NAME:_______________________________________________________________________________ (First Name) (Middle Name) (Last Name) ADDRESS:___________________________________________________________________________ (# and Street, or PO Box) (Apt. # if any) ___________________________________________________________________________ (City) (State) (Zip + zip 4) HOME PHONE #:_________________________________________________ BUSINESS PHONE #:_____________________________________________ FAX #:__________________________________________________________ CELL PHONE#___________________________________________________ EMAIL ADDRESS:________________________________________________ AANA #:_____________________ CHECK ON OK BUTTON TO THE RIGHT TO SEE INFORMATION ON ALL HOTELS AND HOTEL RATES FOR ALL OF OUR MEETINGS ----- Check one or more below to indicate you choice(s): 1.) _____SONOMA, CALIFORNIA: Yes, I am applying to your January meeting in Sonoma, California! (Cost is $455.00 for year 2010, or just $395.00 if you apply and pay in full by November 1, 2009.) IMPORTANT NOTICE: 20 CE Credits for the 2010 meeting. 2.) _____NEW ORLEANS, LOUISIANA: Yes, I am applying to your April meeting in New Orleans! (Cost is $395.00 for year 2010, or just $345.00 if you apply early and pay in full by Februray 1, 2010.) IMPORTANT NOTICE: 20 CE Credits for the 2010 meeting. 3.) _____KILLARNEY, IRELAND: Yes, I am applying to your September, 2009 meeting in Killarney, Ireland. (Cost is $695.00 for year 2009 or just $595.00 if you apply early and pay in full by June 25, 2009). Price paid to C & H is for lectures and lecturers only. Check with Margarita Ramirez at Traveling Matters regarding cost of land package and option post meeting excursion. Her email is: info@travelingmatters.com and her web site is www.travelingmatters.com. Don't delay, apply today as spaces are limited for this meeting. IMPORTANT NOTICE CONCERNING THE IRELAND 2009 MEETING: This meeting is not offered every year and will not be offered in 2010. Therefore we urge you to apply for the 2009 meeting if you want to join C & H EDUCATIONAL SYSTEMS in Killarney, Ireland for the Charm of Ireland Anesthesia Update. |
C & H EDUCATIONAL SYSTEMS APPLICATION FORM FOR CEC MEETINGS |
Print this form on your printer and fill out the application. Send this application with your payment for the meeting that you choose (see meeting list and payments below). If you apply early and pay in full you can save money. See details of each program below. Be sure to print in block letters or type. When completed send this application to: C & H EDUCATIONAL SYSTEMS PO BOX 5035 BUENA VISTA, CO 81211-5035 We only accept checks. Therefore, be sure to make your check payable to: C & H EDUCATIONAL SYSTEMS |
NAME:_______________________________________________________________________________ (First Name) (Middle Name) (Last Name) ADDRESS:___________________________________________________________________________ (# and Street, or PO Box) (Apt. # if any) ___________________________________________________________________________ (City) (State) (Zip + zip 4) HOME PHONE #:_________________________________________________ BUSINESS PHONE #:_____________________________________________ FAX #:__________________________________________________________ CELL PHONE#___________________________________________________ EMAIL ADDRESS:________________________________________________ AANA #:_____________________ CHECK ON OK BUTTON TO THE RIGHT TO SEE INFORMATION ON ALL HOTELS AND HOTEL RATES FOR ALL OF OUR MEETINGS ----- Check one or more below to indicate you choice(s): 1.) _____SONOMA, CALIFORNIA: Yes, I am applying to your January meeting in Sonoma, California! (Cost is $455.00 for year 2010, or just $395.00 if you apply and pay in full by November 1, 2009.) IMPORTANT NOTICE: 20 CE Credits for the 2010 meeting. 2.) _____NEW ORLEANS, LOUISIANA: Yes, I am applying to your April meeting in New Orleans! (Cost is $395.00 for year 2010, or just $345.00 if you apply early and pay in full by Februray 1, 2010.) IMPORTANT NOTICE: 20 CE Credits for the 2010 meeting. 3.) _____KILLARNEY, IRELAND: Yes, I am applying to your September, 2009 meeting in Killarney, Ireland. (Cost is $695.00 for year 2009 or just $595.00 if you apply early and pay in full by June 25, 2009). Price paid to C & H is for lectures and lecturers only. Check with Margarita Ramirez at Traveling Matters regarding cost of land package and option post meeting excursion. Her email is: info@travelingmatters.com and her web site is www.travelingmatters.com. Don't delay, apply today as spaces are limited for this meeting. IMPORTANT NOTICE CONCERNING THE IRELAND 2009 MEETING: This meeting is not offered every year and will not be offered in 2010. Therefore we urge you to apply for the 2009 meeting if you want to join C & H EDUCATIONAL SYSTEMS in Killarney, Ireland for the Charm of Ireland Anesthesia Update. |
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