National Association of Subacute / Post Acute Care

National Association of Subacute / Post Acute Care :: Forms


REGISTRATION INFORMATION :
NASPAC Member Yes No
Name / Title:
Organization / Company:
Address: Home Work:
City/State/Zip:
Phone (required):
Email:
Fax (required - all conference updates will be sent to you by fax)
Check here if you require special services (i.e., wheelchair, etc.). Specify
To receive CEUs, please provide the following information:
Type: Adm RN Other License # State


REGISTRATION OPTIONS AND FEES :
3-DAY CONFERENCE: NOVEMBER 2-4, 2005 (WEDNESDAY - FRIDAY)
INDIVIDUAL Prior to 7/31/05:	$395
INDIVIDUAL on or after 7/31/05:	$445 Member	$495 Non-Member
TEAM Discount* Prior to 6/1/05:	$370 Member / pp	$420 Non-Member / pp
TEAM Discount* on or after 6/1/05:	$400 Member / pp	$450 Non-Member / pp
EARLY BIRD SPECIAL prior to 01/01/05:	$350
*TEAM Discount: 4 or more persons from the same organization - must register at the same time. PRE-CONFERENCE PROGRAMS: OCTOBER 31 - NOVEMBER 2, 2005
MDS Certification Course and Exam $595.00	MDS Certification Course Only $395.00	MDS Certification Exam Only $200.00


† Lunch not included

METHOD OF PAYMENT :
Please indicate total amount included or to be charged $
All credit card transactions are processed manually at the NASPAC offices
(No confirmation will be sent without full payment)
MasterCard Visa
Card Number	Exp. Date