2008 WNCHN Annual Meeting Registration

2008 WNCHN Annual Forum Registration, October 29-30, 2008

(The Hawthorne Inn & Conference Center, 420 High Street, Winston-Salem, NC 27101)

Name:

Hospital or Healthcare Organization:

Title:

Address:

City/State/Zip:

Phone:( ) -

Fax:( ) -

Email:

Conference Fees:

Early Bird Registration Before 9/29/08-No Charge

Registration After 9/29/08 $50.00 Each

Guest Registration: (includes all meals and events) $25.00 Each
Note: (Must be a spouse, family member, or significant other)

Guest Name for Badge:

Hotel Information: (WNCHN is funding one night's lodging for the first 100 members registered before 9/29/08. WNCHN will secure your room reservation and will email you your confirmation number. WNCHN will notify registrants who do not qualify for the free room night.)

Arrival Date:

Departure Date: