Loewenstein All Day Program Registration
Networking lunch and 6 contact hours (CEU’s) are included in the cost of the meeting.
Name: _______________________________________________
Address: ______________________________________________
_____________________________________________________
Phone: ______________________________________
email: _______________________________________
Please check all that apply:
____ NESTTD Member: $100
____ NESTTD Student/Retiree Member: $70
____ Full-time
Non-profit Agency Employee: $80____ Non-member: $110
____ 6 CME’s (for M.D.’s only): $20
TOTAL Enclosed $_______________
Deadline for mail-in registration is March 19, 2008. On site registration the day of the meeting will cost an extra $10.
Cancellations as of March 19 receive a refund minus a $25 processing fee. No refunds after March 19, 2008.
Please return this registration form and check made out to NESTTD to:
Member Services Director
NESTTD
P.O. Box 506
Malden, MA 02148-7837