To register for any of these programs, complete the form below and  fax to 217-544-3361.

 Name:_________________________________________________________________________

Position/Title:____________________________________________________________________

 License #:______________________________SSN____________________________________

 Institution:______________________________________________________________________

 City/State/Zip:___________________________________________________________________

 Home Address:__________________________________________________________________

 City/State/Zip:___________________________________________________________________

 Phone (H):_______________________________ (W)___________________________________

 E-mail:_________________________________________________________________________

 Master Card Visa American Express

 Card #:________________________________________________________________________      Expiration Date:________________________________

  Pay by check (Please make payable to "Critical Care ED" and mail to Critical Care ED, 206 S. 6th, Springfield, IL 62701 

Select from the following programs:    

____ September 6 & 7, 2007 "12 Lead and Stress Testing" Indianapolis  $260

____ November 14-16 2007 "Order & Disorder in the Cardiac Rhythm-Beyond the Basics" Philadelphia $370 ($385 if 14 days or less before the course)

____ November 27 & 28, 2007 "12 Lead and Stress Testing" St Louis  $260

 Any questions, please contact Linda Moulton at (217) 544-3306 or by e-mail at Lmoulton@cceconsulting.net 

Cancellations:  Cancellations may be faxed in writing. Cancellations received 7 days before the course will receive a full refund.  Cancellations received after this time will be assessed a $20.00 processing fee.  No refunds are given for “no shows” or cancellations received after the conference begins. A $20.00 fee is charged on any returned check. Your check must be received within ten days if you register by phone or fax or your registration may be cancelled.

For questions about any of our courses, call 217-544-3306. These courses and others can be brought to your city or institution.  We can also bring ACLS or CPR to you: Call 217-544-3306 for details.