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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:
 
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LAST NAME                                      FIRST                       MIDDLE
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MAILING ADDRESS
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CITY                                                    STATE                       ZIP 
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E-MAIL ADDRESS
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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 
Non-MEMBER...........$125.00 ($35+$90 for AARC membership)
Student........................$  10.00
Non-members will need to fill out an AARC application form. They can be found in the AARC Times, Respiratory Care Journal, or will be made available at the conference.

Conference Registration                          $_______________
Guest Lunch ($10 each)                          $_______________
Total Enclosed                                        $_______________

Send registration form with check or money order (made payable to ISRC 2002 Conference) to:

Ramona Sailor
 1274 E. 4150 N.
 Buhl, ID  83316

For further information call Ramona at 208-543-8052.

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