OACVPR | Register for Annual Meeting Non- Member

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			Annual Conference Registration Form

Ohio Association of Cardiovascular and Pulmonary Rehabilitation Annual Conference Registration Form
Personal Information
First Name		Last Name
Title		Phone
Address		City
State		Zip Code
Email Address		Lunch Option______________________

Conference and membership fees:

$150.00 - includes 1 year oacvpr membership & conference with lunch.

$50.00 - Student 1 year oacvpr membership and conference with lunch.

$30.00 annual membership only.

$15.0 student annual membership only.

Please make check payable to OACVPR and send to:

Glenn Feltz

Delta Psychology Center

430 S. Main St

Urbana, OH. 43078

Payment must be received prior to 4-1-07 if registering for sate conference

You must print this page and mail in with your payment to complete the registration process.