WI PHP Annual ConferenceOct 20, 21, & 22, 2024 Please note that membership is required for this event. Click Here to become a member or renew your membership. "*" indicates required fields Name* First Last Nursing License* RN LPN RCS (Ventilator) Certified* Yes No Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code County* Phone*Email* Would you like to nominate yourself or someone else for the PHP Board of Directors?Note that PHP will dissolve at the end of the year IF no qualified volunteer can be found to serve as President. If using a credit card to pay for the conference or recertification classes, what is the name on the credit card?This will help us make sure your registered correctly. 2024 PHP ANNUAL CONFERENCEDates: October 20, 21, & 22, 2024 • Location: Jefferson Street Inn 201 Jefferson Street Wausau, Wisconsin 54403Sunday Oct 20 - CPR Recertification ($50) Quantity Price: $50.00 Quantity Monday, October 21 Conference - ($100) includes lunch Quantity Price: $100.00 Quantity Tues Oct 22 - Morning Conference ($50) Quantity Price: $50.00 Quantity RCS/CPR - Tuesday AfternoonRecertification classes - October 22RCS (ventilator) includes pediatric and adult ($100) MUST HAVE CURRENT PEDS OR ADULT CERT Quantity Price: $100.00 Quantity Total Payment Method* Check Credit Card Check Payment - What is the Name on Check you will be mailing? Please make checks payable to Wisconsin PHP and mail to: Wisconsin PHP, 139 E. Wisconsin Ave, Oshkosh, WI 53066Credit Card MethodPayments processed by PayPal - you do not need a PayPal account to use this method. Just choose Pay with a Credit or Debit card during the payment process.Credit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.
