INSTRUCTIONS
Complete the form below and click on "Submit" to send the form via e-mail. Please complete all parts so that we can list you properly on your nametag and in the attendees list, and so that you will receive all post-conference mailings.
 

 I will attend the conference (see payment options below).

  I cannot attend the conference, but please keep me informed of future activities.

Name: REQUIRED
Credentials: (i.e., MD, RN, PhD)
Title:
Organization:
Mailing Address:
City:
State:
Zip:
Telephone (area code):
Fax (area code):
E-Mail Address: REQUIRED
Special Accommodations:

PAYMENT INFORMATION

 I will pay online using a credit card.

 I am sending you my check today for $75 made payable to NECON.

Check #
Mail to:
Necon Annual Conference, c/o Linda Downing, 11 Bens Way, Hopedale, MA 01747

Please help us control our costs by informing us if your plans change and you cannot attend. No-shows will be invoiced. Cancellations cannot be accepted after December 2, 2008 at 5:00pm.

* Registrations received after the deadline will be accepted on a space available basis, and registrants will not be included in the list distributed at the conference due to printing deadlines.