Online Registration:

A Clinical Guide to Ulcer Assessment Workshop

June 18, 19, 20, 2008

Required Information is marked by an asterisk (*).

Date and Location: *: June 18 - Eau Claire, WI
June 19 - Appleton, WI
June 20 - Brookfield, WI

Facility: *
Address: *
City, State Zip: *
Phone: *
Fax:
E-mail: *

Registration Fee:
(includes handouts, breaks and CEUs)

Non-Members: $129
WHCA Member Fee:: 1st Person - $119; 2nd Person - $109; All others - $99

People Attending:
(You must enter a NHA License Number for each Attendee in order to successfully register. If you don’t have one, please enter “0000”.)

Number of People Attending: *: 1
2
3
4

	Name:	NHA License #:	Amount:
1.*
2.*
3.*
4.*
		* Total Amount Due:

Please send check payable to WHCA at:: WHCA
121 East Wilson Street
Suite L200
Madison, WI 53703

Wisconsin Health Care Association

Online Registration:

A Clinical Guide to Ulcer Assessment Workshop

June 18, 19, 20, 2008