Select Program Day (s): 

Day 1:	Ethics (6 hours CE) and Human Resources (2 hours CE)
Day 2:	Regulatory Update Leadership and Management (8 hours CE)
Day 3:	Strategies for Serving Residents with Dementia (8 hours CE)

Advanced Practice Seminars, $135/per seminar day

or $395.00 for all three days

                 Specify Program Location:
                               1 Day (Specify Date)  
                               2 Days (Specify Date)
                               3 Days (Specify Date)

I want to receive the new C.A.L.A.™  Certificate and am attending the Advanced Practice Seminar. 
Please add in the $60 certificate fee for my payment.  Option #3 on the certificate change notification. 

My certificate number is:    Check this box only if you are unsure that your certificate is current - please advise

Participant Information:

Name
Address (Street)
Mail Add (if different)
City, State, Zip
E-mail
Phone
FAX (for registration confirmation)
Organization

Method of Payment:

Credit Card	Visa   MasterCard
Card Number:
Card Expiration:
Name on Card:
Mailing Address on Card: (include State & Zip)
Mailing a Check

Any Questions or Comments?

* Payment is required at the time of enrollment.
* Cancellation requests received up to two weeks prior to the program date will be refunded at 75% of the registration fee or full credit at another site during the calendar year. 
NO REFUNDS WITHIN THE TWO WEEKS PRIOR TO PROGRAM DATE.