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									Registration Form
10th National Perinatal Outreach Education Conference Building Partnerships for Perinatal Care  August 1—4, 2006 Name: ________________________________________ Credentials: _________________________________ Position / Title: ______________________________________________________________________________ Organization: _______________________________________________________________________________ Mailing Address: ____________________________________________________________________________ City, State, Zip: _____________________________________________________________________________ Phone: _______________________________________ **E-mail: ____________________________________

Conference Fees
(U.S. Funds Only)
Discounted Registration
Postmarked on or before 5/15/2006

 General Conference 
One Day $150 $175 $200 $75 $25 $18 $10

3 Days $295 $345 $395 $75 $25 $18 $10

Small Group Breakout Series A — F Please write in first choice and second choices
1 choice
st

2 choice

nd

Wed. Wed.

A1 B1

A2 B2 C2 D2 E2 F2

A3 B3 C3 D3 E3 F3

A4 B4 C4 D4 E4 F4

______ ______ ______ ______ ______ ______

______ ______ ______ ______ ______ ______

General Registration
Postmarked 5/16/2006 — 6/15/2006

Late Registration
Postmarked 6/16/2006 — 6/30/2006

Thurs. C1 Thurs. D1 Thurs. E1 Thurs. F1

Pre-Conference Registration CME Accreditation Fee Wednesday Evening: Welcome Reception Guest Admission Thursday Evening: Chicago Trolley Bus Tour

(select one only)

Pre-Conference 

 The S.T.A.B.L.E. Cardiac Module with
Kristine Karlsen (includes Cardiac Manual)

 Tools for Trainers with Michelle Deck
 Registration Fees  Full Conference Registration One Day Registration Pre-Conference Tuesday, August 1 CME Credits Welcome Reception Guest Tickets Trolley Tour Tickets Total Registration Fees Enclosed
Special Dietary Needs

Payment, in the form of check or money order, must accompany your registration. Payable to: 10th National Perinatal Outreach Education Conference / POEI
We apologize we are unable to accept credit card payments. **Please ensure an accurate, legible E-mail address is included on registration form for receipt of confirmation materials

 Wednesday, August 2  Thursday, August 3

$ _________ $ _________ $ _________ $ _________ $ _________ $ _________ $ _________

Mail registration form (this page only) to: 10th National Perinatal Outreach Education Conference / Perinatal Outreach Educators of Illinois c/o Lynn Czech 1945 S. Miche Road Pearl City, Illinois 61062

 Vegetarian

 Other:_________________________

Visit us at www.perinataleducators.org for more information

Travel and Accommodations
CONFERENCE LOCATION Wyndham Chicago Hotel 633 North Saint Clair Chicago, Illinois 60611 Wyndham Chicago Hotel is conveniently located in Chicago’s Magnificent Mile, just one block east of Michigan Avenue and within walking distance of many of the sites that our guests enjoy: museums, galleries, restaurants, shopping, and Lake Michigan. The hotel features a fitness facility with whirlpool, steam room, massage, sauna and indoor pool. The hotel is 18 miles from O’Hare International Airport, 16 miles from Midway Airport and 2 miles from Union Train Station.

ROOM RATES: Standard Rooms: $139.00 / night (Conference Code 0801600NOE) A limited block of rooms are being held for conference attendees and their guests at a negotiated special rate. This rate will be in effect for booking – based on room availability. Rates are per room and subject to prevailing state and local taxes. To obtain these reduced rate rooms, you must make your reservation early and before the “hotel room block release date” on 6/30/2006. Rooms may sell out before this date so be sure to make your reservation as soon as possible. After the release date, rooms and group rates may not be available. This rate has been negotiated for rooms booked for any combination of nights between 7/29/2006 and 8/7/2006. BOOKING AND CANCELLATIONS To make your room reservations, call Wyndham Chicago Hotel at (312) 573-0300 or (800) 327-8321 and inform them that you are attending the 10 th National Perinatal Outreach Education Conference. We suggest that you request a confirmation number and written confirmation of your reservation. You must mention Code 0801600NOE to receive this special rate. The first night stay is a required, non refundable charge. For more information go to: www.wyndham.com/groupevents/989NOEC/main.wnt AIRPORT SHUTTLE Wyndham Chicago Hotel recommends airport shuttle arrangements be made with Airport Express, (800) 654-7871 for both O’Hare and Midway travel. Reasonable rates are available. DRIVING DIRECTIONS Maps, directions, travel and parking information are available at: www.wyndham.com/hotels/ORDDT/main.wnt

Registration Information
PRE-CONFERENCE TUITION Pre-Conference sessions are priced independently of regular conference tuition. Tuition includes program syllabus, refreshment break and contact hours. CONFERENCE TUITION Please refer to the registration form for conference fees and discount registration deadlines. Tuition includes conference materials, continental breakfast, lunch, welcoming reception with light refreshments and contact hours. CME accreditation is available for an extra charge. Registration must be accompanied by appropriate payment and may not be shared by individuals. No credit card payments are able to be accepted. REGISTRATION CONFIRMATION Please ensure a legible, accurate E-mail address is included on the registration form. All conference confirmation materials, as well as conference updates and last minute details will be communicated through E-mail. SCHOLARSHIP ASSISTANCE The William Randolph Hearst Endowed Fund for Perinatal and Pediatric Outreach Programs, through The Children’s Hospital in Colorado, is providing four (4) $125.00 registration scholarships. Selection will be determined by financial need. To apply, download an application form from www.perinataleducators.org or request by E-mail: sharyls@uic.edu The completed application form must be received by 4/22/2006 for review. Applicants will be notified of decisions by 5/1/2006 to facilitate meeting the discounted registration fee deadline of 5/15/2006. CANCELLATIONS A refund, minus a $35 administrative fee, will be given for cancellations requested by 06/15/2006. No refunds will be given after this date or for non- attendance, although you may send a substitute. The planning committee reserves the right to alter the agenda or cancel the conference in the event of some unforeseen circumstance. TAX DEDUCTIBILITY Expenses of training, tuition, travel, lodging and meals to improve skills in your profession may be tax deductible. Please consult a tax advisor for more details.

Visit us at www.perinataleducators.org for more information

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