March of Dimes | 37th Annual Perinatal Nursing Conference

March of Dimes | 37th Annual Perinatal Conference

Register

If you prefer not to fill out the registration information online, please download the brochure and fill out the registration page. Telephone registrations are not accepted. Send in the registration page with your payment and mail or fax to:

March of Dimes
Perinatal Nursing Conference
111 W. Jackson Blvd., Suite 2200
Chicago, IL 60604
Fax: (312) 435-0988

NOTE: Single & Multi Day Registrations may not be shared. Cancellations received on or before February 1 2012 will receive a full refund. Those received after this date will be assessed a $50 processing fee. No refunds are given for "no shows" or cancellations received after February 4, 2012. However, substitutions are accepted.

GROUP DISCOUNT: When 5-five people register from the same group concurrently, a 10% discount will be applied. THIS DISCOUNT IS ONLY GOOD UNTIL FEBRUARY 4, 2012. To register groups of 5-five or more please email ablankenberger@marchofdimes.com

For more registration information, special needs, or questions contact:
Anna Blankenberger
(312) 596-4709
ablankenberger@marchofdimes.com

Your Information

First Name*	Last Name*
Organization	Last Name*
Address Line 1*	Address Line 2
City*
State*	Postal Code/Zip*
Phone	Email*

Sessions

Choose Event Registration Type

		Price after 2/4/2012
Thursday only	$150	$200
Friday only	$150	$200
Two Day Special	$250	$300

Breakout Sessions (please select which sessions you choose to attend):

Thurs.	A-1	B-1	C-1	D-1
	A-2	B-2	C-2	D-2
	A-3	B-3	C-3	D-3


Friday	E-1	F-1	G-1
	E-2	F-2	G-2
	E-3 **	F-3	G-3
	** Session	Closed

Choose a Payment Method

Credit Card Debit Card Check

If paying by check, make checks payable to "March of Dimes" and send to:
March of Dimes
Illinois Chapter
Greater Chicago Division
111 W. Jackson Blvd., Suite 2200
Chicago, IL 60604

If paying by debit or credit card, fill out the information below:

Card Type*
Card Number (no spaces)*	Expiration Date*
Security Code	Expiration Date*

Cardholder Information

First Name	Last Name
Address Line 1	Address Line 2
City	Country
State	Postal Code/Zip

Special Thursday Post-Conference Social!
Join us for a networking, refreshment, and line dancing March 1st at 5:00 pm!
Registration required and space is limited.
Sponsored by Clinical Computer Systems, Inc./OBIX
Instructor Mary Castle-Enyard, "Dancing Mary"

Yes, I am interested in attending the Free Thursday Post-Conference Social 5-6 pm

Moms, Babies & You

March 1-2, 2012
Wyndham-Lisle Hotel
3000 Warrenville Road, Lisle, IL
(630) 505-1000
wyndhamlislehotel.com

Click here to learn more