International Transplant Nurses Society

ITNS Symposium Registration Form

[For printable version, download Symposium Registration (PDF) and mail in your check via U.S. Mail]

NAME BADGE INFORMATION
First Name:
Last Name:
Degree / Credentials:
Position / Role:
Employer:
Employer Address:
Preferred Mailing Address:	Home Work
Preferred Email Address:
CORRESPONDENCE ADDRESS
Mailing Address:
City:
State/Province:
Postal Code:		Country:
Phone Number:
Fax Number:
WORKSHOP SELECTION: There are 8 half day workshops. Please select one option for the morning and one option for the afternoon.
Morning Workshop Options (Select ONLY ONE)
Putting It All Together: Integrating Complementary Therapies into Your Transplant Practice Health Literacy: Instant Teaching Tools for Diverse Learners The High Risk Transplant: Identifying Those at Risk, Risk Stratification and Management Strageties The Other Side of Transplant: The Donor World
Afternoon Workshop Options (Select ONLY ONE)
Heart and Lung Transplant: The Future is Now Research and Evidence Based Practice Staff Nurse: Practice Enrichment Through Knowledge and Interaction Issues with Aging Recipients
SIG / COMMITTEE / CHAPTER LEADERS MEETINGS:
APN Cardiothoracic Chapter Leaders Education Research Staff Nurse Pediatrics ITNS Past Presidents
I will attend the Lunch Thursday Friday Saturday
I will attend the Welcome Reception on Wednesday, October 27, from 5:30 pm - 7:30 pm. The Symposium begins Thursday, October 28. Yes No -- (no charge/fee)
I will attend the Poster Session / Wine Reception on Friday, October 29 from 4:45 pm - 6:00 pm Yes No -- (no charge/fee)
I would like to serve as a Moderator for an abstract breakout session? Yes No
Is this your first ITNS Symposium? Yes No
SPECIALTY INTEREST:
Kidney / Pancreas Heart / Lung Liver Small Bowel Research QOL Procurement Pediatrics Donor Other
INTEREST LEVEL:
Staff Advanced Practice Transplant Coordinator Manager/Administrator
SYMPOSIUM REGISTRATION:
$500 ITNS Member Rate		ITNS #
$575 Non-Member Rate		Not a Member Yet? If you would like to join ITNS today, for no additional fee, please complete the membership application at ITNS Become A Member -- DO NOT process a payment for an additional $75 via Google Checkout.
ONE DAY REGISTRATION:
I plan to attend: Thursday Friday Saturday
$175 ITNS Member Rate		ITNS #
$250 Non-Member Rate		Not a Member Yet? If you would like to join ITNS today, for no additional fee, please complete the membership application at ITNS Become A Member -- DO NOT process a payment for an additional $75 via Google Checkout.

International Transplant Nurses Society (ITNS).
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