Event Registration Form | Beth Friesen, RN BSN CCM CSA

Event Registration

Complete student curriculum notebook is provided.

$190 if registered within 14 days of the event

$214 if registered between 14 and 7 days of the event

$234 if registered between 7 days and 24 hours prior to the event

*Continental Breakfast and lunch are provided

A cancellation fee of $75 will be applied.
Which Event Would You Like To Register For?*
Name*
First Last
Email*
Phone*
Company Name - If none, please type n/a*
Address*
Street Address Address Line 2 City State ZIP Code
Additional Information
Order Notes (optional)
How did you hear about this seminar?*
Do you have any food allergies?*
Please provide us with a summary of your relevant work experience.*
Payment Options
I would like to pay*
- By Check
- Through Venmo
Please deliver the check to:
3765 Pablo Ln
Lincoln, NE 68516
Please make a payment through Venmo to:
@Elizabeth-Friesen-4
You may either email the receipt the Beth at info@BethFriesenRN.com, or attach below.
Venmo Receipt Attachment (optional)
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Name
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