NRNPC - Registration Information

ON-LINE REGISTRATION

WE ARE CURRENTLY EXPERIENCING DIFFICULTIES -
PLEASE MAIL OR FAX YOUR REGISTRATION
WITH YOUR CREDIT CARD INFORMATION

REGISTRATION FORM
FAX: (617) 552-3411

Complete all the fields below and click on the "Submit" button when done. Click "Reset" if you wish to clear the form.

Please note: On-line submission may not be secure. If you prefer to fax or mail your registration, print out a copy of the registration form.

Registration Deadline for the 2008 Conference is April 11, 2008. There will be on-site registration ($30 additional fee) based on space availability.

Save on your conference registration! Apply for MCNP Membership

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NAME

ARNP NP RN PA OTHER

HOME ADDRESS

Street
City
State ZIP

SOCIAL SECURITY (last 4 digits only)

PHONE

Work Home

PLACE OF EMPLOYMENT

EMAIL

PLEASE CHECK SESSION CHOICES BELOW. We will try to give you your first choice, but if a session is full, or a choice is not indicated we will assign a session for you.

WEDNESDAY WORKSHOPS:

SESSION 1	1, 2, 3
1st CHOICE 2nd CHOICE
SESSION 2	4, 5, 6
1st CHOICE 2nd CHOICE

THURSDAY PROGRAM:

SESSION 1	1, 2, 3, 4,
1st CHOICE 2nd CHOICE
SESSION 2	5, 6, 7, 8
1st CHOICE 2nd CHOICE
SESSION 3	9, 10, 11, 12
1st CHOICE 2nd CHOICE
SESSION 4	13, 14, 15, 16
1st CHOICE 2nd CHOICE

MCNP Association Meeting NHNPA Association Meetings

FRIDAY PROGRAM:

SESSION 5	17, 18, 19, 20
1st CHOICE 2nd CHOICE
SESSION 6	21, 22, 23, 24
1st CHOICE 2nd CHOICE
SESSION 7	25, 26, 27, 28
1st CHOICE 2nd CHOICE
SESSION 8	29, 30, 31, 32
1st CHOICE 2nd CHOICE

LUNCH: General LUNCH: Pharmacy Regulations ($25) LUNCH: Legislative Update ($25)

I will attend: (check all that apply) Wednesday Thursday Friday

	Early Bird Registration - Postmarked by March 12		Regular Registration		On-Site Registration
	1 day	2 day	1 day	2 day	1 day	2 day
MCNPs & NHNPA Members*	$175	$295	$200	$320	$230	$350
Non-Members	$260	$405	$280	$430	$315	$460
Full-Time Students**	$140	$220	$165	$245	$195	$275
* Current members only as of 03/01/08. Expired membership will be charged full conference fee. Please specify state of membership:
** Enclose letter from department verifying full-time status.

Optional Friday morning Breakfast Symposia ($25)
(Pre-registration required; On-site registration not available)

Breakfast 1: Athsma

Breakfast 2: Hepatitis B

PRE-CONFERENCE WORKSHOP FEE ($200)

REGISTRATION FEE

OPTIONAL BREAKFAST FEE ($25)

OPTIONAL LUNCH FEE ($25)

TOTAL

EARLY BIRD REGISTRATION:
Ends March 8, 2008. Any registration postmarked after this date will be considered Regular Registration.

PAYMENT INFORMATION

Please charge to: Mastercard Visa

Total Amount:

Account Number:
Exp. Date:

Cardholder Name: