AHEC: Registration

Please fill out the form below if you would like to register for the AHEC Educational Session you've selected. Fields labeled with an * are required. This is to ensure that we can respond to your request efficiently. This form will not send unless they are complete. At Southern New Hampshire AHEC we respect your privacy and will not sell or give this information to any other company, organization, or individual.
Please register me for the following session: Diabetes Today: Seven Ways to ... Transition from Novice to Expert November 6, 2009 Location: North Conway Grand Hotel, North Conway, NH Time: November 5th: 2pm - 8:45pm and November 6th: 7:45a Cost: $185.00 both days combined Email: tholmes@snhahec.org WWW: www.snhahec.org Contact Name: Tracie Holmes - Phone: 603-895-1514 ext. 4 Payment should be in the form of a purchase order or check and is due within ten (10) days of registration. You will receive confirmation of your registration once payment has been received. Please make purchase order or check out to Southern New Hampshire AHEC and mail to: 128 State Route 27 Raymond, New Hampshire 03077


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