FORM D ENA COURSE PAYMENT FORM COURSE NUMBER COURSE DIRECTOR CONTACT PHONE NUMBER ENA Fees submitted with $ this filing: ___ participants x $____.___ Manual Fees submitted with $ this filing: ___ manuals x $____.____ Miscellaneous Fees Detail: $ CREDITS Total Payment (USD) $ PAYMENT INFORMATION Cheque Included: Credit Card Number: _________________________________________ Expiry Date: _________________________________________ Name On Card: _________________________________________ Signature: _________________________________________ Send Payment To: Cheques/Money Orders (US Funds) Emergency Nurses Association Course Operations PO Box 83314
FORM D ENA COURSE PAYMENT FORM COURSE NUMBER COURSE DIRECTOR CONTACT PHONE NUMBER ENA Fees submitted with this filing: ___ participants x $____.___ $ Manual Fees submitted with this filing: ___ manuals x $____.____ $ Miscellaneous Fees Detail: $ CREDITS Total Payment (USD) $ PAYMENT INFORMATION Cheque Included: Credit Card Number: _________________________________________ Expiry Date: _________________________________________ Name On Card: _________________________________________ Signature: _________________________________________ Send Payment To: Cheques/Money Orders (US Funds) Emergency Nurses Association Course Operations PO Box 83314
2016-Feb-The-Canadian-Resource-Manual-Administrative-ProceduresforCourse-DirectorsandInstructorsmarg-28229.docx