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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 craigandnoel@charter.net |
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! |
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