Delaware â Maryland â District of Columbia Division Spring ...
Delaware – Maryland – District of Columbia Division Spring Certification Conference and Board Meeting “Making the Leap to Remarkable… The Power of Communication” Registration Form March 9-10, 2012 Name: ___________________________________________________________________________ Name for badge: ___________________________________________________________________ Company: ________________________________________________________________________ Chapter Name: ____________________________________________________________________ Mailing Address: ___________________________________________________________________ City: ________________________________________________ State: _____ Zip: _______________ Phone: (H)___________________ (W) ____________________ (C) ___________________________ E-mail: __________________________________________________________________ Division: ______________________Chapter: __________________________________ Permission to publish e-mail in attendee roster: ____ Yes _____ No CAP: Yes___ No___ Mo/Yr Certified_____/_____ Recertified ____/____ CAP-OM: Yes___ No___ Mo/Yr Certified____/____
Recertified ____/____
Interested in taking: CAP Mock Exam _____ CAP-OM Mock Exam _____ Dietary Restrictions: Yes ____ No ____ List______________________ ******************************************************************************************* IAAP Member/Non-Members
$100.00 _________
Please make checks payable to: DE-MD-DC Division IAAP Mail to: Norma Wagner Treasurer, DE-MD-DC Division – IAAP 2415 Harford Road Fallston, MD 21047 [email protected] (410) 652-3000 To register for this event using your MasterCard, Visa, Discover, or American Express credit card, please log on to the DE-MD-DC Division website, www.demddc-iaap.org, and click on the “PayPal” button. If using PayPal, please e-mail a copy of your registration form to Norma Wagner at [email protected] NOTE: There will be no refunds after March 2, 2012. A $35 fee will be assessed by Wells Fargo Bank on all returned/non-sufficient funds (NSF) checks.
Delaware – Maryland – District of Columbia Division Spring Certification Conference and Board Meeting “Making the Leap to Remarkable… The Power of Communication” Chapter Fundraising Table Registration
Chapter Name _______________________________________________________ Contact person _______________________________________________________ (Must be a registered conference attendee.) Phone ________________________________ Cell _________________________ E-mail ____________________________________________________________ Full Table _______
Half Table ________
Only registered attendees can work at the chapter fundraising tables. Fundraising will be from 4:00pm – 6:00pm on March 9 and 8:00am-8:45am on March 10 Set up: 3:30pm Attach completed form* to an email message and send by February 24, 2012 to
Ruth Bradley [email protected] *Due to space, table space cannot be guaranteed after February 24, 2012
Recertified ____/____
Interested in taking: CAP Mock Exam _____ CAP-OM Mock Exam _____ Dietary Restrictions: Yes ____ No ____ List______________________ ******************************************************************************************* IAAP Member/Non-Members
$100.00 _________
Please make checks payable to: DE-MD-DC Division IAAP Mail to: Norma Wagner Treasurer, DE-MD-DC Division – IAAP 2415 Harford Road Fallston, MD 21047 [email protected] (410) 652-3000 To register for this event using your MasterCard, Visa, Discover, or American Express credit card, please log on to the DE-MD-DC Division website, www.demddc-iaap.org, and click on the “PayPal” button. If using PayPal, please e-mail a copy of your registration form to Norma Wagner at [email protected] NOTE: There will be no refunds after March 2, 2012. A $35 fee will be assessed by Wells Fargo Bank on all returned/non-sufficient funds (NSF) checks.
Delaware – Maryland – District of Columbia Division Spring Certification Conference and Board Meeting “Making the Leap to Remarkable… The Power of Communication” Chapter Fundraising Table Registration
Chapter Name _______________________________________________________ Contact person _______________________________________________________ (Must be a registered conference attendee.) Phone ________________________________ Cell _________________________ E-mail ____________________________________________________________ Full Table _______
Half Table ________
Only registered attendees can work at the chapter fundraising tables. Fundraising will be from 4:00pm – 6:00pm on March 9 and 8:00am-8:45am on March 10 Set up: 3:30pm Attach completed form* to an email message and send by February 24, 2012 to
Ruth Bradley [email protected] *Due to space, table space cannot be guaranteed after February 24, 2012
