Ê iÌܜÀŽÃ\Ê,iLiVV>Ê-ÕÌ«…i˜]ÊÆÊ-ÕiÊÀˆi`“>˜]Ê6
UÊ,iÛi>ˆ˜}Ê̅iÊ-̜ÀÞÊ7ˆÌ…ˆ˜\ʓÞʜiÎÞ]Ê*…Æʜ>˜˜>Ê,Õ`˜ˆVŽ
UÊ-…>Àˆ˜}Êi˜ïVÃʘvœÀ“>̈œ˜Ê܈̅Ê
…ˆ`Ài˜\ʘ}i>ÊÀ>`LÕÀÞ]Ê
UÊ7œÀŽÃ…œ«\ʜÀ“œ˜iÊ,i«>Vi“i˜Ìʇʜœ`]Ê>`]ʘÊiÌÜii˜¶Ê˜˜iʜÀ`]Ê
12:30 pm – 2:10 pm Lunch and Spirit of Empowerment Awards
2:15 pm – 3:40 pm Concurrent Session V (choose one of the following)
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
Ê
UÊ««Àœ>V…iÃÊ̜Êi˜ïVÊ
œÕ˜Ãiˆ˜}Ê>˜`Ê/iÃ̈˜}ʈ˜ÊˆvviÀi˜ÌÊ
œÕ˜ÌÀˆiÃ\Ê
ÊÊÊ-ÌiÛi˜Ê >Àœ`]Ê
UÊ
œ“«i“i˜Ì>ÀÞÊ>˜`ʘÌi}À>̈ÛiÊi`ˆVˆ˜iÊvœÀÊ-ޓ«Ìœ“Ê>˜>}i“i˜Ì\Ê
Diljeet Singh, MD
UÊÃÊ>Ê
ˆ˜ˆV>Ê/Àˆ>Ê,ˆ}…ÌÊvœÀÊi¶Ê>À}œÊˆV…>iÃ]Ê*
UÊiÌ>ÃÌ>̈VÊiÀi`ˆÌ>ÀÞÊÀi>ÃÌÊ
>˜ViÀ\Ê7…>̽ÃÊ iܶÊiˆ˜`>Ê/iˆ]Ê
UÊ iÌܜÀŽˆ˜}\Êi˜Ê܈̅ÊÕÌ>̈œ˜Ã\Ê>ۈ`ÊÕœ>˜
UÊ*œÃ̇“>ÃÌiV̜“ÞÊ,iVœÛiÀÞÊ>˜`Ê,i…>LˆˆÌ>̈œ˜\ʓÞÊ
ÕÀÀ>˜Ê>ŽiÀ]Ê
UÊ9œ}>\Ê>˜>ÊÕœ>˜Ê­Ã«>ViʈÃʏˆ“ˆÌi`Ê̜ÊÎäÊ«iœ«i®
UÊ9œÕ˜}Ê-ÕÀۈۜÀýÊ7œÀŽÃ…œ«\ʘ˜Ê*>ÀÌÀˆ`}i]Ê
3:45 pm – 4:30 pm Afternoon Break
4:35 pm – 6:00 pm Concurrent Session VI (choose one of the following)
Ê
Ê
Ê
Ê
Ê
Ê
Ê
UÊ
œ“«i“i˜Ì>ÀÞÊ>˜`ʘÌi}À>̈ÛiÊi`ˆVˆ˜iÊvœÀʜÜiÀˆ˜}Ê,ˆÃŽ\ʈiiÌÊ-ˆ˜}…]Ê
UÊiÀ̈ˆÌÞ]Ê*Ài}˜>˜VÞ]Ê>˜`Ê*>Ài˜Ìˆ˜}ÊvÌiÀÊÀi>ÃÌÊ
>˜ViÀ\Êi˜˜ˆviÀʈÌ̜˜]Ê
UÊ iÌܜÀŽˆ˜}\Ê"Û>Àˆ>˜Ê
>˜ViÀÊ-ÕÀۈۜÀÃ\ʜÀˆÊ,ˆ``i‡7>ŽiÀ]Ê/
UÊ*ÕÌ̈˜}ÊÌʏÊ/œ}i̅iÀÊ̜Ê>ŽiÊiVˆÃˆœ˜Ã\Ê>Ài˜ÊÕÀiÞ]Ê*…ÆʏˆÃœ˜ÊÕÀˆ>˜]Ê
UÊ,iVœ˜ÃÌÀÕV̈œ˜Ê*>˜iÊ+ÊEÊÊÓ\ʜÅÕ>Êiۈ˜i]ÊÆÊ-VœÌÌÊ-ՏˆÛ>˜]Ê
UÊ1«`>ÌiÃÊ"˜Ê/>À}iÌi`Ê/…iÀ>«Þ\ÊÕ`ÞÊ>ÀLiÀ]Ê
UÊ1Ș}ÊՓœÀÊ̜Ê
œ«i\ÊÛ>ʜœ˜
6:00 – 6:10 pm Conference Closing
Directors & Faculty
Course Directors
Susan Friedman, DVM
Founder and Executive Director
FORCE: Facing Our Risk of Cancer
Empowered
Tampa, FL
Susan Domchek, MD
Executive Director
Basser Professor of Oncology
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Philadelphia, PA
Rebecca Sutphen, MD
Professor, Departments of
Pediatrics and Oncologic Sciences
College of Medicine
University of South Florida
Tampa, FL
Faculty
Andrew Ashikari, MD
Breast Surgeon
Ashikari Breast Center
Amy Curran Baker, MA
Occupational Therapist, Registered
Author, Now What? A Patient’s Guide
to Recovery After Mastectomy
Amy Boesky, PhD
Associate Professor, English
Director of the English Department’s
Honors Program
Boston College
Angela Bradbury, MD
Assistant Professor of Medicine
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Rachel Brem, MD
Director, Breast Imaging and Intervention Center
George Washington University
Robert A. Burger, MD
Director, Women’s Cancer Center
Fox Chase Cancer Center
Dana Bushman
Certified Yoga Instructor
David Bushman
FORCE Volunteer
Mary Daly, MD, PhD
Chair, Department of Clinical Genetics
Fox Chase Cancer Center
Kathryn Doran, DPT, CLT
Oncology Rehabilitation/Manager
Cancer Treatment Centers of America
Neill Epperson, MD
Director, Penn Center for Women’s
Behavioral Wellness
Basser Research Center for BRCA
University of Pennsylvania
Anne Ford, MD
Associate Clinical Professor of Obstetrics and Gynecology
Duke University
Tara M. Friebel, MPH
Center for Clinical Epidemiology and
Biostatistics
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Kristi Funk, MD
Founder/Medical Director
Pink Lotus Breast Center
Judy Garber, MD, MPH
Director, Cancer Risk and Prevention
Program
Dana-Farber Cancer Institute
Clarisa Gracia, MD
Director, Fertility Preservation
Basser Research Center for BRCA
University of Pennsylvania
Kristi D. Graves, PhD
Assistant Professor
Georgetown University
Mark Greene, MD
Chief, Clinical Genetics Branch
National Cancer Institute
Ziva Green-Kredow, MS Ed
Chicago FORCE Outreach Coordinator
Lindsey M. Hoskins, PhD, LCMFT
Couple and Family Therapist
Lindsey Hoskins and Associates
Karen E. Hurley, PhD
Clinical Psychologist
Lauren Johnson, MD
Fellow, Reproductive Endocrinology
and Infertility
Basser Research Center for BRCA
University of Pennsylvania
Noah Kauff, MD
Director, Ovarian Cancer Screening and
Prevention.
Memorial Sloan-Kettering Cancer
Center
Andrew Kaunitz, MD
Associate Chair, Department of
Obstetrics and Gynecology
University of Florida College of
Medicine
Susan Kellogg-Spadt, CRNP, PhD
Director of Vulvar and Sexual Medicine
The Pelvic & Sexual Health Institute of
Philadelphia
R. Michael Koch, MD
Plastic Surgeon
New York Group for Plastic Surgery
Paul C. Kredow, PsyD
FORCE Spouse Support Outreach
Coordinator
Allison Kurian, MD
Assistant Professor of Medicine and of
Health Research and Policy
Stanford University School of Medicine
Anna Kuwada
Seattle FORCE Outreach Coordinator
Joshua Levine, MD
Reconstruction plastic surgeon
The Center for Microsurgical Breast
Reconstruction
Jennifer Litton, MD
Associate Professor, Department of
Breast Medical Oncology
MD Anderson Cancer Center
Kara Maxwell, MD, PhD
Fellow, Division of Hematology/
Oncology
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Margo Michaels, MPH
Executive Director
Education Network to Advance Cancer
Clinical Trials
Eva Moon
Jazz Musician and Humorist
Steven Narod, MD, FRCP
Director of Familial Breast Cancer
Centre for Research in Women’s Health
Women’s College Research Institute
Jill Oravitz, RD
Oncology Dietitian
Cancer Treatment Centers of America
Ann Partridge, MD
Founder and Director, Program for
Young Women with Breast Cancer
Dana-Farber Cancer Institute
Sabitha Pillai-Friedman, PhD, LCSW
Assistant Professor, Human Sexuality
Program
Widener University
Jackie Powers, MS
Genetic Counselor, Cancer Risk
Evaluation Program (CREP)
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Anya Prince, Esq
Postdoctoral Fellow
Center for Genomics and Society
University of North Carolina
Timothy Rebbeck, PhD
Director, Center for Genetics and
Complex Traits
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Lori Riddle-Walker, LMFT
FORCE Volunter
Joanna Rudnick
Documentary Director and Producer
Kartemquin Films
Anil Rustgi, MD
Chief of Gastroenterology
Basser Research Center for BRCA
Abramson Cancer Center
University of Pennsylvania
Ali Sadeghi, MD
Plastic Surgeon and Reconstructive
Microsurgeon
Aesthetic & Reconstructive Breast
Center
Kathryn Schmitz, PhD, MPH
Associate Professor Division of Clinical
Epidemiology
Basser Research Center for BRCA
University of Pennsylvania
Rachel Shapira, MS
FORCE Volunteer
Diljeet Singh, MD, DrPH
Program Director of Gynecologic
Oncology
Program Director of Cancer Prevention
and Integrative Medicine
Banner MD Anderson Cancer Center
Kathy Steligo
Health Writer
Author, The Breast Reconstruction
Guidebook
Scott Sullivan, MD
Co-Founder Center for Restorative
Breast Surgery and
St. Charles Surgical Hospital
Melinda Telli, MD
Assistant Professor of Medicine
Stanford University Cancer Center
Cara Tenenbaum, JD, MBA
Senior Advisor, Office of Health and
Constituent Affairs
U.S. Food and Drug Administration
Allison Werner-Lin, PhD
Assistant Professor
University of Pennsylvania
Registration
>“i
Address
City
/ii«…œ˜iÊÊ
State
Ê
Zip
ÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊÊ>Ý
E-mail
ÊÊÊÊÊÊÊi˜ïVÊ
œÕ˜ÃiœÀÊÊÊÊ
ˆVi˜ÃiʛÊ
­Ê- Ê
Ê
,/-®
ACCOMMODATIONS FOR DISABILITIES | Please notify the Conference Planning office at 866-288-7475 ext. 701 within a minimum of 10
working days in advance if a reasonable accommodation for a disability is needed. FORCE events and activities are available without regard
to race, color, sex, national origin, disability, age or Vietnam veteran status as provided by law and in accordance with FORCE’s respect for
personal dignity.
f£™xÊi˜iÀ>Ê,i}ˆÃÌÀ>̈œ˜Ê­"˜ÊœÀÊLivœÀiÊ>ÞÊ£®
fÓxäÊi˜ïVÊ
œÕ˜ÃiœÀÃÊ­"˜ÊœÀÊLivœÀiÊ>ÞÊ£®
fÓ£äÊi˜iÀ>Ê,i}ˆÃÌÀ>̈œ˜Ê­"˜ÊœÀÊ>vÌiÀÊ>ÞÊÓ®
fÓÇxÊi˜ïVÊ
œÕ˜ÃiœÀÃÊ­"˜ÊœÀÊ>vÌiÀÊ>ÞÊÓ®
$35 Welcome Reception
f£xÊ*Àˆ˜Ìi`ÊÃޏ>LÕÃÊ­ œÌi\Ê>Ê>ÌÌi˜`iiÃÊ܈Ê…>ÛiÊvÀiiÊ>VViÃÃÊ̜Ê>˜ÊiiVÌÀœ˜ˆVÊÛiÀȜ˜ÊœvÊ̅iÊÃޏ>LÕî
Total _______________________
Êʅ>ÛiÊëiVˆ>Ê`ˆiÌ>ÀÞʘii`ÃÊÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚ
THERE ARE THREE WAYS TO REGISTER
UÊ,i}ˆÃÌiÀʜ˜ˆ˜i\Ê
www.facingourrisk.org/conference
UÊ>ÝÊÀi}ˆÃÌÀ>̈œ˜ÊvœÀ“]ʈ˜Ê«ÀˆÛ>VÞÊ>˜`Ê
confidence, to Conference Planning at
954-827-2200
U,iÌÕÀ˜ÊÀi}ˆÃÌÀ>̈œ˜ÊvœÀ“Ê>˜`Ê«>ޓi˜ÌÊ̜\
FORCE
£ÈäxÇÊ/>“«>Ê*>“ÃʏÛ`°Ê7°Ê›ÎÇÎ
/>“«>Ê]ÊÎÎÈ{Ç
*9 /Ê/"
Check ­“>ŽiÊ«>Þ>LiÊ̜Ê",
®ÊÊÊÊÊÊÊ>ÃÌiÀ
>À`ÊÊÊÊÊÊÊÊÊ6ˆÃ>ÊÊÊÊÊÊÊÊʓiÀˆV>˜ÊÝ«ÀiÃÃÊÊÊÊÊÊÊʈÃVœÛiÀ
Amount $______________
Ài`ˆÌÊ
>À`Ê Õ“LiÀÊÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÊÊÝ«ˆÀ>̈œ˜Ê>ÌiÊÚÚÚÚÚÚÚÚÚÚÚÚÚ
>À`…œ`iÀÊ >“iÊÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÊ-ˆ}˜>ÌÕÀiÊÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚÚ
For further information, please call: 866-288-7475 ext. 701, email: conference@facingourrisk.org
or log on to: www.facingourrisk.org/conference
˜ÞÊV>˜Vi>̈œ˜Ãʓ>`iÊ܈̅ˆ˜ÊÇÓʅœÕÀÃʜvÊÀi}ˆÃÌiÀˆ˜}ʵÕ>ˆvÞÊvœÀÊ>ÊvՏÊÀiv՘`°Ê
>˜Vi>̈œ˜Ãʓ>`iÊ>vÌiÀÊÇÓʅœÕÀÃÊ܈ÊÀiViˆÛiÊ
a refund minus a $25 processing fee. We will not be able to provide refunds on cancelations made on or after June 2.
Please allow 3-4 weeks to receive your refund.
FORCE: Facing Our Risk of Cancer Empowered
16057 Tampa Palms Blvd. W, PMB #373
Tampa, FL 33647
TAMPA FL
Permit # 638
PAID
NON-PROFIT ORG
US POSTAGE