Pathways to the Future: 2001 Joint Fall Conference of the Georgia Tumor Registrars’ and the South Carolina Cancer Registrars Associations

Meeting Registration Form

Name and Credentials ___________________________________________________________________

Title ______________________________________________________________________________________________

Facility/Employer ___________________________________________________________________________________

Mailing Address ____________________________________________________________________________________

City, State Zip ___________________________________________________________________________________
– Please indicate: ____Work ____Home

________________________ ________________________ _________________________________________
Work Telephone Fax Telephone e-mail address: –____Work ____Home

Indicate association affiliation: ___GATRA ___SCCRA Membership Number (if applicable): ___________________

Please include current or past Office held (include Year held) _________________________________________________

GA/SC Member Early Bird (before 10/14) Regular (by 11/01) Late (after 11/01) Amount Due

All three days $75 $85 $95 __________

Wednesday only 50 50 60 __________

Thursday only 50 50 60 __________

Friday only 50 50 60 __________

Banquet guest* 35 35 35 __________

Total Amount Due………………………………………………………………………………………__________

Non-Member Early Bird (before 10/14) Regular (by 11/01) Late (after 11/01) Amount Due

All three days $105 $115 $125 __________

Wednesday only 60 60 70 __________

Thursday only 60 60 70 __________

Friday only 60 60 70 __________

Banquet guest* 35 35 35 __________

Total Amount Due………………………………………………………………………………………__________

Registration covers all breaks, continental breakfast (both mornings), luncheon and banquet (on Thursday), and handout materials. *If you are bringing a guest to the banquet, there is an additional charge of $35.

Please indicate below which meals you plan to attend and if you would like a vegetarian meal:

Day-Meal	Yes, I Plan to Attend	No, I DO Not Plan to Attend	Vegetarian or Special Needs Meal?
Thursday-Breakfast
Thursday-Luncheon
Thursday-Banquet
Friday-Breakfast

Make check payable to GATRA – Payment must be received no later than November 9^th. Registration form must be received by date indicated for registration type.

Please fax your completed registration form to:
(404) 250-2276 ATTN Kimberly DeWolfe

Please mail your completed registration form and/or check to:

Kimberly DeWolfe, Cancer Registrar

Children’s Healthcare of Atlanta

Suite 260, 5455 Meridian Mark Rd

Atlanta, GA 30342

For more information: Dolores McCord (770) 975-3595

Cheryl Wheeler (706) 774-8900 Kimberly DeWolfe (404) 250-2853

Debbie Dolan (706) 310-0261 Laura Sanders (803) 819-4271

Pathways to the Future: 2001 Joint Fall Conference of the Georgia Tumor Registrars’ and the South Carolina Cancer Registrars Associations

Meeting Registration Form

GA/SC Member Early Bird (before 10/14) Regular (by 11/01) Late (after 11/01) Amount Due

Total Amount Due………………………………………………………………………………………__________

Non-Member Early Bird (before 10/14) Regular (by 11/01) Late (after 11/01) Amount Due

Total Amount Due………………………………………………………………………………………__________

Make check payable to GATRA – Payment must be received no later than November 9th. Registration form must be received by date indicated for registration type.

For more information: Dolores McCord (770) 975-3595

Make check payable to GATRA – Payment must be received no later than November 9^th. Registration form must be received by date indicated for registration type.