Super Symposium Registration 2021

Personal Information

Name*

First Last

AARC Number

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Is this your home address?*

Yes
No

Phone

Email*

Enter Email Confirm Email

Permission to Advocate on Your Behalf*

I give the PACT committee of the CTSRC permission to use the following information whenever there is legislation that might impact the profession of Respiratory Therapy or our patients. The permission is granted from now - Dec 31, 2020. I understand that this list will not be shared or sold.

Yes
No

Employment Information

Facility or School*

Job Function*

if other, If other, identify your employment status or position.

Would you like a vegetarian meal?

Yes
No

Do you require dietary accommodations?

Yes
No

Special Dietary Accommodations

Special Note About Registration

*Registration, for non-AARC members no longer includes an AARC member. If you are not an AARC member, you are STRONGLY earned to become an AARC member to receive the discounted rate.

Registration includes parking

Registration Options

Early registration ends August 15th, after that time there will be a price increase.

Student One Day - Tuesday

Price: $55.00 Quantity:

Student One Day - Wednesday

Price: $55.00 Quantity:

Student One Day - Both Days

Price: $55.00 Quantity:

Coupon

If you have a coupon code, enter it in the box.

Total

$0.00

Refund Policy*

It is policy of the CTSRC that all cancellations must be submitted in writing, 14 calendar days before the scheduled event to be eligible for a registration fee refund. Refund requests must be made in writing to Maureen Parmelee at mparmele@ascension.org. A $25 administrative fee will be deducted from the refund.

I have read the refund policy.

Payment Choice

When you click REGISTER NOW, you will be directed to the PayPal site to complete your transaction. Payment can be made using a credit card OR by using your Pay Pal account.

Checks must be mailed to:

CTSRC

c/o Maureen Parmelee

90 Creamery Rd

Durham, CT 06422

Checks must be received 2 weeks before the event to be valid.

Total

$0.00

Name

This field is for validation purposes and should be left unchanged.

Super Symposium Registration 2021

2020 Symposium Registration

Personal Information

Employment Information

Checks must be mailed to:

Checks must be received 2 weeks before the event to be valid.