IV Venipuncture Certification Registration Form		   

The seminar fee is $299.00 which includes a continental 
breakfast and lunch but NOT PARKING. 

Early Bird Special: $250.00 
(payment must be received by October 1st)

Payment by cash, check or money order 
NO credit or debit cards will be accepted. 

Mail this form with a check made payable to:		   DO NOT
MAIL CASH
Perivascular Nurse Consultants
8013 Bingham Street
Philadelphia, PA 19111-1503

All Checks must be received by   October 9, 2015

				Please Print Clearly 

Name: ______________________________________

Address: _______________________________________

City ___________________	State _____	Zip _________

Phone _____________		Email ________________________

For more information or questions:
call us at  215-742-9833  or email us at  pncnurse@aol.com