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Education
ARN 29th Annual Educational Conference Registration Form
Print this form, complete it, and then submit via 1 of 3 ways:
 Mail
ARN Conference
PO Box 839
Glenview, IL 60025-0839
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 Fax
877/734-9384
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 Phone
800/229-7530 or
847/375-4710
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- If you fax this form, please do not mail the original.
- Fax and phone orders accepted only with credit card payment.
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| C03 WEB |
FOR OFFICE USE ONLY
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Customer #  |
Mtg Ord #3- |
| Date |
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 Check here if this will be your first ARN conference.
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| Complete name |
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| First name for badge |
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| Title |
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| Facility |
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| Facility city/state |
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| Mailing address |
Home Work |
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| City/State/Zip |
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| Phone |
() |
Fax |
() |
| E-mail |
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| In case of emergency during the conference, please contact this person: |
| Name: |
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| Work phone |
() |
| Home phone |
() |
| Section B |
1–Day Conference Registration
Check the day(s) you’ll be attending: |
| Thursday |
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(TH) |
Friday |
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(FR) |
Saturday |
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(SA) |
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| ARN member |
(MDR) $215 |
| Nonmember |
(NDR) $270 |
| Student |
(SDR) $120 |
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| Be sure to complete box C |
Subtotal B: $ |
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| Section C |
Preconference Workshops-Wednesday, Oct 15
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(ADV) Advanced Practice Course (8:30 am–5 pm)
ARN members $185, nonmembers $205 |
$ |
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(LW) Delegation, Supervision, and All That Jazz (8 am–Noon)
ARN members $90, nonmembers $110 |
$ |
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(PW) Approaching Pain from a Rehabilitation Perspective (1–4:30 pm)
ARN members $90, nonmembers $110 |
$ |
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Subtotal C: $ |
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| Section D |
Session Registration
The following sessions are included with your registration. Please enter the 3-digit number for each session you plan to attend.
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| Section E |
Optional Events
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| Wednesday, October 15 |
(PT) Professional Tour (1-5 pm)
___ No of tickets @ $20 each |
$ |
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(GST) Opening Reception/Exhibits (extra cost for guests/spouses only)
___ No of guest/spouse tickets @ $25 each |
$ |
| Guest Name(s):
___________________________________ |
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| Thursday, October 16 |
(RNF) RNF Benefit Event (7-10 pm)
___ No. of tickets @ $105 each |
$ |
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| Friday, October 17 |
(NL) Networking Lunch (12:45-2:15 pm)
___ No. of tickets @ $30 each |
$ |
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(OPT1) Rock 'N' Bowl (6-10 pm)
___ No of tickets @ $40 each |
$ |
| Saturday, October 18 |
(OPT2) RiverWalk (6-10 pm)
___ No. of tickets @ $28 each |
$ |
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Subtotal E: $ |
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| Section F |
| Please accept my tax-deductible contribution to support rehabilitation nursing research. |
$ |
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| Section G |
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| Any registration postmarked after 9/15/03 |
(LF) |
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+$50 |
| A or B + C + E + F |
Subtotal $ |
| Please allow ample time for processing payment within your facility. |
Total $
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| Payment (Must accompany this form) |
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| • If rebilling of a credit card charge is necessary, a $25 processing fee will be charged. |
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| Check (enclosed) |
Make check payable to ARN.
• Checks not in U.S. funds will be returned. • A charge of $25 will apply to checks returned for insufficient funds.
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Account number
Signature
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Expiration date
Cardholder’s name (Please print.)
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Special Requests |
| I will need a vegetarian meal. |
(SDV) |
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I will be using a wheelchair at the conference
(information needed to project space accommodations for meeting rooms and other functions). |
(SA) |
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| Cancellation Policy |
All cancellations must be made in writing. A $75 processing charge will apply to all cancellations. No refunds will be made on cancellations postmarked after October 1, 2003. All refunds will be processed after the conference.
ARN reserves the right to substitute faculty or to cancel or reschedule sessions due to low enrollment or other unforeseen circumstances. If ARN must cancel, registrants will receive full credits or refunds of their paid registration fees. No refunds can be made for lodging, airfare, or any other expenses related to attending the conference.
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