2010 Symposium Registration
Make checks payable to SCDHA and mail to Shera Davis, RDH • 444 Hindman Road • Travelers Rest, SC 29690. 
A check must still be mailed before pre-registration deadline to above address. We do not accept credit cards. Pre-registration deadline is September 20, 2010. Late fees apply after that date.  CONFIRMATIONS: will be sent by e-mail to the e-mail address you provide below.

Print this form before clicking submit. Please, mail the form with your payment.

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Full Name
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Choose One
Address
City, State, ZIP
Home Phone
Work Phone
Cell
E-Mail Address for confirmation
Students, please give the name of your school.
ADHA Membership Card ID#
   

SYMPOSIUM FEES                 FULL SYMPOSIUM      SINGLE DAY**

Member ADHA                                $130.00                $105.00

Non-Member ADHA                        $185.00                $130.00

Student ADHA Member                  $ 40.00                 $ 40.00

Student Non-Member ADHA          $ 50.00                 $ 50.00

**Single Day Registrants: Circle the day you will attend: 
                Friday   or    Saturday

LIMITED ATTENDANCE FUNCTIONS:

To register for the following functions, you must be registered for the FULL or SINGLE DAY Symposium. Luncheons limited to the number in parentheses.

Friday, October 1, 2010 Events

Lunch and Learn – RDHs                 $ 27.00                $ 27.00

Lunch and Learn – Students             FREE                  FREE

(To reserve a plate, students MUST check FREE if plan to attend LUNCH.)
(For RDHs, this Lunch and Learn is limited to the first 80 to register.)

Saturday, October 2, 2010 Events

Lunch and Learn (limited to 60)         $ 27.00                 $ 27.00

CPR (limited to 25)                             $ 45.00                 $ 45.00

Late fee (after September 20, 2010)   $ 25.00                 $ 25.00

TOTAL PAYMENT                         $                   $
   
_____ CHECK HERE IF YOUR PREFERENCE FOR LUNCH IS VEGETARIAN

Refund Policy – Pre-registration deadline is Monday, September 20, 2010. Registration fees less a $15 service charge is refundable if requested before that date. Written requests for a refund, less a $25 administrative charge, will be granted if received by Friday, September 24, 2010. No refunds after September 24, 2010

INQUIRIES regarding pre-registration forms should be directed to: Shera Davis, RDH, Treasurer, at treasdavis@aol.com or 864-834-1809.  INQUIRIES regarding general and course information should be directed to: JoAnn Rice, RDH, CE Chair, at jorice1@charter.net or 864-354-6858.

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