TSRC CONVENTION & EXHIBITION
June 17th and 18th

(Please Print)
AARC / TSS Number: ________________ Name: _____________________________________

EMAIL Address (required): _______________________________________________________

Address: _____________________________________________________________________

City / State / Zip: _______________________________________________________________

Phone Number: ________________________________________________________________

Please circle one: RT Manager    RT Staff   RT Home Care  RT Student   Polysomnography    RN

Registration cost:         AARC/TSS Member/RN:       Non Member:    AARC Student Member:  

Early 2 Day Registration:         $150.00                        $210.00                  $60.00
(By March 15th)

2 Day Registration:                $160.00                     $220.00             $65.00

Single day Registration:           $90.00                          $115.00                 $35.00

Circle Day:                             Thursday                              Friday
(Nurses will receive less continuing education credits than RT’s)

Retired Respiratory Therapist
$90.00 – 2 days (Must show documentation of retired RT license)
Active Duty Military
$90.00 – 2 days (Must show documentation of military status)
_____________________________________________________________________________
Late Registration Fee (After April 26th, 2010)
$60.00

Pre-registration Deadline Postmarked no Later than April 26th, 2010.
If wishing to pay by credit card, please contact Kim at the below Email

Make Checks / Money Orders Payable to:
TSRC
ATTN: Kim Kermeen
Respiratory Care
SRMC
PO Box 1558
Gallatin, TN 37066
615-328-6653
kim.kermeen@sumner.org