STERILE PROCESSING UNIVERSITY


REGISTRATION and PAYMENT FORM

23rd Annual Seminar

"Current Issues in PeriOperative,
GI/Endo and Sterile Processing Services"


INFORMATION:

**DATE**
Saturday, April 21, 2018

**LOCATION**
Holiday Inn Hotel
Portsmouth, New Hampshire

**FINAL REGISTRATION DEADLINE**
April 13, 2018

--Early-bird registration fee of $85 per person must be received by April 6, 2018

--Regular registration fee is $95 per person if received AFTER April 6, 2018


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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