CONFERENCE REGISTRATION FORM LYMPHATIC DRAINAGE THERAPY OVERVIEW Friday, September 21st and Saturday, September 22nd, 2018 Best Western Ramkota Rapid City - 2111 N Lacrosse St, Rapid City, SD 57701 NAME ____________________________________________________________________________ ADDRESS_________________________________________________________________________ CITY, STATE, ZIP__________________________________________________________________ PHONE___________________________________________________________________________ EMAIL ADDRESS__________________________________________________________________ EMERGENCY CONTACT INFORMANTION__________________________________________________ Registration Rates: AMTA Member (Member ID # ) ...................................$ 170 First Time Attendee or Student (with Proof) ...............................$ 150 Non-Members .............................................................................$ 200 At the Door ................................................................................Add $ 40 Total Amount Enclosed: $_______________ Check #____________ Make checks payable to: AMTA-SD Send registration and fee to: Amber Rasmussen 8330 Heather Dr. Rapid City, SD 57702-7706 NO CONFIRMATION LETTER WILL BE SENT • 12 CEU Hours • No Shows are non-refundable • 2-party checks are not accepted / Credit Cards accepted through Online Registration • Tables, linens are needed
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