Maine Society for Respiratory Care
2017 Conference Registration
May 17th & 18th

Please fill out the required information below. 
We will email you an electronic invoice within 72 hrs. 
We accept Visa, MasterCard, American Express, Discover or PayPal.

**Please make sure to check which registration you are signing up for.**

First Name:
Last Name:
Email Address: *
Address Street:
Security Code: *  
Zip Code: (5 digits)
Daytime Phone:
 Place of Employment: *  
   AARC Member 1 Day - $80.00
   AARC Member Day 2 ONLY (1/2 Day) - $50.00
   AARC Member 2 Days - $125.00
   AARC Non Member 1 Day - $180.00
   AARC Non Member Day 2 ONLY (1/2 Day) - $145.00
   AARC Non Member 2 Days - $230.00
   Student - Lunch - $25.00
   Student - NO Lunch - Free
   *** If you are not a member of the AARC, your payment can include a membership. 
In order to process your membership, please fill out the additional parts of this form.
 Date of Birth:  
    Any registrations received after May 5, 2017 will be charged an
extra $10.00 per day, including onsite registrations.

Refund requests must be in writing to and must be
received by the MeSRC by Tuesday, April 30, 2017.
A fee of 35% will be deducted from the refund to cover processing. No refunds will be made after April 30, 2017.

Hotel accommodations are to be made directly with Spruce Point Inn 
88 Grandview Avenue, Boothbay Harbor, Maine, 04538.
207.633.4152 | Reservations 800.553.0289 |

Please mention you are part of the MeSRC 
Conference Block to receive discount pricing. 
Reservations must be made by April 29, 2017 to receive discount

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