Electronic Registration & Payment for OKPRN Convocation 2008
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  Let us make your registration convenient via  
   
First Name:

Middle Initial (optional):

Last Name:

Title:

Email For PayPal Invoice:

Registration Fee:
(Members: $150; Non-members: $175;
               Saturday night dinner per guest: $30)
Attending Days:   Saturday      Sunday       Both days
Number of Guests With Me: (add $30 / guest for Sataurday night dinner)

  Additional Contact Information:
   

Name of Business:

Street Address:

City:

State:

Zip Code:

Country:

Phone Number:

Fax Number:

Comments:

Copy Verification Code From Grid On The Right:

  
Please contact the Quartz Mountain Resort at (877) 999-5567 and mention the 2008 OKPRN Convocation to reserve your room. Space is limited. 
(c) 2008 OKPRN Health IT Solutions. All rights reserved.