St. Luke's Regional Conferences Registration

Please complete the following form to register for St. Luke's Regional Conferences. If you have any questions or concerns, please contact St. Luke's Staff Development at 319-369-8750.

An administrative fee of $10 will be charged for cancellations less than two weeks before the conference. Onsite registration will be an additional $5 fee, which must accompany registration.

Lunch is provided.

St. Luke's Staff Development
P.O Box 3026

Cedar Rapids, IA 52406-3026
www.stlukescr.org

* required info
First Name *
Last Name *
Address *
City *
State *
Zip *
Employer
Title
Phone *
License Number
Email Address *
Conference Attending * R. Thomas Stewart Clinical Ethics Conference
Autism Conference - Both days
Autism Conference - Day 1 Only
Autism Conference - Day 2 Only
Nelson/Criswell Critical Care Conference - Both days
Nelson/Criswell Critical Care Conference - Day one only
Nelson/Criswell Critical Care Conference - Day two only
Current Trends in Mental Health Conference
Psychosocial Oncology Care Conference
Conference Fee * $35/day - Retired Nurses (age 62 and older)
$35/day - Undergraduate Student Nurses
$50/day - St. Luke's and IHS Associates and Volunteers
$80/day - Others
Payment Options
Card Type *
Card Number *
Card Expiration Date *
V Code (three digits on back of card) *
Billing Address (if different from above)
Name on Card
Organization
Address 1
Address 2
City
State
Zip
Phone Number