2008 Annual MRHA Conference
September 24-25, 2008
Bill To Information:
First Name:
Last Name:
Title:
Address:
City:
State:
Zip:
Email Address:
Phone:
Fax:
Organization:
I am a(n):
CAH
RHC
CHC
AHEC
Student
Nursing Home
LPHA
Rural Hospital
Other
CHECK APPROPRIATE BOX IF YOU NEED:
Vegetarian Meal
Diabetic Diet
Accommodations (ADA Accessibility)
Sessions:
Please ENTER THE NUMBER of the session you will attend for TIME FRAME. Incomplete registration forms will be returned. This information is needed to make room assignments and to avoid overcrowding the sessions. SESSIONS MAY BE LIMITED BECAUSE OF SPACE, SO REGISTER EARLY. Thank you for your cooperation.
Wednesday, September 24, 2008
Thursday, September 25, 2008
Session #
Session
Time
Session #
Session
Time
Pre-Conference (1 - 3)
9:00-11:00 a.m.
Sessions 10 - 12
8:00 - 9:15 a.m.
Sessions 4 - 6
1:30-2:45 p.m.
Sessions 7 - 9
3:00 - 4:15 p.m.
REGISTRATION FEES: (please use only numbers in the below fields - do not use "X's")
Member
Non-Member*
Conference Only
$155
$265
Pre-Conference and Conference
$200
$310
Pre-Conference Only
$50
$95
*Non-member fee includes 2009 MRHA Individual Membership (valued at $50).
Please Enter Your Name How You Want Your Name Tag To Appear:
First Name:
Last Name:
Total Amount:
Payment Options:
Pay By Check
Pay By Credit Card
Pay At The Conference
QUESTIONS? Call the MRHA Office at (573) 636-5554
Fax: (573) 632-6678