ACEN

WORKSHOP REGISTRATION FORM

Effectively Leading an ACEN-Accredited Program: A Workshop for the New Nurse Administrator
January 17, 2014 || Atlanta, Georgia

All fields are required.

PARTICIPANT INFORMATION
Firstname:
Lastname:
Academic Credentials:
Position/Job Title:
PROGRAM INFORMATION
Governing Organization:
Nursing Education Unit:
Program Type(s):
CONTACT INFORMATION
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
REGISTRATION FEE & PAYMENT INFORMATION
   
  
REGISTRATION FEE: $175.00
METHOD OF PAYMENT: (Please select one)
  Check or Money Order
Payment due upon receipt of ACEN invoice.
  Credit Card (Please complete the Billing Address Information below.)
An ACEN Accounting Associate will be contacting you
by phone to process credit card information.

Credit Card Billing Address:
Address:

City:

State:

Zip:

  Purchase Order
If your institution requires a Purchase Order (P.O.)
Please enter P.O. No.

IMPORTANT INFORMATION:
Payment must be received to confirm registration. Cancellations will be charged $100.00 fee. Fees are not refundable within 45-days prior to the workshop. Click here for more detailed information on fees and cancellation policies. Travel or hotel arrangements should be made after you have received confirmation of your registration from the ACEN office.

This continuing nursing education activity was approved by the Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.


If you have any questions or require technical assistance, please contact:

Carla Haynes, Operations Specialist
Phone: (404) 975-5011
Fax:  (404) 975-5020
chaynes@acenursing.org

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