State of the Science Registration Form
 

To register, complete and return this form. Early registration deadline is September 6, 2002.

Name_____________________________________________________________________

Title______________________________________________________________________

Employer/School____________________________________________________________

Address___________________________________________________________________

City/State/Zip_______________________________________________________________

Phone___________________________________Fax_______________________________

E-mail_____________________________________________________________________


__ Check here is you have a disability and require special assistance. Please attach a written description of your needs so we can accommodate you.

Registration Fees (check fees that apply)

Through September 6
___ $349 regular
___ $199 student

After September 6
___$399 regular
___$249 student

___ $75 media training (not included in registration fee)

Payment Information
Payment must accompany registration. For credit card charges, please note that we accept only Visa and Mastercard.

Check Method of Payment:
____Check or Money Order made payable to AACN
____ Visa ____ MasterCard

Amount_________________________________

Account Number____________________________________________________________

Expiration Date___________________________

Name of Cardholder__________________________________________________________

Signature of Cardholder_______________________________________________________

Return completed registration form with payment to:

AACN
Dept. 178
Washington, DC 20055-0178.
Fax: 202-785-8320 (If faxing form, do not mail the original.)

Registration questions:
Contact Shana Cohen at 202-463-6930, ext. 261 or scohen@aacn.nche.edu.

Cancellation Policy
Registrations that are canceled up to one week before the meeting will be refunded minus a $50 fee. Cancellations received with less than one week's notice will be refunded minus a $150 fee. All requests for refunds must be made in writing to AACN. There will be no refunds given for no-shows.

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