2023 Symposium Series Registration

2023 Symposium Series

Registration form
Programs
- Thursday, October 12, 2023
  - Recognizing Risk and SAfety Behind the Wheel
  - 9:30 am - 1:00 PM
  - Hybrid
    
    Community Health and Wellness Center, Saint Paul or via Teams
    
    45 W 10th Street, St Paul
* Details may change as the Education Commitee partners with speakers and other subject matter experts to bring you quality programming.
Details
Please review our health and safety guidelines for attending in-person symposiums prior to submitting your registration.

Fee Schedule
- Individual Symposiums:
  - $35 for FCNs (MN)
  - $45 for FCNs (Outside of MN)
  - $50 for all non-FCNs
  - $15 for nursing students
- Full Symposium Series:
  - $120 for FCNs (MN)
  - $150 for FCNs (Outside of MN)
  - $180 for all non-FCNs
  - $55 for nursing students
- Registrations received within 5 days of event will be assessed a $5 late registration fee
- Refunds are not provided.
Contact Hours
- Each symposium will be awarded 3 contact hours for State Boards of Nursing.
- This activity has been designed to meet the Minnesota Board of Nursing continuing education requirements. However, participants are responsible for determining whether this activity meets the requirements for acceptable continuing education credit.
Schedule
- Each program begins at 9:30 AM (check-in opens at 9:00 AM)
- Registration closes 48 hours prior to the program start time.
- Virtual programs include an additional 15 minutes for attendees to talk with program sponsors
- For virtual programs, registrants will receive an email with the agenda, handouts, and Zoom link in the week leading up to the program.
Contact Information
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number*
E-mail Address*
Are you a faith community nurse?*

Yes, I am an FCN practicing in MinnesotaYes, I am an FCN in a state other than Minnesota.No, I am not an FCNNo, I am a nursing student
Please tell us about your FCN practice:

I am an active FCNI am not currently practicing as an FCNI am a retired FCN
I would like to learn more about becoming a faith community nurse
Faith Community / Organization Information
Name of Organization/Faith Community*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Denomination
Additional Information
How did you hear about this offering?*
If other, please specify:
Payment
FULL SERIES

FCN rate: $120 (MN)FCN rate: $150 (Outside of MN)Non-FCN rate: $155Nursing student rate: $55Add lunch to June and October: $30
June 15: Gender Identity

FCN rate: $35 (MN)FCN rate: $45 (Outside of MN)Non-FCN rate: $45Nursing student rate: $15In- person, Add lunch: $15In-person, No lunch: $0PHS/Fairview/Lyngblomsten (for office use only)
October 12: TBD

FCN rate: $35 (MN)FCN rate: $45 (Outside of MN)Non-FCN rate: $45Nursing student rate: $15Add Lunch: $15PHS/Fairview/Lyngblomsten (for office use only)
Subtotal
Total Due
Total Due (Complete payment after clicking "submit")

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USDDescription
Will you be attending the Symposium in person?

YesNo
Would you like a lunch?

YesNoOther
We will be staying for the program following the symposium to honor Jessica? (Dessert will be served)

YesNo
Do you wish to leave a note for Jessica, if you are unable to attend the program?
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