Professional Homecare Providers

2020 Conference Registration

ITEM COST QTY TOTAL

Thursday Sept 10 Half-day Conference $15.00
RCS RECERTIFICATION Thursday Sept 10 $100.00
Friday Sept 11 Conference $25.00
Saturday Sept 12 Beginner Session half-day $15.00
Saturday Sept 12 Advanced Session half-day $15.00
PHP Annual Membership $50.00
2021 Entertainment Card (PHP fundraiser, $20.00
makes great gifts!)

Prize Tickets (15 tickets) $10.00

TOTAL:

Name: ______________________________________________________

Address: _____________________________________________________

City: _______________________________ State: ______ Zip Code: ___________

Email Address: ______________________________________________________

Phone Number: ______________________________

Mail completed form with check or money order made out to Professional Homecare
Providers to: PHP Mail-in registrations MUST be postmarked by
PO Box 270239 Wednesday, September 2 in order to ensure we receive
them in time to get your information processed.
Hartford, WI 53027