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FPIC 42nd Conference
2017 Registration
September 13 - 15, 2017 
Rhonda Marples

Email 2017 Registrar

​Phone- 772-581-2074
FLORIDA PROFESSIONALS IN INFECTION CONTROL

Last Name:
First Name:
Email Address:
Required for Handouts Access Passwords
Address:
City:
State:
ZIP:
Company / Employer:
Business Address:
City:
State:
ZIP:
Phone #
FAX #
Area of Practice:
CIC Certified?
If Yes, Expiration Year:
FL License #:
Discipline:
PLEASE ENTER LICENSE # FOR CEU CREDITS
FPIC Conference Attendance Options
Please select your preference
FPIC Tax ID 59-2079842

   Special Needs:
   Meal Request:
   FPIC Member Cost Qualifications
  • Member dues paid by June 1st
  • ONE discounted member registration per institutional membership.
  • Must provide FPIC Member #
FULL CONFERENCE:    Wednesday - Friday

Advance Registration    Closes Aug 11, 2017
Regular Registration       

Non            Member
Member:    Cost:
ONE DAY ATTENDANCE   No 'pay by date' discounts available. 
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FPIC Member ?
Total Registration Fee:
FPIC Conference Payment Options. Select one:
1) I will pay online by Credit Card via secure PayPal link.
Note: Payment to be completed prior to stipulated date to qualify for advance registration pricing.
2) I plan to pay by Check.  Please make check payable to FPIC. Check must be received prior to stipulated date to qualify for advance registration pricing.
Do not mail payment after August 30, 2017.

        Mail check payable to FPIC to: 
           FPIC Registrar
           Rhonda Marples

REFUND POLICY
  • All cancellations will be charged a $25 processing fee.
  • PayPal transactions will be refunded via Check.
  • No refunds for cancellations after September 1, 2017
TWO DAY ATTENDANCE
REQUIRED INFORMATION BELOW:

Name as you wish it to appear on Badge:
Credentials as you wish it to appear on Badge:
Hyatt Regency Orlando International Airport
9300 Jeff Fuqua Boulevard  
Orlando, FL 32827
Phone: 407-825-1234

Simple process for those attendees paying by check:

1) Online registration is required PRIOR to mailing payment. 

2) See instructions for mailing check when applicable (not paying by PayPal).

3) Ensure your name is on the check before mailing.

(Mailed application
 is no longer required.)

4) Mail check to:
​Rhonda Marples
1395 River Ridge Drive
Vero Beach, FL 32963


We encourage you to contact FPIC's Conference Registrar with any questions:
No more need to 
print or fax
Pay online now by link below:
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na$345.00$300.00
na$395.00$350.00
na$140.00$125.00
na$280.00$250.00
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Disabled na
Vegetarian na
Gluten Freena