2010 PACAH Spring Conference Registration (Non-Members)
April 19-22, 2010
Attendee Information
First Name:
Last Name:
Alternative First Name for Badge:
(optional)
Title:
Company:
Address:
City:
State:
Zip:
E-mail:
Phone:
() -
Days Attending (Check all that apply): Full Conference: $290
Tuesday Only: $125
Wednesday Only: $150
Thursday Only: $135
Events Attending: YesNo: Monday Education Session (1:00 - 4:00)
YesNo: Tuesday Golf
Guest & Children Information
(includes group meals, activities, & PACAH sponsored events) NHA credits do not apply. Guests can not include staff from facilities.
Guests ($70.00 Each):
  First Name Last Name
1)
2)
SUBTOTAL:

Miscellaneous

Please list any special dietary or physical accommodations or needs as described by The Americans with Disabilities Act (ADA)

Payment and Cancellation Information


Cancellations must be submitted via email to Stephanie Zweitzig and must be received by 4 pm on April 12, 2010 to qualify for a refund. NOTE: No requests for refunds of the registration fee will be honored after that date. However, if last minute schedule changes prevent you from attending the meeting, another may attend in your place. A $25 administrative fee will be deducted from all refunds issued. ALL REGISTERED NO SHOWS WILL BE BILLED.

I do not want to receive notifications, updates, and other PACAH mailings via email.

TOTAL DUE:
Please verify the information entered above is correct,
and press the button to register

By submitting this form, you acknowledge that the name, title, agency, and email above
will be included on the attendee list that will be shared with all other conference participants.

 


Questions? Please contact:
Stephanie Zweitzig, (717) 232-7554 x3134