NEI Registration

NEI Registration

First Name: Last Name: County:

Mailing Address: City: State:

Zip Code: Phone Number: E-Mail Address:

Employer: Address:

City: State: Zip:

Cancellation Policy: An administrative fee of $100.00 will be charged for changes to registrations prior to March 15, 2010. After March 15, no refunds will be issued.

Will be attending the opening reception Will be bringing a guest

Will be attending the closing reception Will be bringing a guest

Pre-Conference Sessions

NCLEX Test Items ..... $139
NCLEX Curricular Innovations ..... $139
Clinical Simulation ..... $139
NLN Post-Conference Workshop ..... $175

Breakout Session 3:00 to 4:00
A Creating a Realistic Simulation
Learning Lab From Scratch

Breakout Session 3:00 to 4:00
B Participate In / Practice Simulation
Technology With Students

Early-bird
Registered before Feb. 1

Registration Fee ..... $475
Group Discount (3 or more) ..... $450 per attendee

Regular
Registered after Feb. 1

Registration Fee ..... $525
Group Discount (3 or more) ..... $500 per attendee
Large Group Rate (6 or more) ..... $425 per attendee

Any one-day fee

One Day Only ..... $150 per attendee
Student Fee Thursday ONLY..... $75 per attendee

Tuesday Wednesday Thursday (Barb)

Requests: I Request a Vegetarian Lunch I Request a Registration Receipt

This form does not total your fees, please be sure of what you checked.
If we spot an error, we will contact you at the phone number you provided above.

I authorize use of my credit/debit card: VISA Mastercard Discover

Card Number: A value is required. 3-Digit V-Code*: A value is required.Exp. Date: A value is required.Invalid format.

Address: A value is required. Personal Credit Card: Please make a selection. Business Credit Card Please make a selection.

Since it's hard to sign a web page, please indicate the month of your birthdate: Please select an item.

*(the 3 digit v-code is that silly little number on the back of your card)