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First Name *

Last Name *

Home Address *

Address (extra field)

City *

Your State of Residence *

Zip *

Email *

Phone Number *

Profession/Credentials *

Employer *

Perinatal Association Membership? *

Which days will you attend? *

One day only (Sunday, September 29) [$105.00]

One day only (Tuesday, September 27) [$105.00]

Full Conference [$250.00]

Which days will you attend? *

One day only (Sunday, September 29) [$295.00]

One day only (Tuesday, September 27) [$115.00]

Full Conference [$295.00]

Pre-conference Workshop (Select One) + $75 *

Pre-conference 1 [$100.00]

Pre-conference 2 [$100.00]

Supporting Our Perinatal Famiilies [$75.00]

I do not plan to attend a pre-conference workshops

Pre-conference Workshop (Select One) + $50 *

Pain Nurse Liaison Training [$50.00]

Pain Management in the Neonate/Medically fragile NICU Grad [$50.00]

Supporting Our Perinatal Famiilies [$50.00]

I do not plan to attend a pre-conference workshops

CONCURRENT SESSION A (PLEASE SELECT ONE)

1) session 01

2) session 02

3) session 03

4) session 04

CONCURRENT SESSION B (PLEASE SELECT ONE)

5) Postpartum LARC - Improving on patient-centered care

6) Breastfeeding the Tongue-Tied Baby

7) Unsafe Sleep: Case Studies from the Field

8) Evidence for a Small Baby Unit: Creating Expertise by Experience

Which Business Lunch do you plan to attend

NC

SC

I have dietary restrictions (i.e. vegetarian, gluten free, allergies)

No

Yes

I have dietary restrictions (i.e. vegetarian, gluten free, allergies) Yes

If Yes, please tell us what your dietary restrictions are.

Please indicate if you will attend the Reception

Yes

No

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