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                                                           TEPES 2008 Beach CME Conference On-line Registration      

Use this form to register on-line. Your completed form will be e-mailed to TEPES.
Press the Submit Button, below, to send the form to us. You will then go to the pay on-line page.

We look forward to seeing you at the Beach !!!
Application approved for 15 hours of Cat I CME and 18 NCNA contact hours.
Fee includes all meals and activities. (Note there is a guest fee for the Friday Beach Bash-new event this year)
Cancellations will be honored if received by May 29, 2008($35 administrative fee deducted for all cancellations)

TEPES reserves the right to make scheduling changes without prior notification.  Space is limited to 100 attendees.

   Contact Information      

Name:
Credentials(i.e. PA-C, NP,etc)
Street address:
City
State:  ZiP:
Home phone:
Work phone:
E-mail:

   Conference Fees

Register Before March 31, 2008
Members $135/ Non-Members $175:

Register After March 31, 2008
Members $175/Non-Members $200:

Friday Beach Bash included in your registration fee
I will attend the Friday Beach Bash:

Guest Fees for Friday Beach Bash
How many Adults @ $35 each:   How many Children(4-12) @ $12.50 each:
Enter your total amount for guest fees: $

Enter Grand Total (registration+guest fees): $

Additional comments:



Check registration for accuracy and click the Submit button.
Follow the directions that appear. Thanks.