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CENTRAL STATES CONFERENCE ON HEARING 2009 Annual Convention & Education Seminar Branson Convention Center Hotel • Branson, MO March 12-14, 2009 ADVANCED REGISTRATION FORM |
| Name | _______________________________________________________________ |
| Company | _______________________________________________________________ |
| Address | _______________________________________________________________ |
| City State Zip | _______________________________________________________________ |
| Telephone/ Email | (____)_______________________ (____)_____________________________ |
| _______________________________________________________________ |
Please check:
q
Audiologist (q
ASHA
q AAA)
q
Hearing Instrument Specialist
q
Other (________________________________)
Conference Fees:
| Conference |
|
After 02/14/09 |
| OHAA Members* | q $235.00 | q $285.00 |
| Non-Members | q $335.00 | q $385.00 |
| Thursday Only Member Fee | q $75.00 | q $100.00 |
| Thursday Only Non-Member Fee | q $125.00 | q $150.00 |
| Friday Only Member Fee | q $150.00 | q $175.00 |
| Friday Only Non-Member Fee | q $200.00 | q $225.00 |
| Saturday Morning Only Member Fee | q $75.00 | q $100.00 |
| Saturday Morning Only Non-Member Fee | q $125.00 | q $150.00 |
| Saturday Afternoon (Westone | ||
| Spouse Package (meals/exhibits hall only) | q $100.00 | |
| Spouse Name _________________________ | ||
| Paying by credit card:
q Visa or
q Mastercard Charge Card No. ____________________________________ Name of Card Holder _________________________________ Expiration Date:_______/_________ |
TOTAL Enclosed |
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PLEASE CHECK STATE(S) WHERE CEU’S ARE NEEDED: |
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*An additional fee will be charged for Texas registrants requiring CEU’s
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Make check payable and return with the registration form to: CENTRAL STATES
CONFERENCE ON HEARING
REFUNDS:
Full refund of fee
will be made if cancellation notice is received at least two weeks prior to the
opening date of the convention. (Must be postmarked by February 26th or before).
A 50% refund will be made if cancellation is received by 5:00 p.m. March 3,
2009. NO REFUNDS WILL BE MADE AFTER MARCH 4, 2009. |