Registration Form

“ANOTHER APRIL IN ASHEVILLE”

CAROLINAS CLINICAL CONNECTION 2010

CROWNE PLAZA HOTEL ASHEVILLE, NORTH CAROLINA

APRIL 21-23, 2010

 Name___________________________________________________    Phone _________________________

 

 Home Address__________________________________________  State_______     Zip ____________

 

 Employer_______________________________          Email address (Print) _____________________________

 

Organizational Membership (Circle all current memberships that apply to you)

 

NCSCLS       NCSSAMT      SCSCLS     SCSSAMT      NCABB       AACC-NC      Student   CLMA/Pee Dee chapter

 

Important: Use the Program brochure or the At A Glance to circle the number of breakout sessions that you will most likely attend at CCC 2010. Your choices will assist us in assigning appropriate size rooms for each session. Note: The three general sessions (#1, 14 and 27) will be held in the Expo Center.

 

Wednesday     2          3           4           5            6          7

          

Thursday         8          9           10         11         12        13       15      16       17      18      19       20

         

Friday            21        22         23         24         25        26 

 

Are you willing to moderate a session? ___ Yes  ____ No

Registration fees: Full registration includes all sessions, exhibits, vendor reception on Wednesday, breakfast Thursday and Friday, lunch on Thursday and all breaks. Deadline for registration is March 29.  After that date a $20 late fee will be added.  On site registration will include lunch subject to availability.

 

Full Conference (Members)                        $150.00       _______

Full Conference (non-members)               $180.00       _______

 

Institutional Passes $300.00         ______  (allows 2 people to attend at any given time. Lunch on Thursday is not

                                                                               included. Institutional badges will be held at the registration desk)

 

LaZoom Shuttle Bus ticket $10     ______ (round-trip bus to downtown Asheville restaurants. Join colleagues &

                                                                             friends for a night on the town without the hassle of driving or parking)

Day Passes:

Wednesday              $50.00              ______   (includes vendor reception)

Thursday               $125.00              ______   (includes breakfast and lunch)  

Friday                     $50.00              ______   (includes breakfast)

 

Student (member) $20.00             ______    with Thursday buffet lunch $30    _______

Student (non-member) $25.00     ______    with Thursday buffet lunch $35    _______    

                                                                                                              Total amount enclosed $___________

Make Check or Money Order payable to:   CCC 2010    (No Credit Cards Accepted)

Mail to:                Judy Smith

                            201 Bluff Street

                            Mount Airy, NC 27030   

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HOTEL INFORMATION and GPS address:

Crowne Plaza Tennis and Golf Resort

One Resort Drive

Asheville, NC 28806

Reserve your room on-line at www.ashevillecp.com. Use the group code of CAC to get the conference rates ($115 per night for a King or two double beds) or phone toll free at 800-733-3211. The local number is 828-254-3211. Call for conference prices for King Executive and Villa Suites.  Reservations must be made by Monday, March 29, 2010 to guarantee conference rates.  Late reservations are subject to space availability and rate increase. Extending your stay is possible, at conference rates, on a space available basis.