L-OADN REGISTRATION FORM………………….CONVENTION 2007

 Please print or type.

NAME:  ___________________________________________________________________

Affiliation:  _______Education   ________Practice    ________Student    ________Guest

Home Address:  _____________________________________________________________

City:  ___________________________  State: _________________  Zip: _____________

Phone #: ___________________  E-mail Address: ________________________________

Employer/School: __________________________  Position/Title: ____________________

FEES:  (Please check the appropriate fee).

* Member rates apply only to those licensed individuals in good standing with N-OADN.  Agency members receiving reduced registration must be one of the 2 designated agency members listed on N-OADN membership records.

 ** STUDENT REGISTRATION:  Schools (or their designated person) are to collect student registration forms and fees.  Send a list of students registering from a school and one check made out to L-OADN for the total registration fee to Donita Qualey below by March 1, 2007.  Individual registration from students will not be accepted.  Students will not be allowed to register late or on-site.

 Membership forms for N-OADN are available at www.noadn.org.

Early registration fee includes continental breakfast, lunch and break refreshments, access to exhibits, poster sessions, contact hours for attended focus sessions and keynote speaker.

 Late and on-site registrants may not receive lunch.

Cancellation policy:  Refunds (less $15 processing fee) if requested in writing by March 9, 2007.  E-mail: cbuancor@ololcollege.edu

 MAIL completed registration form with check (payable to L-OADN) to:

Donita Qualey

Delgado Community College

Charity School of Nursing

450 S. Claiborne Ave.

New Orleans, LA  70112

 If special accommodations are needed please contact Susan Schaff at least seven working days prior to convention date:  sschaf@dcc.edu