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15-17 May 2014

6-8 Nov 2014




First Name:

MI:

Last Name:

Certification (FNP, ANP, WHNP, PA, Pharm):

Address:

Street:

City:

State:

Zip:

Phone Number:

Registrant’s Email is MANDATORY for ALL Communications

Registrant’s Email:

EKG Workshop (Friday Afternoon):

Joint Injection Workshop (Saturday Afternoon):

Comments/Special Needs (ie: Handicap Accessibility, diet, etc):

Type of Registration:




Registration Amount:
Full Registration - NOT Sharing

Registration Amount:
Full Registration - Sharing


Registration Amount:
NOT Staying at the Hotel


Pre-Printed Notes:

All the slides will be available on a CD at the meeting.  The Notes will be available on-line prior to the meeting so that you can save money by printing your own. ALSO:  Electricity will be available at the tables so that you can use your computer at the meeting as desired.

Name of Roommate:

My spouse will be attending and wishes meals and health Club Benefits:  

Room Type (the Hotel will do their Best to meet request):

Registration is a TWO PART PROCESS - Completion of the above form and completion of the next page - Payment Options

Complete this form and submit.  
This will direct you to the PayPal page.
If you wish to use a credit card, you may complete the PayPal page for credit card payment.
If you wish t use a check, please follow the appropriate link on the payment page.
TROUBLE??? Call me - –Stacy - 843-685-4177