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Register online OR mail/fax this completed form to:

6134 Poplar Bluff Circle, Suite 101, Norcross, Georgia 30092 FAX (305) 422-3327

Please include payment if required

June 10-12, 2011

Kiawah Island Golf Resort Kiawah Island, South Carolina

2011 GSD Meeting Registration Form Select Category Early Reg. After May 13 � GSD Member/Applicant* N/C* $50* *2011 dues or membership application fee MUST be paid in order to receive the member rate. Dues may be paid online at www.gaderm.org

� Non-GSD Member/Resident of $150 $200 GA, NC, SC,TN, AL or FL � Non-GSD Member/Resident of $300 $350 all states NOT listed above Contact Info

Name

� MD or � other (please indicate)

Spouse/Guest Name, IF attending

Child(ren) Name(s)/Age(s), IF attending

Email (req.)

Mailing Address

City/State/ Zip

Phone

Fax

Education Sessions, check all days you will be attending lectures

� Friday, June 10 � Saturday, June 11 � Sunday, June 12 Activities, I/we plan to attend the:

Friday, June 10, 5:45 - 7:15 pm � Cocktail Reception in the Exhibitor Hall, # attending _______ � Children’s Activity Room, # attending _______ � Tween Movie Room, # attending _______

Saturday, June 11 � Oyster Roast and BBQ - REGISTRATION INCLUDES 4 tickets, ADD’L tickets are $75/person aged 13 and up, $30/aged 3-12), # attending:

_______ ages 13 and up, _______ ages 3 -12, _______ under 3

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Method of Payment (Reg Fee & add’l Sat tickets if applicable)

� Check Make checks payable to: GSD

� American Express � Visa � MC � Discover

Card #:

Exp: CID#:

Name as it appears on card:

Full Billing Address:

56th Annual Meeting of the

Georgia Society of

Dermatologists

REGISTER TODAY ONLINE OR VIA ENCLOSED FORM

www.gaderm.org

Questions? Please contact Maryann McGrail

404-310-5866 or maryann@theassociationcompany.com

Meeting Description The Annual Meeting of the Georgia Society of Dermatologists is a three-day program designed for Dermatologists, Dermatologic Surgeons, Dermatopathologists and other interested health care providers. We strive to create a program that is educational and informative using both nationally renowned speakers as well as our own physician members. We also include a resident abstract competition that includes the participants from Emory University and Medical College of Georgia/GHSU* Residency programs.

Objectives Attendees will be updated on a broad range of new developments in dermatology and acquire a better understanding of advances in medical and surgical therapies. They will also gain greater insight into current trends in practice management as well as financial and medical/legal challenges facing today’s clinician. At the conclusion of this learning activity, participants will have • Increased knowledge of recent medical advances in the

diagnosis, management and treatment of diseases of the skin. • Reviewed, interpreted and summarized new clinical, scientific

and research information in the study of dermatology, dermatologic surgery, pediatric dermatology, dermatopathology and cosmetic dermatology.

• Learned and improved techniques that will allow the physician to offer the best treatment options and care to patients.

• Expanded their expertise in select practical aspects of dermasurgery.

• Compared and contrasted methods in order to fully assess patient needs and treatment options.

• Improved standards of practice.

Featured Speaker

Keynote Speakers

Agenda *Visit www.gaderm.org for full agenda, faculty, event and resort details.

Friday, June 10, 2011 8:00 am - 4:00 pm Registration / Check In 9:00 - 11:00 am GSD Executive Committee Meeting 11:00 am - 12:00 pm Exhibit Viewing and Light Refreshments 12:00 - 12:10 pm Welcome and Announcements 12:10 - 12:40 pm Resident Abstracts - Emory 12:50 - 1:30 pm Reconstructions and Interesting Cases, Richard Bennett, MD 1:40 - 1:50 pm Break 1:50 - 2:00 pm New Approaches to Facial Fillers; Restructuring instead of Wrinkle Filling, Richard Sturm, MD 2:00 - 2:10 pm Pearls in Cutaneous Surgery, Katarina Chiller, MD 2:10 - 2:20 pm TBD 2:30 - 3:10 pm Onychomycosis: Classification revisited and therapeutic implications, Robert Baran, MD 3:20 - 3:45 pm Break and Exhibit Viewing 3:45 - 3:55 pm How to Approach Delusions of Parasitosis, Loretta Davis, MD 3:55 - 4:05 pm FD&C Blue Dye 2 and Sulfa Allergy, Robert Swerlick, MD 4:05 - 4:15 pm Flushing, Blushing and Redness: Is it all Rosacea? Jonathan Weiss, MD 4:25 - 5:05 pm Infectious Eschars: Anthrax, Rickettsiosis & Deep Fungi, Jeannette Guarner, MD 5:45 - 7:15 pm Welcome Reception & Exhibit Viewing, Children’s Activities 7:30 pm Executive Committee/Guest Speaker Dinner Saturday, June 11, 2011 7:00 am - 12:00 pm Registration / Check In 7:00 - 8:00 am Exhibit Viewing and Breakfast 8:00 - 8:40 am GSD Business Meeting 8:40 - 9:00 am Georgia Legislative Update Don Bolia, GSD Lobbyist 9:00 - 9:40 am Legislative Issues 2011, Marta Van Beek, MD 9:50 - 10:20 am MCG/GHSU* Presentations 10:30 - 10:55 am Exhibit Viewing and Coffee Break 10:55 - 11:35 am Nail Clinic: Interesting Cases and Management, Robert Baran, MD and Mark Holzberg, MD 11:45 am - 12:25 pm How to Avoid Malpractice Litigation and What to do If It Happens to You, Ken Warner and Gary Lovell 12:45 pm Resident’s Lunch 6:30 - 10:00 pm Low Country Oyster Roast, Barbeque and Party Attendees and their guests/families are welcome Sunday, June 12, 2011 7:00 am - 12:00 pm Registration / Check In 7:00 - 8:00 am Exhibit Viewing and Breakfast 8:00 - 8:10 am Announcements 8:10 - 8:20 am Different Clinical Entities Can Look Very Similar Under the Microscope, Narayan Naik, MD 8:20 - 8:30 am A New Approach For the Clinical Diagnosis of Melanoma, Stuart Goldsmith, MD 8:30 - 8:50 am Dermatopathology Report in 2011 - What do you need to know? Petra Milde, MD 9:00 - 9:40 am Treating Melanoma with Mohs Surgery, Richard Bennett, MD 9:50 - 10:15 am Exhibit Viewing and Coffee Break 10:25 - 11:05 am Reuben Reifler Lecture: Challenges for Healthcare Reform, Louis Sullivan, MD 11:15 - 11:20 am New President Introduction, Closing Remarks *On February 1, 2011, Medical College of Georgia (MCG) will become Georgia Health Sciences University (GHSU)*

Robert Baran, M.D. Head of the Nail Disease Center in Cannes, France Consultant Dermatologist to the Gustave Roussy Cancer Institute in Villejuif, France.

Richard Bennett, M.D. Professor of Clinical Dermatology - UCLA & USC Schools of Medicine Specialist in Mohs Micrographic Surgery

Marta Van Beek, MD Fellow of the American Academy of Dermatology Chair, Congressional Policy Committee

Jeannette Guarner, MD Associate Professor, Pathology and Laboratory Medicine - Emory Infectious Disease Pathology Guest Researcher at the CDC

The Honorable Louis W. Sullivan, M.D. President Emeritus of Morehouse College of Medicine Former Secretary of Health and Human Services for President George H.W. Bush (1989-1993)

Accreditation See www.gaderm.org/2011Accreditation.htm

Kiawah Island, South Carolina Just miles from the beautiful historic town of Charleston, South Carolina lies an immaculate ten-mile barrier island known as Kiawah Island. The island is located in the heart of Low country where decades of dedication have preserved the beauty of Kiawah’s pristine beach, tidal marshes, maritime forests and freshwater ponds. Kiawah, named after the Indians who lived there in the 1600’s, is committed to maintaining a balance between the resort community and its fragile natural surroundings. Amongst the beauty of Kiawah, you will find a nurturing habitat for wildlife including a large variety of plants and animals. Enjoy the beauty of Kiawah Island on a bike ride, a long stroll down the beach or a relaxing kayak ride.

Accommodations The Official Golf Resort at Kiawah Island is a resort unlike any other and provides an experience you will never forget. Guests at The Kiawah Island Golf Resort will not only enjoy the pristine beaches, but also the award-winning championship golf courses, outstanding tennis facilities, recreational activities for the entire family and exquisite dining. http://www.kiawahresort.com/

Guests renting villas and homes directly from the resort, as well as hotel guests, will receive these exclusive benefits:

• Use of both indoor and outdoor pools • Preferred golf and tee times • Preferred tennis and court times • Preferred nature programs and Kids Kamp • Complimentary door-to-door resort transportation • Advance dining reservations and preferred availability • Advance spa reservations and preferred availability • Resort charging privileges provide ‘cashless’ experience • Personal serve from over 1,000 employees

Reserve your villa at the Kiawah Island Golf Resort!

A block of 1 and 2 bedroom scenic view villas have been reserved at The Kiawah Island Golf Resort

at a reduced rate of $300 per night.

Call (800) 654-2924 and mention booking ID# 7411

or the Georgia Society of Dermatologist room block.

The room block expires on May 9, 2011 There is a daily resort fee of 8% per villa per night which includes ALL on-island transportation to resort owned venues for group and individual use via the existing fleet of resort vehicles (during regular business hours), access to the villa fitness room and the two villa resort pools.