REGIONS PCCS ONLINE REGISTRATION

REGIONS PCCS ONLINE REGISTRATION

Registration online is easy, just fill out this and press the submit button when you are finished.

MAIL YOUR CHECK AND A COPY OF THIS COMPLETED REGISTRATION
Please make your check payable to:

LARRY PRATHER & ASSOCIATES INC.
P.O.Box 20896,
Wichita, Kansas 67208

General Registration Fee $200 per person per conference
OR
Exhibitors Only Registration Fee $800 per conference
OR
Special Exhibitors Registration Fee $2500 for all 4 conferences
(Special Exhibitors Registration Fee Due before January 15th, 2010,
fill in attendees each conference)

Please Check Conference you are attending

Order Number: 090410202610

	REGIONS VII & VIII PCCS JANUARY 24 & 25, 2011 25th Annual Workshop THE EMBASSY SUITES HOTEL NEAR THE KANSAS CITY AIRPORT 7640 N. W. Tiffany Springs Parkway, Kansas City, Mo. 64153 Reservations Phone (816) 891-7788 Fax 816-801-2229 Click here for online Hotel Registration (after submitting this form)
	REGION IV FEBRUARY 21 & 22, 2011 Doubletree Club Atlanta Airport 3400 Norman Berry Drive,Atlanta, GA. 30344 Near the Hartsfield-Jackson Atlanta Int’l Airport – Shuttle service is provided Phone (404) 763-1600 Click here for online Hotel Registration (after submitting this form)
	REGIONS I, II & III APRIL 18 & 19, 2011 Hilton Philadelphia Airport 4509 Island Ave. Philadelphia, Pa 19153 Phone (215) 365-4150 Fax 215-937-4535
	REGION V MAY 23 & 24, 2011 Indian Lakes Resort 250 W. Schick Road, Bloomingdale, IL.60108 PHONE (800) 334-3417 Special transportation with A-1 Limo Phone 800-354-5849 O’Hare or Midway Click here for online Hotel Registration (after submitting this form)

Attendee Name:
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Institution or Exhibitors Name
Address
Phone Number Fax
E-mail
Total General Registration attendees $
Or Exhibitors Registration for one conference or all 4 conferences $

MAIL YOUR CHECK AND A COPY OF THIS COMPLETED REGISTRATION
Please make your check payable to: :

LARRY PRATHER & ASSOCIATES INC.

P. O. Box 20896, Wichita, Ks

Wichita, Ks 67208

E-mail larryprather@cox.net Web Site – regionspccs.com