SATNET | Pre Registration Form

Pre-Registration Form

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CANCELLATIONS & REFUNDS
In order to receive a refund, cancellation requests must be made in writing and postmarked by July 14, 2010. No cancellations will be accepted by phone. Speakers are subject to change. In the unlikely event that this conference is cancelled, conference fees will be refunded to pre-registered participants.

Clint Brown, Conference Director
SATNET
POB 43818
Tucson, AZ 85733

520-795-2170

NOTE NONE OF THE REGISTRATION FEE IS CONSIDERED A TAX DEDUCTIBLE DONATION.

SATNET Attendees Receive…

Free T-Shirt or Hat
Free Monsoon Madness
Souvenir Discounts
Door Prizes

Pre-Registration Form

Southwest Regional Trauma Conference
August 12–13, 2010
JW Marriott Starr Pass Resort and Spa
3800 W. Starr Pass Blvd., Tucson, AZ 85745

We have provided this form for your convenience. Fill in all form fields and submit. You will then receive an email invoice from SATNET for your conference fee. You can pay by a check or money order made out to SATNET or by credit card...either Visa or Master Card.

If you prefer, you may download the form, print it out, fill it in and send it to us with your payment.

Prefix:
Last Name:
First Name:
Middle Initial:
Last Degree(s):
Position: (Choose One)	CEP,EMT,Firefighter RN MD RT Other ^*
*^Specify:**
Title:	Ex: Nurse Mgr, Director, Captain, etc.
RN or RT License Number: *(Required for CEU's)*
Organization:
Org. Address: Will appear on badge
Org. City:
Org. State:
Org Zip Code:
Home Address: (Not for Publication)
Home City:
Home State:
Home Zip Code:
Email Address:
Email Location	Work Home
Work Phone:
Home Phone:

I WILL BE ATTENDING

Both Days
August 12th Only
August 13th Only

SATNET ATTENDEE Yes, please enroll me as an associate and I will add $15 to my registration amount.