LACES REGISTRATION FORM |
Please complete this form and use the print feature of your browser to print. Once the form is printed, mail the form and payment to the address below. Date your scheduling Name RN # CRNA# Address Address 2 Apt # City State Zip Code Home Phone Work Phone Name of Primary Work Setting Registration Fee: By Check only. Please make payable to Lower Alabama Continuing Education Seminars, Inc. (LACES, Inc) and mail to Karen Tully, 1816 Catala Road, Birmingham, AL 35216 Pre-Registration: Select One Pre-Registration Deadline for March 28th Meeting is March 12th. After Pre-Registration Deadline, add $30.00 to above fees. ON-SITE registration add $50.00 Refunds will be made with written notice only up to Pre-Registration Deadline less $50.00 cancellation charge. |