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PHP Conference Registration 2018
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* Indicates required question
First Name
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Your answer
Last Name
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Your answer
Title
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RN
LPN
RCS Certified?
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No
Pediatric
Adult
Both Pediatric and Adult
Street Address
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Your answer
City
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Your answer
State
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Your answer
County
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Your answer
Zip Code
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
Conference Dates
Select the dates you will be attending
Monday, September 10 ($100) includes lunch
CPR/RCS
Please check if you will be attending re-certification classes
Sunday Sept 9 CPR Recertification ($50) Please note that CPR is Sunday from 3-7pm from feedback (too long when added to the end of a conference day).
Tuesday Sept. 11 RCS (ventilator) includes pediatric and adult ($100)
PHP Membership
Please note that membership is required for this event. If you are not a current member, we will email you the membership application for the additional information to process your membership.
PHP Membership ($50)
Total Payment you will submit via PayPal
*
Follow the link to complete payment after submitting your registration.
Your answer
Would you like to nominate yourself or someone else for the PHP Board of Directors?
*
If yes, please complete the next question to submit your nomination.
No
Yes
Who would you like to nomintate?
Your answer
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