Name:
Email:
Phone:
		Please provide 3 email addresses for any registered nurses that may be interested in the course.
		Course Dates:	Choose one October 1-4, 2009 February 26th-March 1st, 2009
Email 1:
Email 2:
Email 3:
		Disclaimer: *Contestant winner will be responsible for travel, hotel, and expenses other than course/seminar.