HNS Ethics Workshop
Coffee, teas, juices, and breakfast are included in the registration
fee. Registration deadline is Monday, November 7th. If email addresses are provided,
registrations will be confirmed via email. If you plan to register on-site,
contact Jennie Rexer, Ph.D., at least 24 hours in advance (JennieRexer@aol.com, or (713) 799-2818, to
confirm program status and space availability.
NAME: _______________________________________________________________
Last First MI Degree/Licensure
ADDRESS: _______________________________ CITY: _________________
STATE: _______________________________ ZIP
CODE: _________________
PHONE: _______________________________
Area code, phone / Area code, fax
EMAIL: _______________________________
Registration Fees (please indicate):
$75.00 Registration Fee (up to Monday, November 7,
2005)
$85.00
Registration Fee (after Monday, November 7, 2005)
Please
make checks payable to the Houston
Neuropsychological Society and mail registration form and payment to:
HNS Ethics Workshop
C/O Jennie Rexer, Ph.D.
7707 Fannin
Please check here if special assistance is
needed
Cancellation / Refund Policy
The Houston Neuropsychological Society (HNS)
reserves the right to cancel this workshop not less than 5 working days prior
to the scheduled program date, if unforeseen circumstances make this necessary.
Should this occur, registration fees paid will be refunded in full, though HNS
is not responsible for any other costs incurred such as airline, car rental, or
hotel charges, including penalties.