Healthy Children's Courses and Conferences

Registration Form

First Name:^*
Middle Initial:
Last Name:^*
Organization:

Type of Address^*
PO Box / Mail Stop:
Primary Address:^*
City:^*
State:^*
Zip:^*
Country:
Phone 1:^*	ext.
Phone 2:	ext.
Email:^*
Fax:

Continuing Education Credit

RN License #:
RN License State:
ALPP CLC #:
IBCLC #:
IBCLC Exam Year:

Registration Information

Location:^*

Course Tuition

Regular Tuition (per person)
$375 (US)	Regular Tuition
$355 (US)	Early Bird ^**
Group / Agency Rate Tuition^***
$350 (US)	Regular Tuition
$330 (US)	Early Bird ^**
Agency:

** Early Bird: An early registration discount of is available if your check or credit card information is received 4 weeks (28 days) prior to the beginning of the training.

Online courses are not eligible for Early Bird pricing.

*** A group discount is available when 4 or more people from the same agency register and identify themselves as part of that agency. The group must be identified at the time of registration. Group discounts will not be given retroactively.

Textbook

Maternal and Infant Assessment for Breastfeeding and Human Lactation: A Guide for the Practitioner 3rd Edition (2021). This textbook can be purchased as you register or through this web page.

$60.75(US)	Maternal and Infant Assessment for Breastfeeding and Human Lactation: A Guide for the Practitioner 3rd Edition (2021) (for Online Course incl. Shipping)
$0 (US)	No Book

Notes

Payment Information

We are unable to hold a place for you without payment or a purchase order number.
If you are paying by credit card, please provide the address and information
associated with the credit card.

My Billing information is the same as above

First Name:^*
Last Name:^*
Organization:
Address:^*
City:^*
State:^*
Zip:^*
Billing Phone:^*	ext.
Email:^*
Payment Type^*
Credit Card #^*
Exp (MM/YY)^*
Verification #^*
PO#^*

$25 per person surcharge for POs / bill your agency

***The verification # is the 3 digit number on the back of your MC/VISA/Discover, or 4 digit number on the front of your AmEx.

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