(Note: * You must be a up to date member” to receive member discount) “paid Name (please print):______________________________________________________ Hospital/organization:____________________________________________________ Address:________________________________________________________________ Emergency contact number:_______________________________________________ (Cancellation due to bad Weather) Type of Payment (check one): Personal Check_____ Money order_____ Hospital check______ (For hospital checks only: Registration form must be faxed to: (551) Attention: Val DeVries 996-4980 Amount enclosed:__________ RSVP must be by Friday, November 24, 2017 “postmarked” NJHCSA Make check payable to: Send to: NJHCSA PO Box 7121 North Arlington, NJ 07031 For more information, contact Val DeVries @ (551) 996-2160 or e-mail Visit our Website: Cancellation Policy: must cancel by Tuesday, November 28, 12:00 PM for a full refund
(Note: * You must be a “paid up to date member” to receive member discount) Name (please print):______________________________________________________ Hospital/organization:____________________________________________________ Address:________________________________________________________________ Emergency contact number:_______________________________________________ (Cancellation due to bad Weather) Type of Payment (check one): Personal Check_____ Money order_____ Hospital check______ (For hospital checks only: Registration form must be faxed to: (551) 996-4980 Attention: Val DeVries Amount enclosed:__________ RSVP must be “postmarked” by Friday, November 24, 2017 Make check payable to: NJHCSA Send to: NJHCSA PO Box 7121 North Arlington, NJ 07031 For more information, contact Val DeVries @ (551) 996-2160 or e-mail Visit our Website: Cancellation Policy: must cancel by Tuesday, November 28, 12:00 PM for a full refund
December_Brochore_CEs.docx