Spring 2015 Self-Study Forum

LOCATION

Atlanta, Georgia – April 9-10, 2015
Host Hotel: Atlanta Marriott Buckhead Hotel & Conference Center
SPECIAL SESSION: “The Novice Accreditee” – Making the Most of the Process

REGISTRATION FEE

Please note: Space is limited. Registrations may no longer be accepted once venue is filled to capacity.

Registrations processed after January 26, 2015 for the Chicago Forum and after February 9, 2015 for the Atlanta Forum

  • $ 445.00 per participant
  • $ 395.00 per participant if 3 or more registrations from the same governing organization or agency.

IMPORTANT INFORMATION:
Payment must be received to confirm registration. Cancellations of confirmed registrations will be charged $150.00 per attendee. Fees are not refundable after February 9, 2015 for the Atlanta Forum. For more detailed information on fees and cancellation policies, please visit . Travel or hotel arrangements should be made after you have received confirmation of your registration from the ACEN office.

REGISTRATION FORM

Are you planning to attend the free Special Session? *

For Attendees of the Atlanta Forum: April 9, 2015 - A Focus on Standard 4 Curriculum

Yes

No

Name of Governing Organization or Agency*

Nursing Education Unit or Department*

Nursing Program Type(s) Offered [Please check all that apply.]*

Clinical Doctorate

Master's/Post-Master's Certificate

Baccalaureate

Associate

Diploma

Practical

Other/Not Applicable

Firstname*

Lastname*

Academic Credentials*

Position/Title*

Address*

City*

State/Province*

Zip Code*

Email*

Phone*

Fax


Method of Payment*

If paying by credit card, please provide your billing address below if different from the nursing program. Credit card payments will be processed by phone upon processing of registration. For questions or assistance with payments, please contact Jocelyn Pineda, Accounting Specialist at .

Check or Money Order

Credit Card

ACEN Voucher Certificate

Purchase Order

Billing Address*

Check if same as above address

Address*

City*

State/Province*

Zip Code*

Comments/Special Instructions

Spring 2015 Self-Study Forum Registration1