2010 PSRC Eastern Regional Conference
                                                                       April 8 & 9, 2010
                           Radisson Hotel, Valley Forge, PA
______________________________________________________________________

                                Pre-Registration - By Mail

Pre-registration by mail with payment by check or money order must be postmarked by 3/25/10 (NOTE:  Postmark date for "Early Bird" registrations is 2/15/10.). 

To register by mail, print out this form (or click here to download and print a PDF file of the conference program which includes this form), complete it and mail it along with a check payable to the "PSRC Eastern Regional Conference" to:

PSRC Eastern Regional Conference
c/o 225 Hampshire Drive
Sellersville, PA 18960-2876


Name_________________________________      Credentials ________________

AARC Membership #_____________________ or    ___  Non-AARC Member
(If you don't know your membership number, call the AARC at 972-243-2272)

Address___________________________________________________________

City _______________________________ State___________ Zip_____________

Telephone (Day) ___________________ E-mail ____________________________

Hospital/Business/School Affiliation_______________________________________

Circle The Date(s) For Which You Are Registering:     

April 8th Only         April 9th Only         BOTH April 8th & 9th

Full refund provided for cancellations made by March 25, 2010. A credit for a future PSRC event will be provided for cancellations made after March 25, 2010.

Questions? Send an email to ExecutiveDirector@psrc.net