2017 Conference Registration Form
Please fill out the form below. If choosing to mail the form (rather than e-mail), please mail to:
Basking Babies, LLC
5050 NE 38th Ave.
Des Moines, IA 50317
Name ___________________________________________
Address __________________________________________
City, State, Zip ____________________________________
Phone ___________________________________________
Email ____________________________________________
Nursing License # __________________________________
IBCLC #__________________________________________
Other Licenses with numbers to which you would like Continuing Education Credit:
_________________________________________
__________________________________________
REGISTER AND PAY INSTRUCTIONS
Please do one of the following:
Option 1 - Mail this completed form with your payment (cash or check).
Option 2 - E-mail ([email protected]) this completed form and pay by PayPal (link below). When e-mailing, please make "2014 Conference" your subject line and include the email address linked to your PayPal account in the body of the message.
FORM CAN BE DOWNLOADED BELOW.
Please fill out the form below. If choosing to mail the form (rather than e-mail), please mail to:
Basking Babies, LLC
5050 NE 38th Ave.
Des Moines, IA 50317
Name ___________________________________________
Address __________________________________________
City, State, Zip ____________________________________
Phone ___________________________________________
Email ____________________________________________
Nursing License # __________________________________
IBCLC #__________________________________________
Other Licenses with numbers to which you would like Continuing Education Credit:
_________________________________________
__________________________________________
REGISTER AND PAY INSTRUCTIONS
Please do one of the following:
Option 1 - Mail this completed form with your payment (cash or check).
Option 2 - E-mail ([email protected]) this completed form and pay by PayPal (link below). When e-mailing, please make "2014 Conference" your subject line and include the email address linked to your PayPal account in the body of the message.
FORM CAN BE DOWNLOADED BELOW.
| 2014conference.docx |