OCTOBER 12-30, 2020 VIRTUAL INTERDISCIPLINARY CONFERENCE · 2020-06-11 · Member Non-Member...
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VIRTUAL INTERDISCIPLINARY CONFERENCE 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 Information If 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 Policy Cancellation 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 Mail NHPCO, 2020 Virtual Interdisciplinary Conference PO Box 824392, Philadelphia, PA 19182-4392 Overnight Delivery NC Bank C/O NHPCO, Lockbox #824392 Route 38 & East Gate Dr. Moorestown, NJ 08057 Fax (703) 837-1233 Send Your Completed Form
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
