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Air Care 2004 Form

       

Air Care 2004 Conference Registration Form

Please Register the Following Persons to attend AIR CARE 2004 April 30 - May 1:
    PRINT NAME (as desired on name tag)    Attend Conference?   Friday Dinner? (circle y or n)

1)                                                                                     Y   N                     Y   N

2)                                                                                     Y   N                     Y   N

3)                                                                                     Y   N                     Y   N

4)                                                                                     Y   N                     Y   N

5)                                                                                     Y   N                     Y   N
      (for additional persons continue the list on another copy of the form)

Form completed by: __________________________________________

Phone Number__________________________  Group__________________________

Email address_________________________________

Number at conference ___ x $35  = _____ plus  No. at Friday dinner  ___ x $30  =_____

        Total remitted: $____________ by mailed check #_________  

or check this box if bringing your check to the conference ______               

NOTE: Payment by check is preferred and can be mailed to us or brought with you to the conference.  

Signed ________________________________________________________

FAX COMPLETED FORM TO: 603-806-7937 BY Fax deadline   April 27, 2004
   Or MAIL TO ADDRESS BELOW BY   Mail Deadline    April 23, 2000

AIR CARE 2004 Registrar
Angel Flight of Georgia
2000 Airport Road  Suite 227
Atlanta, GA 30341    

AFTER THOSE DATES call us at (770) 452-7958 ext 3, fax us at 603-806-7937 , or 
email us at
mailto:angeladmin@aol.com for late registration and on-site registration information.

See the bottom of our conference page for hotel information - www.aircareall.org/aircare2004.htm   
Questions? Send them to conference@aircareall.org

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