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Idaho Society for Respiratory Care |
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| Please print off and use the following registration form if needed for the ISRC 2002 Annual Conference: |
| ________________________________________________ | ||
| LAST NAME FIRST MIDDLE | ||
| ________________________________________________ | ||
| MAILING ADDRESS | ||
| ________________________________________________ | ||
| CITY STATE ZIP | ||
| ________________________________________________ | ||
| E-MAIL ADDRESS | ||
| ________________________________________________ | ||
| AFFILIATION (name of hospital, school, home care, business) | ||
| AARC MEMBERSHIP NUMBER: ____________________________
CEUs being applied for? YES NO NOTE: Membership rates are for AARC Members only. To register at member rates, you must be able to provide a valid AARC membership number (NOT NBRC or Idaho License) when submitting registration fees. AARC MEMBER...... $ 35.00
Conference Registration
$_______________
Send registration form with check or money order (made payable to ISRC 2002 Conference) to: Ramona Sailor
For further information call Ramona at 208-543-8052. |
| Back to Conference Page |
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