Template Registration Form

Advance Attendance Registration Form
April 25-26, 2008
Annual Spring Educational Meeting
Ramada Plaza Inn and Suites, Fargo

701-277-9000 or 1-800-272-6232
Note: Please enter your information as you would like it to appear on your name card.

First
Last
ANA#	Status
Facility
Address
City	State Zip
Contact Phone	eg. 701-000-0000
Email
	Planning on attending Saturday Lunch? Choose Yes or No

Please Choose Appropriate Registration Fee
Using Drop Down Arrow

Please note that payment must be made by cash, check or money order.

Indicate Payment Type

Hit the Submit Button Only Once

Mail Payment and Registration form:
North Dakota Association of Nurse Anesthetists
P.O. Box 1755
Bismarck, ND 58502-1755
701-221-7797