NBNA Conference 2008 Online Registration

Use the form below to complete Step 1 of your online registration. After submitting your information you will be sent to Step 2 for online payment.

To Fax or Mail your form click the brochure cover on the right to download the registration form.





1. Registration Information (Exhibitors and Sponsors DO NOT use this form)

....One registration per form.
 
First Name
 
Last Name
 
Credentials (required*)
 
Address
 
City
 
State
 
Zip
 
Home Phone
 
Work Phone
 
Fax
 
Email
 
Current NBNA Member
    If not would you like to become a member? If yes, click here.
 
NBNA ID#
 
RN/LPN/LVN License No.
 
Social Security #
 
I am a Direct Member (do not belong to a chapter)
 
Name of Chapter (required*)
 
Emergency Contact
 
Phone
 
Do You Require Vegetarian Meals?

Institute Registration
Continuing Education Units will be awarded at the 36th Annual Institute and Conference. To receive the full compliment of continuing education units, you MUST attend the Institute and/or Workshop of your choice IN ITS ENTIRETY. The Institutes will be held on Wednesday, August 6, 2008. Please choose one of the following (click on the drop down box):
This is my first NBNA Conference
I plan to go on the Local Chapter Sponsored Tours
Presidents' Leadership Workshop (for chapter Presidents and Vice Presidents ONLY-August 4,2008)

Guest Registration*
NON-Nurse Guest(s) Registration (Adults or Children) $150.00 Each: *Registration Includes: Sessions Open to the Public, Exhibit Area President's Reception and Banquet, and Sunday Brunch.
  Please check here if Guest(s) require vegetarian meals
 
Non-Nurse Adults
   
  Address: (If different from registrant's)
  Children Age
    Age
   

MEMBER Pre-Conf 4/1-6/15/08
RN/LPN/LVN...... $325
Student (NON-Licensed)...... $205
Retired.... $250

NON-MEMBER Pre-Conf 4/1-6/15/08
RN/LPN/LVN...... $500
Student (NON-Licensed)...... $280
Retired.... $345
GUEST(S)
Adults or Children....$150 each



Additional Banquet or Brunch Tickets

Institute of Excellence Luncheon....$75 per ticket
President's Banquet & Gala ....$80 per ticket
Brunch & Closing Session....$50 per ticket
© National Black Nurses Association