NCSF Future of Nursing Conference Registration

Attendee First Name: (as it appears on your license):
Attendee Last Name: (as it appears on your license)
Preferred Name: (as you wish it to appear on your name badge)
Credentials: (i.e. RN, MSN, ARNP, CCRN)
License: (i.e. ARNP 1234567)
State: (if not licensed in FL)
Email:
Organization	Other
Title:
Admission Level:	Member Non-Member Student
Price:
Early-bird student registration Early-bird member registration Early-bird non-member registration Registration after January 31, 2012	$ 90.00 $ 90.00 $100.00 $120.00
Note: If you are registering as a student you will need to present a current student ID card on the day of the conference at the registration desk.
Payment method:	Credit Card Check Please mail a check or money order made payable to the Nursing Consortium of South Florida to: Nursing Consortium of South Florida 5751 SW 58 CT South Miami, FL 33143-2349