STERILE PROCESSING UNIVERSITY


REGISTRATION and PAYMENT FORM

Sterile Processing Management,
Regulations and Responsibilities
On-site Course

INFORMATION:

*COURSE #1
June 10 - 13, 2019
Embassy Suites
Portland, Maine

--Early-bird registration fee of $800 must be received by May 17, 2019
--Regular registration fee of $875 must be received by May 31, 2019

**COURSE #2
September 16 - 19, 2019
Homewood Suites Hotel
Pittsburgh, Pennsylvania

--Early-bird registration fee of $800 must be received by August 26, 2019
--Regular registration fee of $875 must be received by September 6, 2019

***COURSE SELECTION***

COURSE #1: Portland, Maine

COURSE #2: Pittsburgh, Pennsylvania

Please Complete the Form Below


*Your E-mail Address:


*E-mail Address For Credit Card Receipt:


*Name:


*Facility Name:


Dept:


*Address:


*Is this your Home Address?


*City:


*State:


*Zip Code:


*Phone Number:


Special Dietary Restrictions:


Fax Number:


CREDIT CARD


*


*Person's Name on the Card:


*Card Number:


*Expiration Date:


*Security Code on the Card:


*Credit Card Billing Address:


Final Comments:





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