ARDS SURVIVOR CONFERENCE REGISTRATION FORM COTTONWOOD CENTER MURRAY

NAME: _______________________________________________

ADDRESS: ____________________________________________

CITY: __________________________________STATE: _______

PHONE NO: _____________________

E-MAIL: ________________________

Medical Professional: __   ARDS Survivor: __   ARDS Family:__

Topics: (mark choices)

__ Session A: Post ARDS challenges (cognitive issues, ongoing health issues, anxiety/depression issues, sleep problems, dental problems.

__ Session B: Pulmonary/rehabilitative challenges (living with oxygen, rehabilitation, how to know the signs more rehab is needed, after hospital care, life changes due to ARDS)

__ Session C: Family of Survivors issues (how to help the survivor adjust to a “new normal”, how to deal with family members emotions, how to keep lines of communication open, how to spot the signs that the survivor may need further follow-up medical care

__ Session D: Pastoral Care

__ Session E: New research in both the treatment of ARDS and in survivor issues

__ Session F: Discussion of current ARDS treatments

All sessions will be repeated several times in order to accommodate all
participants.

Return completed registration form along with payment to:
Ken Jonah
12 Red Cypress Place,
Danville, CA 94506

Registration fee: $49.00 per person. Make checks payable to: ARDS Support Center Inc. (please include
number of persons attending and names of each attendee) : Number of persons _______
Names: ________________________ ________________________ _______________________
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