Appendix PP of State Operations Manual (SOM)

Name*

First Last

Job Title*

Employer*

Employer Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone*

Email*

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone

Home Phone

RN License Number*

NHA License Number

NHA Registry Number

First Convention

Is this the first time you are attending PADONA's annual convention?

Yes

Full Conference Registration Fee*

Are you currently a member of PADONA?

Single Day Registration Fee (Members Only)

If you would like to register for multiple single days, please enter the appropriate quantity here. (Wednesday, Thursday, Friday)

Price: $175.00

Single Day Registration Fee (Non-Member)

If you would like to register for multiple single days, please enter the appropriate quantity here. (Wednesday, Thursday, Friday)

Price: $225.00

Single Day Attendance

If you have registered for single day attendance, please list the day(s) you will be attending the conference virtually. (Wednesday, Thursday, Friday)

Billing Address

Street Address Address Line 2 City State ZIP Code

Payment via Paypal

Once you click the register button below, you will be forwarded to Paypal to complete your registration. You do not need a Paypal account in order to complete your transaction. Paypal allows you to pay via credit card without an account.

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Additional Info

Cancellation Policy

Security & Liability

Additional Questions

Payment via Paypal

Additional Info

Cancellation Policy

Security & Liability

Additional Questions

Payment via Paypal

Payment via Paypal

Additional Info

Cancellation Policy

Security & Liability

Additional Questions

Payment via Paypal

Additional Info

Cancellation Policy

Security & Liability

Additional Questions

Payment via Paypal

Payment via Paypal