PAYPAL
TENNESSEE DIVISION EDUCATION SEMINAR SATURDAY, MARCH 17, 2012 9:00 A.M. – 3:30 P.M. (REGISTRATION OPENS AT 8:30 A.M.)
HAMPTON INN & SUITES MT. JULIET 5001 CROSSING CIRCLE MT. JULIET, TN 37122 (615-553-5900) (CONTINENTAL BREAKFAST INCLUDED IF YOU STAY AT THE HOTEL)
Registration Deadline – March 10!
REGISTRATION FORM REGISTRATION FEE: $80.00 – MEMBERS $50.00 – MERITED MEMBERS AND FULL-TIME STUDENTS (INCLUDES ALL SESSIONS AND LUNCH) PRE-REGISTRATION IS REQUIRED. PAYPAL AVAILABLE AT www.paypal.com CAP OM
NAME: ADDRESS:
CITY:
STATE
NAME FOR BADGE:
COMPANY NAME:
HOME PHONE:
OFFICE PHONE:
FAX:
IAAP MEMBER NUMBER:
CHAPTER:
E-MAIL ADDRESS:
PROFESSIONAL MEMBER MERITED MEMBER FULL TIME STUDENT
$80.00 $50.00 $50.00
ZIP
CELL/OTHER:
NO REFUND AFTER MARCH 7, 2012_ REGISTRATION MAY BE TRANSFERRED TO ANOTHER IAAP MEMBER.
SCHEDULE 8:30 A.M. 9:00 A.M. 9:30 A.M. 10:30 A.M. 10:45 A.M.
REGISTRATION WELCOME/INTRODUCTIONS MORNING SESSION BREAK MORNING SESSION CONTINUES
NOON 1:00 P.M. 2:15 P.M. 2:30 P.M. 3:30 P.M.
LUNCH INCLUDED AFTERNOON SESSION BREAK AFTERNOON SESSION CONTINUES CONCLUSION
PLEASE LIST ANY MEDICAL DIETARY RESTRICTIONS OR SPECIAL NEEDS: VEGETARIAN
METHOD OF PAYMENT:
CHECK
PAYPAL
Check #
MAKE CHECK PAYABLE TO:
TENNESSEE DIVISION IAAP
[email protected]
MAIL REGISTRATION FORM AND CHECK TO:
GLADYS CARR CAP 621 CENTER ST MADISON, TN 37115
HAMPTON INN & SUITES MT. JULIET 5001 CROSSING CIRCLE MT. JULIET, TN 37122 (615-553-5900) (CONTINENTAL BREAKFAST INCLUDED IF YOU STAY AT THE HOTEL)
Registration Deadline – March 10!
REGISTRATION FORM REGISTRATION FEE: $80.00 – MEMBERS $50.00 – MERITED MEMBERS AND FULL-TIME STUDENTS (INCLUDES ALL SESSIONS AND LUNCH) PRE-REGISTRATION IS REQUIRED. PAYPAL AVAILABLE AT www.paypal.com CAP OM
NAME: ADDRESS:
CITY:
STATE
NAME FOR BADGE:
COMPANY NAME:
HOME PHONE:
OFFICE PHONE:
FAX:
IAAP MEMBER NUMBER:
CHAPTER:
E-MAIL ADDRESS:
PROFESSIONAL MEMBER MERITED MEMBER FULL TIME STUDENT
$80.00 $50.00 $50.00
ZIP
CELL/OTHER:
NO REFUND AFTER MARCH 7, 2012_ REGISTRATION MAY BE TRANSFERRED TO ANOTHER IAAP MEMBER.
SCHEDULE 8:30 A.M. 9:00 A.M. 9:30 A.M. 10:30 A.M. 10:45 A.M.
REGISTRATION WELCOME/INTRODUCTIONS MORNING SESSION BREAK MORNING SESSION CONTINUES
NOON 1:00 P.M. 2:15 P.M. 2:30 P.M. 3:30 P.M.
LUNCH INCLUDED AFTERNOON SESSION BREAK AFTERNOON SESSION CONTINUES CONCLUSION
PLEASE LIST ANY MEDICAL DIETARY RESTRICTIONS OR SPECIAL NEEDS: VEGETARIAN
METHOD OF PAYMENT:
CHECK
PAYPAL
Check #
MAKE CHECK PAYABLE TO:
TENNESSEE DIVISION IAAP
[email protected]
MAIL REGISTRATION FORM AND CHECK TO:
GLADYS CARR CAP 621 CENTER ST MADISON, TN 37115
