Name
Spouse's/Guest's Name
Address

At least one (1) phone number is required

Home
-
Work
-
FAX
-
Cell
-
E-mail

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CONVENTION FEES

1.     CONVENTION FEE $130 per person: Includes all lectures, Saturday  banquet; breaks during the lectures; and tour of selected hospital sites. This DOES NOT includ:hotel room, valet parking, phone calls, etc.

2.     CONVENTION FEE FOR SPOUSE/GUEST $115 per person: Must be accompanied by someone paying the full convention fee (Item #1 above). This includes everything listed in Item #1 above.

3.     FEE FOR BANQUET ONLY $35 per person

We need to know if you are going to attend the Saturday tour
in order to get an accurate count for the number of busses to hire.

Saturday Tour

Total fee is Amount of Fee x Quantity

Fee $130 per person (Enter Total)
 $ 
Fee for Spouse/Guest $115.00 (Enter Total)
 $ 
Fee for Banquet Only $35.00 per person (Enter Total)
 $ 

All convention fees include a $50.00 non-refundable booking fee.
Conference fee cannot be refunded after April 1st,2018

NO REGISTRATIONS ACCEPTED AFTER April 1st, 2018

NO WALK-ON REGISTRATIONS ACCEPTED
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Verification: