First Name:

Last Name:

Credentials:

Email:

Agency Name:

Work Address:

City, State, Zip:

Phone:

Fax:

I Need:

CEUs CMEs Only the Information

What Discipline?

How would you like to pay?

Credit Card Check

How would you like us to contact you for payment?

Phone Email

Other Comments:

After you complete the Contact Form above, click the submit button.

Feel free to print this page (before you click submit) for your records or
to attach to your payment.

Other Ways to Register

Phone: Call Lanette Filstrup at 512-383-4468
Email: Click here for Form then save & email to Lanette Filstrup

Mail: Click here to get the Form to complete, print and mail with payment.
Fax: Complete Registration Form and fax it to 512-462-6749

If you have any questions, contact Lanette Filstrup at 512-383-4468 or click here to email.

Click here to print the Conference Brochure.

Cancellation Policy

If you notify us 30 days from the event (before or on August 25th) - we will reimburse you $95.00, which is the full amount less a $5 fee to cover costs for processing your payment. If you notify us less than 30 days from the event (on or after August 25th) - we will reimburse you 50% of your registration fee ($50).

To notify us: Call Lanette Filstrup at 512-383-4468 or send an email to click here to email