The Licensed Practical Nurses Association of Alabama
66th Annual Convention on Sep 25th & 26th, 2014
Decatur First Baptist Church
123 Church St. N. E.
Decatur, AL 35601
LPNAA Member Yes ( ) No ( ) If yes, What Chapter __________
Please check correct credentials: LPN __________ RN __________
Full Name: ____________________________________________________________________
Mailing Address: _______________________________________________________________
City: _________________________________________ State __________ Zip __________
Home Phone: __________________________ Work Phone: ____________________________
Employer: _____________________________________________________________________
School of Nursing: ________________________________________________________________
REGISTRATION
Members LPNAA $100.00
Members AFLPN $100.00
Non-Members $140.00 (includes 1 year membership to LPNAA or AFLPN)
BANQUET TICKETS FOR GUEST: $20.00 (advance)
BANQUET TICKETS FOR GUEST: $20.00 (advance)
Registration after September 15, 2014
DOOR REGISTRATION
Members LPNAA $120.00
Members AFLPN $120.00
Non-Members $160.00 (includes 1 year membership to LPNAA or AFLPN)
Educators $ 40.00 (Educators will receive CE's)
Students $. 10.00
BANQUET TICKETS FOR GUEST: $25.00 (at the door)
ONE DAY REGISTRATION For Sep 25th ONLY (includes lunch) $75.00
Total Registration Payment Sent: ________________________________________________
BANQUET TICKETS FOR GUEST: $25.00 (at the door)
ONE DAY REGISTRATION For Sep 25th ONLY (includes lunch) $75.00
Total Registration Payment Sent: ________________________________________________
Please mail registration fees by CHECK or MONEY ORDER to the following address. ON SITE registration will be CASH ONLY. Contact Hours will be handed out at the end of the day. Please bring your NURSES LICENSE for scanning. Please bring a sweater or wrap if needed.
Alabama Provider Number ABNP0008 2/13/14 to 2/13/18
Mail Payment to: James Selmar
4013 Ray Dr.
Montgomery, AL 36109
If cancellation is required contact: James Selmar 334-558-1435
By September 15, 2014
For more information call Janett Blackwood 256-232-5934
Leave a message and Janett will return your call.
HOTEL RESERVATIONS ON YOUR OWN AT HOTEL OF YOUR CHOICE.
