APT August Conference - Individual Registration

2023 Arizona Perinatal Trust Annual Conference

Individual Registration
Name*

First Last Suffix
Affiliation
Health System, Organization, Hospital, Company
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone

Area CodePhone Number
Can we include your name on our Attendance List?*

YesNo
Are you seeking nursing CEUs*

YesNo
RN License # *
Please indicate how you would like your name printed on your badge*
Registration Fees and Payment
Payment Method*

CheckCredit card
SELECT ONLY if paying by Credit Card*
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Credit Card Registration Fee$200.00
No refunds will be made after 7/31/2023. "No Shows" are still due and payable in full, as meals and conference materials are purchased based on your registration. Should you have any questions about your registration you can email apt@azperinatal.org.
When you click "Submit Registration," you will be redirected to the PayPal login.

IF YOU HAVE a PayPal account, login and complete your payment.

IF YOU DO NOT HAVE a PayPal account, select the button on the bottom of the PayPal login labeled "Pay with Credit or Debit Card."
When you click "Submit Registration," you will receive a confirmation email with instructions for mailing your check.
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Registration Fees and Payment