Council for the Advancement of Nursing Science (CANS)

Click here to download a fax/mail version

Registration Form
Practice-Based Evidence
Another Side of the Knowledge Development Coin
October 24, 2007   Omni Shoreham Hotel, Washington, D.C.

Confirmation and Mailing Information
(Please provide your name as you wish it to appear on your badge)

First Name: Last Name:
Title: Professional Designations:

City: State: Zip:

The Above address is my  (choose one)              

Phone: Fax: E-Mail:

Special Needs: Please indicate if you have any special needs and a staff member will contact you to arrange accommodations.

Registration Fees                                  
April 2-September 1
$250 $325
$175 $225
September 2-October 1
$275 $350
$200 $250
Registration Total:    

Method of Payment
                 (Payable to the Council on the Advancement of Nursing
                                                                       Science (CANS) – please write name of registrant on check.)
Name on Card:
Card Number:
Expiration Date Month: Year:

Mail to: Council for the Advancement of Nursing Science, Special Topics Conference Registration, 555 East Wells Street,
Suite 1100, Milwaukee, WI 53202-3823

Fax: 414-276-3349

Registration conformations will be mailed to fax/mail registrants who register before October 1, 2007.

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