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APPLICATION FOR CONFERENCE SUPPORT

NORTHEAST REGIONAL NURSE PRACTITIONER CONFERENCE
Radisson Hotel Manchester
Manchester, New Hampshire

May 7 - 9, 2008

This form serves as initial intent of conference support. Please indicate your choice of support. Space is limited and will be assigned when payment is received. Send form to Boston College School of Nursing, Continuing Education ATTN: NP Conference, Service Building room 206, Second Floor, Chestnut Hill, MA 02467-3812.
To be received no later than November 22, 2007 for inclusion in brochure.
Exhibit booth at Pre-Conference May 7 $400.00
Exhibit booth at Conference May 8 - 9
(Early Bird Payment must be received
by February 29 , 2008) 		$800.00
Exhibit booth at Conference May 8 - 9
(Late Registration postmarked after
February 29 , 2008)
 $900.00
Refreshment Break(s)
(Four) 		$1000.00 / each
  Date   AM PM
  Date   AM PM
Contribution to defray the cost of the conference

If sponsoring a particular speaker, please make honorarium check payable directly to speaker and indicate amount of honorarium:
  Speaker name:
  Lecture topic:
   
Other support checks should be made out to:
Trustees of Boston College
CONFERENCE TAX ID# 04-2103545
   
Credit Card Payment:
  Credit Card Type: VISA MASTERCARD
  Credit Card Number:
  Expiration:
   
All future communication to:
TEL: 617 - 552 - 4257      FAX: 617 - 552 - 3411
   

The person who will be responsible for conference support should be listed below:
NAME:
TITLE:
COMPANY:
DIVISION OF:
ADDRESS:
CITY:
STATE:

ZIP:
TELEPHONE:
FAX:
E-MAIL:
Confirmation to be sent to:

Northeast Regional Nurse Practitioner Conference