MAPAN Fall Conference 2011
"PACU: SPECIAL NEEDS/SPECIAL CARE"
October 22, 2011
Soaring Eagle Casino & Conference Center, Mt. Pleasant, MI 
Special 35th Anniversary Rate

Registration Form

Please print, complete and mail along with the registration fee. No online registration accepted.  (Late Registrants please call and confirm)

Name:   ______________________________ Phone: __________________________

Address: _____________________________________________________

___________________________________________________________

eMAIL Address: ______________________________________________

(Used to confirm registration)

Place of employment: _____________________________________________________

RN License Number: ______________________

ASPAN Membership # ____________________

___ RN   ____ CPAN    ____ CAPA    ____ CCRN    _____ OTHER: _______________

Payment: Make Check Payable to MAPAN

 MAPAN/ASPAN Member     $75                                                          

 Non Members                         $125                                               

Mail to:                Kathy Russell

Refund minus $25 cancellation fee before 10/10/2011
No refunds after 10/10/2011
 

Late Registrations Call:  Kathy Russell for registration information at (W) 248-273-8135 or (H) 248-546-2616

Registrations will be taken at the door only if space is still available.  Seating is limited so early registration is recommended.