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FPIC 41st Conference
2016 Registration
September 21 - 23, 2016 

Emily Appleton

Email 2016 Registrar

​Phone #386-424-5185
FLORIDA PROFESSIONALS IN INFECTION PREVENTION

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    Closed Aug 12, 2016
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 advanced or regular registration.
2) I plan to pay by Check.  Please make check payable to FPIC. Check must be received prior to stipulated date to qualify for advanced or regular registration.
Do not mail payment after September 9, 2016.

        Mail check payable to FPIC to: 
           FPIC Registrar
           Emily Appleton
           
REFUND POLICY
  • All cancellations will be charged a $25 processing fee.
  • PayPal transactions will be refunded via Check.
  • No refunds for cancellations after September 9, 2016
TWO DAY ATTENDANCE
REQUIRED INFORMATION BELOW:

Name as you wish it to appear on Badge:
Credentials as you wish it to appear on Badge:
Orlando Airport Marriott
7499 Augusta National Dr
Orlando, FL  32822

Simple process for those attendees paying by check:

1) Online registration is required PRIOR to mailing payment. 

2) Select "By Check" under Conference Payment Options

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

(Mailed application
 is no longer required.)

4) Mail check to:
68 W Bay Drive
Cocoa Beach, FL 32931

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:
YESNO
na$345.00$300.00
na$395.00$350.00
na$140.00$125.00
na$280.00$250.00
Yes
No
Disabled na
Vegetarian na
Gluten Freena
Online
By Check