NHPCO NewsLine Spring 2020 - 17

CONFERENCE
July 22-23, 2020

Registrant Name _________________________________________________________Credentials _____________________________________________________________
Registrant Email Address (Required) __________________________________________________________________________________________________________________
Title ____________________________________________________________________________________________________________________________________________
Organization ____________________________________________________________________________________________________________________________________
Organization Address _____________________________________________________________________________________________________________________________
City _____________________________________________________________________________________ State ______________________Zip _______________________
Phone __________________________________________________________________Fax ____________________________________________________________________

Registration Fees

Additional Sites

Individual
Organization
Member*/Non-Member Member*/Non-Member
(Eligible for CE/CME)**
(Eligible for CE/CME)***

Type

Early Bird

(Early Bird Dates:
Until June 7)

Regular

(Regular Dates:
June 8 - July 18)

Late: After July 18

(within 72 hours
of conference)

Additional Sites
(Added to Organization
Registration)

q $350 / q $700

q $450 / q $900

q $75

q $450 / q $900

q $550 / q $1,100

q $100

q $1,000 / q $2,000

q $1,200 / q $2,400

q $200

Organizations can purchase additional logins (computer
connections), to host the conference in multiple locations.
Provide contact information below for each additional site registered to
participate in the conference. Please attach a list of additional site contacts
as needed.
1. Additional Site Contact Name _____________________________________
Contact Email Address ____________________________________________

CE/CME

Contact Phone __________________________________________________
FREE

FREE

FREE

* The member rate applies to NHPCO, AAHPM and HPNA members.
** Provides 1 login and 1 participant eligible for CE/CME for FREE.
*** Provides 1 login and unlimited number of participants eligible for CE/CME credit for FREE.

2. Additional Site Contact Name _____________________________________
Contact Email Address ____________________________________________
Contact Phone __________________________________________________

Payment
Check # ___________ or q

Total Due $ _______________________________

q

q

Payment Information
Payment in full is required at the time of registration to ensure registration is
processed and confirmed.
*
*
*
*

CREDIT CARD NUMBER

EXP DATE

Make checks payable to NHPCO
Checks must be in US funds
A charge of $25 will apply to checks returned for insufficient funds
If the total calculated is incorrect, we will charge the remaining amount deemed to
be accurate and appropriate

Visa/MC Cvv Code
3-digits back right side.
AMEX Cvv Code
4-digits front right side.

Continuing Education (CE/CME) Credit: Continuing education credit for nurses and physicians and
non-physician healthcare professionals will be available. Requests for CE/CME credit can be made following the
conference through the conference attendance and evaluation process. There is no charge for CE/CME credit
processing. See www.nhpco.org/vc2020 for additional information.
Registration Cancellation Policy: All cancellations and refund requests must be made in writing.
A refund of the conference fees, minus a $50 administrative fee, will be provided for cancellations received
by June 7, 2020.Cancellations between June 8 and July 18, 2020, will receive a 50% refund less the $50 a
dministrative fee. No refunds will be granted for requests postmarked after July 18, 2020. Submit all requests to
conferences@nhpco.org. Refunds or credits will be processed within 15 business days after the conference.

NAME ON CARD (PLEASE PRINT CLEARLY)

SIGNATURE

DATE

Send Your Completed Form
Mail
NHPCO, 2020 Virtual 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
http://www.nhpco.org/vc2020
NHPCO NewsLine Spring 2020

Table of Contents for the Digital Edition of NHPCO NewsLine Spring 2020
