| Name: |
________________________________________ |
| Institution Name: |
________________________________________ |
| Mailing Address: |
________________________________________ |
| City, State, Zip: |
________________________________________ |
| Bus. Telephone: |
________________________________________ |
| Home Telephone: |
________________________________________ |
| Fax: |
________________________________________ |
| E-mail address: |
________________________________________ |
| Fees
|
| (check applicable fee(s)): |
|
____
|
$10 |
All students and post-doctoral trainees |
|
____
|
$35 |
Faculty, staff, and non-students |
|
____
|
$15 |
Late registration fee
(after
May 1, 2008) |
|
|
Fees cover the following:
all conference materials,
continental breakfast, lunch, and breaks |
|
|
| Payment Method: |
___ Check
Make check payable to Emory University. Please note on check Registration Fee, SCRS School of Nursing |
|
Amount enclosed $______________ |
