conventionregistration

GANS 2003 Convention Registration Form

Convention Fees:
(circle one)

GANS and Sustaining Members

Visitors and non-members

Faculty and Consultants*

*Credentials for Badge: __________________________

Last Name: ___________________________     First Name: ________________________

Mailing Address: ________________________________     City: ____________________

State: __________   Zip: _________   Phone: (_____) ___________________________

School of Nursing: _____________________________     Graduation Date: ____________

Email: ________________________________________     NSNA Membership # _______

   I WILL attend the Saturday Night Awards Dinner Banquet (no additional fee): Y_____     N_____

   I WILL attend NCLEX Mini-review Course (breakfast include in fee):     Y_____     N_____
   ($20-advance    $25-on site) If attending, please circle ONE: Friday Morning / Saturday morning

   I WILL attend the Luncheon "So You've Made an Medication Error"   Y___   N____
   ($15-advance     $20-on site)

Cut-Off Date!!!!
Must be
Postmarked By
Sept. 22 2003!!!
(After this date, form will be returned and the individual must register on site)

For Office Use Only:
Date received: __________
Amount Enclosed: _______
Check # _______________
Money Order: __________

Advance

$45

$60

$45

On-Site

$60

$70

$60

Mail Completed Registration Form to:
Noel Lawson
1720 Epps Bridge Road
Suite 108, PBM 121
Athens, GA 30606
[email protected]

Registration fee: __________
Luncheon (if applicable): __________
NCLEX review (if applicable): __________

TOTAL AMOUNT Enclosed: __________

Only ONE person may register per form! Please photocopy, if necessary. GANS members and sustaining members will save money by registerin in advance for the 2003 GANS Annual State Convention!! Please remember to include your NSNA membership number to receive member rates. GANS members may be asked to show proof of NSNA membership when picking up convention badges on site. Registration fee includes three dinners and is non-refundable.

Please remember to reserve rooms in Country Inns and Suites Riverswalk, Augusta, GA. NO LATER THAN SEPTEMBER 8, 2003 to get GANS $105 room rate (please refer to the GANS room block when making reservation). Rooms may be limited and will be reserved on a first-come basis!