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SANE Spring 2011 Conference Online Registration Form

The Ohio State University Medical Center

SANE Spring 2011 Training Course
March 17-18, 21-23

Registration

PLEASE NOTE THAT REGISTRATION IS NOW FULL FOR THIS CONFERENCE. PLEASE CHECK BACK FOR FUTURE CONFERENCE DATES OR EMAIL: OSUSANE@OSU.EDU WITH QUESTIONS.

Please complete the registration form below and click SUBMIT once completed. Once payment is received, you will receive a confirmation email from our coordinator. Individual registrations must be completed for each individual attending. Registration is limited and must be completed by March 1, 2011. NOTE: All fields are required.

Payment

Payment must be made by check in the amount of $400. Group payment can be accepted along with a list of those individuals who are registered to attend. In the event of a cancellation, refunds will be issued if cancellation notice is received prior to March 4, 2011. No refunds will be given to cancellations received on or after March 4, 2011.

Make checks payable to:

OSU Medical Center Emergency Department

Mail your check to:

2011 SANE Training Course
The Ohio State University Medical Center Emergency Department Administration Office, N016
450 W. 10th Ave.
Columbus, OH 43210

Please contact Hayley Westmeyer at osusane@osu.edu  if you have questions or have not received confirmation of your registration by March 4, 2011.

First Name *
Middle Initial *
Last Name *
Title *
Organization *
Street Address *
City *
State *
Zip *
Email *
Phone *
Fax *
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