Annual Conference Registration

First Name Required.
Last Name Required.
Nick Name    (for badge~ i.e. Jim for James, etc.)
Job Title Required.
Facility/Company Required.
Address Required.
City Required.
State Required.
Zip Required.Invalid format.
Daytime Phone Required.Invalid format.
Fax Invalid format.
Email Required.Invalid format.
RN License #   (for CEU credit)
I will be attending the Thursday Evening Reception.
    Yes 
    No
      (No additional charge to attendees)
CDC Member ~ LATE Registration:
    Full Conference $325    
    Friday only $220    
    Saturday only $200 
Non-CDC Member ~ LATE Registration:
    Full Conference $375    
    Friday only $250   
    Saturday only $230