AlaSHES/AP

REGISTRATION for Summer Program/Conference

July 11, 2008

Name:

Title:

Hospital System:

Address:

City/State/Zip:

Phone:

E-Mail:

Please complete the registration form above and send to Nancy Jarrett for your attendance and lunch. We would appreciate receiving your registration no later than June 30.

There is NO REGISTRATION FEEE for the July 11^th program/conference.

Make checks payable to AlaSHES/AP.

E-Mail, Mail or Fax this form to:

Nancy Jarrett, Program Chairman

Children’s Health System

1600 7^th Avenue South

Birmingham, Alabama 35233

Phone: (205) 939-9176

Fax: (205) 939-9189

Email: nancy.jarrett@chsys.org