Name: _____________________________________
Address: ____________________________________
RN License #: ____________________________
(Both required for CEU) National NAPNAP # (if applicable): ____________________________
Home Phone: _____________________________________
Home Email: _____________________________________
Work Phone: _____________________________________
Work Email: _____________________________________
Member National NAPNAP [ ] YES [ ] NO
Member WA State NAPNAP [ ] YES [ ] NO
Student [ ] YES [ ] NO
Registration Fee (includes breakfast & lunch)
Please check the appropriate spaces and mark the total in the space provided.
Conference Fee
Student [ ]$ 150
Total Amount Due: ________

Please complete membership application/renewal if applying for membership or renewal with conference registration.

Make checks payable to WA State NAPNAP
Send registration to:
Karen L. Fitzgerald
2220 Simmons St Unit A
Dupont, WA 98327

Refunds: If unable to attend or send a substitute, you may request a refund less $10 administrative fee prior to March 3, 2009.
Return to Washington State NAPNAP