REGISTRATION FORM
ANNUAL FALL RESPIRATORY THERAPY SYMPOSIUM
October 22nd, 2010
Long Island Huntington Hilton

ONLINE REGISTRATION DEADLINE HAS EXPIRED
TO REGISTER & PAY ON-SITE, PLEASE FOLLOW INSTRUCTIONS 1-5 & ARRIVE EARLY

1. FILL OUT THIS REGISTRATION FORM BELOW USING YOUR COMPUTER.
2. TYPE IN ALL THE REQUESTED INFORMATION IN THE BOXES BELOW, DO NOT HAND WRITE.
3. AFTER TYPING THE INFORMATION, CLICK NEXT AND THEN PRINT THE COMPLETED FORM.
4. BRING THE COMPLETED FORM WITH YOU TO THE SYMPOSIUM REGISTRATION AREA.
5. PAY ON-SITE; BRING ONLY CASH OR MONEY ORDER TO THE REGISTRATION AREA.

ON-SITE REGISTRATION MAY NOT BE AVAILABLE IF THE EVENT IS FILLED TO CAPACITY.
CHECK THIS WEBSITE FOR UPDATES PRIOR TO ARRIVING.

YOU ARE REQUIRED TO FILL IN ALL FIELDS.
PLEASE TYPE YOUR NAME AS YOU WOULD LIKE IT TO APPEAR ON YOUR ID BADGE
Complete this form and click NEXT for a printable copy of the registration form.

AARC Member?   Yes   No If Yes - AARC#
First Name MI Last Credentials
Email Address:
Mailing Address: Home Work
City State Zip
Phone
Employer :(or school if student)
Job Title:
Please indicate any special dietary needs by checking the choices: VEGETARIAN KOSHER
I would like to be a NYDART Member? Yes No Membership is FREE.
If yes, applicant agrees to receive emails from NYDART regarding information about future
professional events and educational programs.
(NYDART will maintain the privacy/confidentiality of your information and will not share your address or email)


You must submit your AARC Membership # for CRCE Credits to be placed on the
AARC website transcript. Non-AARC members must retain the certificate of
attendance as proof of earned credits.
The NY State Ed. Dept automatically accepts all AARC approved CRCE credits.
YOU MUST ATTEND ALL LECTURES IN ORDER TO RECEIVE THE CERTIFICATE.


FEES: Payment of appropriate fees entitles registrant to attend all symposium events.
$125.00 On-Site Registration Fee……… cash or money order only (NO CHECKS OR CREDIT CARDS)
$70.00 On-Site Student Registration Fee* cash or money order only (NO CHECKS OR CREDIT CARDS)
*Students must present a valid student ID card at the door, or be charged the non-student full price.