OCTOBER 12-30, 2020 VIRTUAL INTERDISCIPLINARY CONFERENCE · 2020-06-11 · Member Non-Member...
Transcript of OCTOBER 12-30, 2020 VIRTUAL INTERDISCIPLINARY CONFERENCE · 2020-06-11 · Member Non-Member...
VIRTUAL INTERDISCIPLINARYCONFERENCE
Sessions Available Until December 31, 2020
Please type or print clearly. Complete a separate registration for each registrant.
Registrant Name___________________________________________________ Credentials (RN, LCSW, etc.) _______________________________
Title ____________________________________________________________________________________________________________________________
Registrant E-mail Address (required) ___________________________________________________________________________________________
Organization __________________________________________________________________________________________________________________
Organization Address _________________________________________________________________________________________________________
City ________________________________________________________ State_____________________________________ Zip____________________
Phone___________________________________________________________ Fax _________________________________________________________
❑ Opt Out - Exhibitor Mailing List (email and/or direct)
Group Registration: There will be $50 off for five or more registrations from the same organization. Group registration discounts will be processed and refunded after registration has closed on December 31, 2020.
NHPCO Conference
Member Non-Member Faculty
Rates ❑ $499 ❑ $599 ❑ $325
I would like to donate to the National Hospice Foundation
❑ $5 ❑
$10 ❑ $25 ❑ $50 ❑
$100
Payment
Payment InformationIf payment in full does not accompany this form, your registration will not be processed. Checks must be in US funds. A charge of $25 will apply to checks
NHPCO will charge the remaining amount deemed to be accurate and appropriate to the cardholder listed below.
Registration Cancellation PolicyCancellation requests must be made in writing; a $50 processing fee will apply. Cancellations postmarked on/before October 1, 2020, receive a full refund less the processing fee. Refunds will not be provided for cancellations postmarked
Send cancellation or substitution requests via email [email protected] or via fax at (703) 837-1233.
the right to substitute faculty or to cancel or reschedule sessions due to unfore-seen circumstances.
TOTAL FOR THIS ATTENDEE $ __________________________
Check #__________ or ❑ ❑ ❑
CARD NUMBER EXPIRATION DATE
Visa/MC Cvv Code:3-digits back right side
AMEX Cvv Code:4-digits front right side
________________________________________________________________________________________
________________________________________________________________________________________SIGNATURE DATE
❑ ❑ ❑
❑ ❑ ❑
❑ ❑ ❑❑ ❑ ❑
MailNHPCO, 2020 Virtual Interdisciplinary ConferencePO Box 824392, Philadelphia, PA 19182-4392
Overnight DeliveryNC Bank C/O NHPCO, Lockbox #824392Route 38 & East Gate Dr.Moorestown, NJ 08057
Fax(703) 837-1233
Send Your Completed Form