CliniCal appliCations of the prinCiples in

treatment of addiCtions and substanCe abuse

16th AnnuAl

ConferenCe

January 29 - 30, 2016

embassy suites

lexington, KentuCKy

2016 CAPtASA ConferenCe Weekend SChedule

thurSdAy, JAnuAry 288:00-9:00pm Open 12-Step MeetingfridAy, JAnuAry 297:00-8:15am Registration Continental Breakfast 8:15-8:30am Welcome and Announcements – Brian Fingerson, BS Pharm, RPh, FAPHA8:30-9:20am Opiates – Poppies and Beyond – Greg L. Jones, MD 9:30-10:20am Gambling Addiction Treatment & Peer Recovery –

Eric Martin, MAC, CADC III, CRM, CPS 10:30-11:20am Basics of Sexual Compulsivity – Mary Deitch, JD, PsyD11:20-11:35am Q & A11:35-1:00pm Lunch1:00-1:50pm Marijuana: The Wild West & Youth Recovery – Eric Martin, MAC, CADC III, CRM, CPS and Tony Vezina, Peer Youth Director2:00-2:50pm Tobacco: Addiction's Smoking Gun? – Marc Myer, MD2:50-3:10pm Break 3:10-4:00pm Alcohol and Sedative Hypnotics – Ellen A. Ovson, MD, FASAM4:10-5:00pm Food Wars: Eating Disorders on the Addiction Spectrum – Kim Dennis, MD, CEDS5:00-5:15pm Q & A5:15-6:45pm Break 6:45-7:45pm Conference Banquet7:45-8:00pm Break8:00-9:00pm Banquet Speaker – Ty T. (Louisville, KY)9:10pm Open AA Meeting9:10pm Al-Anon MeetingSAturdAy, JAnuAry 306:30-7:30am Closed AA Meeting7:30am Continental Breakfast 8:15-9:05am Adolescent Brain – Neurophamacology: Normal and Addiction Impact on Behavior – Burns M. Brady, MD, FASAM, FAACP 9:15-10:05am Buprenorphine in Medication Assisted Treatment: Problem or Solution? – Greg L. Jones, MD and Quintin Thomas Chipley, MA, MD, PhD10:05-10:30am Break 10:30-11:20am Review of the Three Major Studies of Addiction Treatment: Project Match, Blueprint Project and Medication Assisted Treatment – Burns M. Brady, MD, FASAM, FAACP11:30am-12:20pm Relapse or Relapse Prevention: A Choice – Brian Fingerson, BS Pharm, RPh, FAPHA12:20-12:30pm Q & A12:30pm Drawing for Door Prizes (must be present to win)12:35-1:40pm Lunch1:40-2:30pm Recovery Kentucky – Mike Townsend2:40-3:30pm The Common Core of 12 Step Recovery: Filling in the Blanks – Quintin Thomas Chipley, MA, MD, PhD

CAPtASA AnnuAl ConferenCe

tArget AudienCeAttendees will include physicians, nurses, pharmacists, dentists, chemical dependency counselors, psychologists, therapists, social workers, employee assistance professionals and other health care providers, as well as recovering professionals.

CAPtASA ConferenCe 2016 obJeCtiveS• Participants will be able to relate to others: buprenorphine’s history 1) of initial development as a poorly-received opiate analgesic, 2) decades before the

drug was re-purposed to manage opiate-withdrawal, 3 and, most recently, as marketed forcefully for Medication Maintenance Treatment in opiate addiction• Participants will be able to list four problems regarding buprenorphine use, as reported anecdotally by both recovering opiate addicts and addiction-

treatment professionals, which call for future stringent investigation: 1) treatment-induced refractory depression, 2) unwelcome euphoria upon induction dose, 3) prolonged, difficult detoxification and 4) diversion of prescription-source buprenorphine to illegal markets to garner cash for obtaining drugs of abuse

• Participants will be able to cite the statistically-demonstrated relationships of 1) exceeding the purported “ceiling effect” of buprenorphine dosing 2) the common abuse of buprenorphine to achieve euphoria and 3) the abuse of diverted (i.e. – without legitimate prescription) buprenorphine, all based on analyzed numeric data gathered from addicts in recovery centers

• Participants will be able to list in rough chronological order the origin-years of some common Twelve Step recovery programs with Alcoholics Anonymous always accurately listed as first and as in 1938

• Participants will be able to list the core concepts or behaviors expressed in each of the Twelve Steps, and will be able to name the common core problem found in all addictions and/or behavioral compulsions

• Participants will be able to name patterns of “drift” and examples of contradiction that have arisen in Twelve Step programs as some become poorly tethered to the Common Core

• Participants will learn how to recognize problematic sexual behaviors• Participants will learn basics of assessment for sexual compulsivity• Participants will learn different diagnostic categories and treatment planning for problematic sexual behaviors• Participants will be able to identify the types of eating disorders• Participants will understand treatment goals of persons with eating disorders• Participants will be able to apply 12-Step facilitation to eating disorder recovery• Participants will be able to place opioids in proper historical perspective• Participants will be able to review the key developments of opioid refinements and uses• Participants will learn the basic pharmacology of opioids – therapeutic and addictive• Participants will be able to discuss tobacco epidemiology• Participants will learn about basic nicotine neurobiology• Participants will be able to appreciate the importance of tobacco cessation in recovery from alcohol and other drugs• Participants will briefly review prevailing theoretical models of conceptualizing gambling addiction treatment• Participants will gain insight regarding the gambling industry (State operated, Casino, Lotteries, Online & Fantasy Football) and it’s exploitative

relationship with addicted gamblers• Participants will learn about Oregon’s gambling peer recovery movement and advocacy• Participants will understand issues regarding marijuana legalization and marijuana epidemiology, products, commercialization and addiction treatment• Participants will understand withdrawal related concerns regarding users of extracts (BHHO, Wax, Shatter, Crumble, Honeycomb, Budder) and

changes in assessing urine drug analysis• Participants will understand voter analysis data related to the legalization of marijuana• Participants will gain a better understanding of post-treatment youth recovery research and the innovation of a new Youth 12-Step Club and youth peer services• Participants will gain knowledge of history of alcohol and sedative-hypnotic use• Participants will gain knowledge of neurobiology of alcohol and sedative-hypnotics• Participants will gain knowledge of signs and symptoms of alcohol and sedative-hypnotic intoxication and withdrawal• Participants will be able to describe the six most common reasons for relapse in health care• Participants will be able to define psychiatric factors that can increase the potential for relapse• Participants will be able to describe back to work issues that when addressed promote successful maintenance of sobriety/abstinence• Be able to review cognitive behavior treatment, motivational enhancement treatment, and 12 Step facilitation treatment• Review a 44-state summary of Physician Health Programs for addiction treatment• Review coordination of neuropharmacology and medications of medication assisted treatment• Learn the relative time of maturity of reward and impulse control in the brain• Learn the neuropharmacology of addiction and how the time of maturity interacts with that• Learn the clinical impact presented by the time of maturity and the neuropharmacology of addiction regarding adolescent addiction treatment• Understand the historical perspective of the Recovery Kentucky program• Understand how Recovery Kentucky, this supportive housing model, promotes long term recovery from addiction• Understand the behavioral outcomes of clients completing Recovery Kentucky's long term recovery program

fACulty

burnS M. brAdy, MD, ASAM, FASAM, ABFP, FAAFP Dr. Burns M. Brady is a 1964 graduate of the University of Louisville Medical School and completed his internship and residency training at St. Joseph's Infirmary in Louisville.

Dr. Brady is a member of numerous professional medical organizations, including the local, state and national medical associations, the American Academy of Family Practice and is a Fellow of the American Society of Addiction Medicine. He is a Board-certified family physician and a Board-certified addictionologist.

Dr. Brady is an addiction consultant for a 400-bed men and women's homeless shelter, The Healing Place, which has been recognized as one of the top five in the United States. He continues to be a very active volunteer.

He served as a clinical instructor on alcoholism for the University of Louisville, University of Kentucky, and Pikeville Schools of Medicine. He also served as a consultant to the American Bar Association, Kentucky Bar Association, Kentucky Dental Association and Kentucky Nurses Association on issues of professional impairment.

Dr. Brady retired for the second time in 2011 as the Medical Director of the Kentucky Physicians Health Foundation-Impaired Physicians Program and has been named Medical Director Emeritus.

Dr. Brady has presented on various topics relating to impairment issues on a local, state, national and international level.

Quinn t. ChiPley, MA, Md Dr. Chipley was born and raised in Memphis, Tennessee. He has degrees from Rice University, Houston, Texas (B.A.-1978), Southeastern Theological Seminary, Wake Forest, North Carolina (M. Div. - 1984), University of Louisville, Clinical Psychology (M.A.-1992) and University of Louisville, M.D. (2000). and University of Louisville, Ph.D (2015), the last with the dissertation, "William Faulkner and Alcoholism: Distilling Facts and Fictions."

Dr. Chipley also serves as the Counseling Coordinator for the students enrolled in the medical, dental, nursing and graduate schools of the University of Louisville at the Health Sciences Center campus. He considers it the ideal position where he can practice psychology against the background of a medical education. Prior mental health profession work experiences have included Director of Staff Development and Training, Central State Hospital ICF/MR, Louisville, Kentucky, a brief stint in the psychiatry residency of the University of Louisville affiliated hospitals, six years of full-time private practice in psychology with

Ragsdell and Associates, Louisville, Kentucky.Dr. Chipley’s other work opportunities in life have been so varied

as to include alumni fundraising for Rice University, three years of teaching in Kenya, East Africa, and bookkeeping for a small Louisville company. Volunteer passions have included active service and board membership for both Alley Cat Advocates and the Drepung Gomang Institute. He is a board member of the Kentucky Physicians Health Foundation, and he was pleased and honored in 2007 to be invited to help with the CAPTASA planning group, a service opportunity he still maintains and cherishes.

MAry deitCh, Jd, PSyd Dr. Deitch was the Program Director for the Keystone Center Extended Care Unit, a residential program dedicated to the treatment of those struggling with sexual addiction, for 6 years. Dr. Deitch specializes in working with offending behaviors, schema focused therapy, relapse prevention, assessment and trauma. Dr. Deitch has presented internationally on the treatment of sexual addiction, assessment of physicians, vicarious trauma, and offending behaviors. She has also created a specialty intensive for sexual addiction utilizing ACT therapy. Dr. Deitch is also a consultant and supervisor for Victim Services Center of Montgomery County, Inc., a non-profit agency working with those who are victims of crime and their significant others. Dr. Deitch’s main focus there is supervising students working with children via play therapy and adults utilizing an empowerment model. Dr. Deitch also serves as adjunct faculty at Widener University Institute for Graduate Clinical Psychology and most recently taught on topics related to merging the fields of psychology and law. Dr. Deitch is a Board member of the Society for the Advancement of Sexual Health and the Co-Chair of the National Conference for SASH.

kiM denniS, Md, CedSC Dr. Kim Dennis is an award-winning board-certified psychiatrist

who specializes in eating disorder treatment, addictions recovery, trauma/PTSD and co-occurring disorders. As CEO & Medical Director at Timberline Knolls Residential Treatment Center, she supervises the medical staff and sets the overall vision and direction for the treatment program. Dr. Dennis maintains a holistic perspective in the practice of psychiatry. She incorporates biological, psycho-social and spiritual approaches into the individually tailored treatment plan for each resident. Dr. Dennis obtained her medical degree from the University Of Chicago Pritzker School Of Medicine and completed her psychiatry residency training at the University of Chicago Hospitals, where she served as chief resident.

fACulty

greg JoneS, Md Dr. Jones has a BA in Chemistry from Huntingdon College in Montgomery, Alabama. His medical degree is from the Medical College of Georgia in Augusta, GA.

His Family Practice training was in Anniston, Alabama, where he also served on the faculty of the Residency until 1992. During his years in Anniston, he was President of the Alabama Academy of Family Physicians and the Director of the Residency program.

He moved to Paducah, Kentucky, working for Lourdes Hospital and then to Danville, Kentucky, working for Ephraim McDowell in Family Medicine.

After completing an Addiction Medicine Fellowship at Willingway Hospital in Statesboro, Georgia, he returned to Kentucky to start the first Medical Detox unit in eastern Kentucky at Pikeville Methodist Hospital, serving as Medical Director.

From there he became the Director of Medical Services at Eastern State Hospital in Lexington. His practice included full in-patient Family Medicine and Addiction Medicine. While in Lexington he was also on the Board of Directors of the Kentucky Physicians Health Foundation and the Shepherd's House in Lexington.

Dr. Jones returned to Willingway Hospital in 2010 as a Staff Physician and remained there until late 2011. He is currently the Medical Director of the Kentucky Physicians Health Foundation.

He is Board Certified in Family Medicine by ABFM and in Addiction Medicine by ABAM.

eriC MArtin, MAC, CAdC iii, CrM, CPS Eric Martin is the Past President & Director Emeritus of the Addiction Counselor Certification Board of Oregon. Eric Serves as both trainer and supervisor of the 4th Dimension Youth Recovery Club and Peer Support Program. Eric is an Adjunct Faculty member with the University of Oregon SAPP program and a contract instructor with Oregon's Child Welfare Division. Eric is a state and nationally certified addictions counselor with 30 years of clinical experience in Inpatient Psychiatric Hospitalization, Residential and Outpatient Addictions Treatment, Recovery Support Services and ATOD Prevention. Eric is an international presenter and recovery advocate. Eric has served on several Governor's advisory boards, the Governor's Council on Substance Abuse Programs and the Governor's Advisory Board on Drugs & Violent Crime. Eric has also produced a number of videos, including "Reunited", a video designed for methamphetamine addicted mothers entering the child welfare system. He has been honored with numerous awards in light of his 30 years of service in Addiction Treatment & Prevention. Most notably, he is the recipient of the Governor's Council Award of Excellence,

presented by Oregon Governor John Kitzhaber, and he is the recipient of the National Association of Alcohol and Drug Abuse Counselors-National, William F. Callahan Award for Sustained and Meritorious Service at the national level to the profession of addiction counseling, presented in Washington D.C. in 2010. Eric currently serves in a leadership capacity to numerous community boards including: 4th Dimension Recovery Center, New Columbia CREW, Chair of the Miracles Club, Voices of Problem Gambling Recovery, Legislative Liaison for the Addiction Counselor Certification Board of Oregon and immediate past Co-Chair of the State's Traditional Health Worker Commission.

MArC Myer, Md Marc Myer, M.D., is the Health Care Professionals Program Director at Hazelden in Center City, MN. Dr. Myer has years of experience treating health care professionals afflicted with the disease of chemical dependency. He is a board certified addiction specialist and an active member of the American and Minnesota Societies of Addiction Medicine. Marc is a past chair person for Physicians Serving Physicians in Minnesota. He is also an adjunct professor in the Hazelden Graduate School of Addiction Studies. Specific interests in addiction include nicotine dependence and cessation, treatment of opioid use disorders, and treatment of addicted nurses. Dr. Myer came to Hazelden in the fall of 2011 after working for 5 years exclusively in the realm of medical informatics and medical software development for Wolters Kluwer Health. He is a graduate of the University of Wisconsin School of Medicine and Public Health.

ellen A. ovSon, Md Dr. Ovson serves as Medical Director of Bradford Health Services in Madison, Alabama. In this role, she diagnoses and treats chemically dependent patients, as well as supervising the activities of the entire treatment team. She has over fourteen years’ experience in clinical Addiction Medicine, with special expertise in eating disorders and sexual addiction as well as substance dependence. She is board-certified by the American Board of Internal Medicine and the American Board of Addiction Medicine.

fACulty

MiChAel e. toWnSend

Mike Townsend serves as Program Administrator of Recovery Kentucky with the Kentucky Housing Corporation. He has worked for the corporation for the past eleven years. Recovery Kentucky is a statewide initiative to build and operate fourteen 100 bed addiction recovery centers throughout Kentucky for persons needing long term substance abuse recovery and housing support. The Recovery Kentucky programs are modeled after The Healing Place of Louisville and The Hope Center of Lexington. Prior to Mr. Townsend's employment with the Kentucky Housing Corporation, he served as state Director for the Division of Substance Abuse within the Cabinet for Health and Family Services for 25 years. He is a graduate of Centre College and graduated from the University of Louisville's Kent School of Social Work where he received his Master's of Science in Social Work.

tony vezinA Tony Vezina is a Co-Founder of The 4th Dimension Recovery Center. He has held the following positions at 4D: Vice President, Out-Reach Coordinator, and currently serves as the Director of Peer-Services. Tony has an Associates Degree in Arts, and is currently working on a CADC 1. He is very active in student affairs, and since his time at Portland Community College, he has started a Recovery Support Club that is now run by students on a scholarship basis. He has served as the Honors Society Phi-Theta Kappa President, Founder of the Equity and Inclusion Coalition that serves as a student driven initiative to advocate for marginalized communities, and currently serves as the Student Body President. Tony is also a person who identifies with long-term recovery, for him this means he hasn’t used drugs or alcohol. Tony has a passion for social justice and will pursue a degree in sociology.

ACCreditAtion StAteMentS

for CAPtASA ConferenCe 2016

Kentucky Medical Association • This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Kentucky Medical Association and CAPTASA. The Kentucky Medical Association is accredited by the ACCME to provide continuing medical education for physicians. • The Kentucky Medical Association designates this live activity for a maximum of 10.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Kentucky Board of Medical Licensure • The Kentucky Board of Medical Licensure has approved 5.25 total CME hours for attendance at all sessions on Friday, January 29th and 5 hours for attendance at all sessions on Saturday, January 30th, as meeting the mandated requirements for House Bill 1. Kentucky Board of Dentistry • This conference has been submitted for approval by the Kentucky Board of Dentistry for 13 hours of Category B continuing education credits. • Credit Designation - Number of CE Points: 13 Category B • Approved for KASPER requirement CEKentucky Board of Nursing • KBN approved nursing continuing education contact hours (offering #01-2016, #02-2016) will be awarded for each date of attendance at this conference. (9.1 contact hours – 1/29/16 and 6.3 contact hours – 1/30/16). To be awarded contact hours attendee must attend all programs each day. The KBN approval of an individual nursing continuing education provider does not constitute endorsement of the offering content.Kentucky Board of Pharmacy • This conference has been submitted for approval by the Kentucky Board of Pharmacy for seven (7) hours on Friday and six (6) hours on Saturday for a total of 13 hours of continuing education. Note: this approval is for CE hours in Kentucky only – it has not been submitted for ACPE approval.Kentucky Board of Examiners of Psychology • CAPTASA is authorized by the Kentucky Board of Examiners of Psychology to provide up to 10.4 CE credits for professionals licensed by the Board and not for students. Kentucky Board of Social Work • This conference has been planned and implemented in accordance with the requirements of the Kentucky Board of Social Work. A maximum of 13 CEU's have been approved for attendance at the entire conference through the Kentucky Board of Social Work.Kentucky State Board of Licensed Marriage and Family Therapists • This conference is planned and implemented in accordance with the requirements of the Kentucky State Board of Licensed Marriage and Family Therapists. Approval for CEU’s has been requested through the Kentucky State Board of Licensed Marriage and Family Therapists.Certified Alcohol and Drug Counselors • Contact hours will be awarded.Licensed Professional Counselors • Contact hours will be awarded.Physical Therapy • This conference has been submitted for approval to the Kentucky Physical Therapy Association for 13 contact hours (Category 1) upon course completion.Employee Assistant Professionals Association • 13 contact hours have been approved by the Employee Assistance Certification Commission.

PLEASE SEE INDIVIDUAL DISCIPLINES FOR CE INSTRUCTIONS

hotel inforMAtion

ConferenCe Site & ACCoMModAtionSAll conference sessions will be held at the Embassy Suites in Lexington. A special conference rate has been arranged for overnight accommodations at the Embassy Suites. Please contact the hotel directly to make your hotel reservations prior to the cut-off date. Be sure to mention the “Clinical Applications of Principles in Treatment of Addictions and Substance Abuse” (CAPTASA) Conference to ensure that you receive the conference rate.

Room Rates - $128 single or doubleCut-off Date - January 11, 2016

To make hotel reservations attendees may either call the hotel directly at the number listed below or by online registration via the link provided below: https://resweb.passkey.com/Resweb.do?mode=welcome_ei_new&eventID=14261452 Hotel Name: Embassy Suites Lexington Hotel Address: 1801 Newtown Pike Lexington, Kentucky 40511 Phone Number: 859-455-5000

For Additional InformationSandy Patrick, Office ManagerKentucky Physicians Health Foundation9000 Wessex Place, Suite 305, Louisville, KY 40222Phone: (502) 425-7761 FAX: (502) 425-6871Email: sandyp@kyrecovery.org Website: www.captasa.org

First _____________________________________________ MI ______ Last _____________________________________

Profession/Credentials ________________________________________________________________________________

Name for Nametag ___________________________________________________________________________________

Institution/Organization ________________________________________________________________________________

Mailing Address ______________________________________________________________________________________

City ________________________________________________ State _____ Zip __________________________________

Phone ______________________________________________ Fax ___________________________________________

Email ______________________________________________________________________________________________

Please list any special needs you may have (dietary, etc.): ____________________________________________________

___________________________________________________________________________________________________

PAYMENT INFORMATION• Personal or institutional check made payable to: CAPTASA Conference• Credit cards NOT accepted• Cost of Banquet INCLUDED in registration fee.• No one day or group rate

NO REFUNDS AFTER JANUARY 15, 2016

$175 Early Registration Fee (postmarked by Jan. 8, 2016) $ _________$200 Regular Registration Fee (postmarked after Jan. 8, 2016) $ _________No registrations accepted if postmarked after Jan. 20, 2016. You will need to register at the door.

I plan to attend the banquet Friday night _______Yes _______NoMUST CHECK IF YOU PLAN TO ATTEND(cost of the banquet ticket is included in the registration fee)

Guest Banquet Ticket(s): # Tickets ______ x $35 per ticket = $ _________

Handouts @ $35 per set: # Sets _______ x $35 per set = $ _________MUST PRE-ORDER BY JANUARY 18 - NOT AVAILABLE FOR PURCHASE AT CONFERENCE

Total Amount Enclosed: $ _________

Mail to: CAPTASA Conference c/o Kentucky Physicians Health Foundation 9000 Wessex Place, Suite 305 Louisville, KY 40222

CAPTASA ConferenceJanuary 29-30, 2016 Embassy Suites- Lexington, KY

Registration Form

Acadia HealthcareAlcoholics AnonymousAl-AnonBaptist Health Louisville & Baptist Health CorbinBradford Health Services The Bridge to RecoveryCapstone Treatment CenterCirque LodgeCumberland HeightsEnglish Mountain RecoveryFairbanks Treatment and Recovery CenterThe Farley Center at Williamsburg PlaceFirstLabFlorida Recovery CenterFood Addicts AnonymousThe Healing Place Kentucky Cabinet for Health & Family Services (KASPER)Lincoln Trail Behavioral Health SystemLindner Center of Hope

2016 CAPtASA ConferenCe exhibitorS

At tiMe of Printing

Kentucky Physicians Health FoundationKentucky Professionals Recovery NetworkKentucky Dental Association MedicineK.A.R.E. for Nurses Program, Kentucky Board of NursingKentucky Association of Addiction ProfessionalsKentucky Chapter of Employee Assistance Professionals AssociationKentucky Psychological AssociationKentucky Board of Social Workers

SuPPorting & PlAnning orgAnizAtionS

Kentucky Medical AssociationKentucky Board of PharmacyKentucky Society of Health Systems Pharmacists

SPeCiAl SuPPort froM

The Menninger ClinicMetro Atlanta Recovery Residences (MARR)The Morton CenterNarcotics AnonymousNew Life LodgeOur Lady of PeacePalmetto Addiction Recovery CenterThe PavillonPine Grove Behavioral HealthThe RanchRecovery WorksRidge Behavioral Health SystemsSt. Elizabeth HealthcareSeven Counties Services, Inc.Sprout Health GroupTara Treatment CenterTimberline Knolls Residential Treatment CenterWillingway Hospital

CAPtASAiS StAying green!

What this means for participants: We will no longer be making copies of presentation handouts for each conference attendee. All presentations will be available at our website www.captasa.org one week prior to the conference so that you may download and print your own copies. This will save greatly on paper, which means fewer trees will be killed! It will also allow us to avoid an increase in registration fees. For those participants who prefer handouts be provided for them there will be an additional charge of $35 per set. We hope you support us in this endeavor to do our little part to save the environment. We look forward to seeing you in January 2016!

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CAPTASA Conferencec/o Kentucky Physicians Health Foundation9000 Wessex Place, Suite 305Louisville, KY 40222

Presort StandardU.S. Postage

PAIDLouisville, KY

Permit No. 1823