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  • 2021 Mail in Form

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    WisconsinPHP
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    This document provides a registration form for a 2021 homecare providers conference held on October 25-26. It lists the costs for attending the Monday conference, obtaining pediatric and adult recertification on Tuesday, CPR recertification on Tuesday, an annual PHP membership, and entertainment cards as a fundraiser. Attendees must fill out their contact information and mail the completed form with payment to the Wisconsin PHP by October 11 to ensure registration is processed on time.

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    Mail In Form

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    This document provides a registration form for a 2021 homecare providers conference held on October 25-26. It lists the costs for attending the Monday conference, obtaining pediatric and adult recertification on Tuesday, CPR recertification on Tuesday, an annual PHP membership, and entertainment cards as a fundraiser. Attendees must fill out their contact information and mail the completed form with payment to the Wisconsin PHP by October 11 to ensure registration is processed on time.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    79 views1 page

    2021 Mail in Form

    Uploaded by

    WisconsinPHP
    This document provides a registration form for a 2021 homecare providers conference held on October 25-26. It lists the costs for attending the Monday conference, obtaining pediatric and adult recertification on Tuesday, CPR recertification on Tuesday, an annual PHP membership, and entertainment cards as a fundraiser. Attendees must fill out their contact information and mail the completed form with payment to the Wisconsin PHP by October 11 to ensure registration is processed on time.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Professional Homecare Providers

    2021 Conference Registration

    ITEM COST QTY TOTAL


    Monday, October 25 Conference $100.00
    Tuesday, October 26 RCS Recertification $100.00
    (Pediatric and Adult)

    Tuesday, October 26 CPR Recertification $50.00


    PHP Annual Membership $50.00
    2021 Entertainment Card (PHP fundraiser, $25.00
    makes great gifts!)

    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:
    Wisconsin PHP
    Mail-in registrations MUST be postmarked by Monday,
    139 E Wisconsin Ave. October 11 in order to ensure we receive them in time
    to get your information processed.
    Oconomowoc, WI 53066

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