Conference Registration

Registration Fee

** Save when registering by October 23rd.
Friday snacks and Saturday continental breakfast, lunch, and snacks are included for registered attendees.

Though it was our objective to provide this conference at no cost to individuals and families, due to the short time frame and uncertainty of adequate corporate sponsorship, we have included a registration cost. Do not let this cost keep you away! If the fee is a problem, simply ask for a waiver of fees by clicking the "waiver" box below.

Printable Registration Form

This is a "printable" form for mailing or faxing. To complete your registration online, use the Secure Online Registration Form.

Fax to: 877-368-5081, Attn: Mary Marchand (no cover sheet required)
Or mail to:
Mary Marchand, Advanced Respiratory, 1020 W. County Rd F, St. Paul, MN 55126

Checks should be made payable to Respiratory Resources, Inc. and mailed to the above address. Payments accepted at the door will not receive the discounted rate.

Note: Some browsers do not print what you've typed into the fields. Either print out the blank form or test it first by entering only your name & then clicking to ensure you're not wasting your time entering all the information.
The preferred alternative: Use the Secure Online Registration Form to submit your registration.

First Name: Last Name:

Address:

City:

State: Zip Code:

Country:

Email:

Website:

Phone:

Cell:

Fax:

Diagnosis/Interest:

Affiliation:

Credentials:

Comments
and Special
Accomodations

Type of Registration

Consumer ($25**/$30)*

(Including aide or family member. Includes meals for two.)

Adults attending (including yourself)

Children attending (even if no meals ordered)

TOTAL eating meals
(Meals for two included. Additional: $15/adult, $7.50/child)*

* If fees cause difficulty, please click for a waiver of all fees:

Name(s) of all attending, sex, age, diagnosis (Eg: Josh M 14 DMD):

Respiratory Therapist (6 CEU Track) ($50**/$60)

Optional AARC Membership ($78.50)

Planning to attend optional Friday session (Bonus 7th CEU)

Would like to assist with Individual Respiratory Assessments

Other Healthcare Professional ($35**/$45)

Privacy Notice & Options
We will make every effort to keep your information tightly controlled. Your information will be shared with the "Conference Presenters" (NIVnetwork, Respiratory Resources, and IVUN), and with Advanced Respiratory who is managing our conference registrations.
With your permission (by checking the boxes below), we will also share your information with:
Other conference sponsors
Other companies offering health-related products and services.
Please check: if you are a healthcare professional interested in being listed at no cost on the NIVnetwork referral system. We will contact you at a future date with more information.