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2021 Homecare Conference Registration

This document provides a registration form for a 2021 homecare providers conference held on October 25-26. It lists the costs for attending the Monday conference, obtaining pediatric and adult recertification on Tuesday, CPR recertification on Tuesday, an annual PHP membership, and entertainment cards as a fundraiser. Attendees must fill out their contact information and mail the completed form with payment to the Wisconsin PHP by October 11 to ensure registration is processed on time.

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WisconsinPHP
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119 views1 page

2021 Homecare Conference Registration

This document provides a registration form for a 2021 homecare providers conference held on October 25-26. It lists the costs for attending the Monday conference, obtaining pediatric and adult recertification on Tuesday, CPR recertification on Tuesday, an annual PHP membership, and entertainment cards as a fundraiser. Attendees must fill out their contact information and mail the completed form with payment to the Wisconsin PHP by October 11 to ensure registration is processed on time.

Uploaded by

WisconsinPHP
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Professional Homecare Providers

2021 Conference Registration

ITEM COST QTY TOTAL


Monday, October 25 Conference $100.00
Tuesday, October 26 RCS Recertification $100.00
(Pediatric and Adult)

Tuesday, October 26 CPR Recertification $50.00


PHP Annual Membership $50.00
2021 Entertainment Card (PHP fundraiser, $25.00
makes great gifts!)

TOTAL:

Name: ______________________________________________________

Address: _____________________________________________________

City: _______________________________ State: ______ Zip Code: ___________

Email Address: ______________________________________________________

Phone Number: ______________________________

Mail completed form with check or money order made out to Professional Homecare
Providers to:
Wisconsin PHP
Mail-in registrations MUST be postmarked by Monday,
139 E Wisconsin Ave. October 11 in order to ensure we receive them in time
to get your information processed.
Oconomowoc, WI 53066

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