A/A SANE Registration

Where the healing begins.

Pediatric

Sexual Assault Nurse Examiner Course

Next Course Date

To Be Announced

Click Here for Course & Registration Information

Adolescent / Adult Sexual Assault

Nurse Examiner Course

Next Course Date

To Be Announced

Click Here for Course and Registration Information

Adolescent / Adult SANE Course Registration

	Your registration form must be filled out completely to be processed.
	For medical participants, payment of $600 must be sent at the time of registration unless prior arrangements are made with conference coordinator. Non-medical participant tuition is $300.
	Class size is limited, register early. Class may fill prior to registration deadline. Incomplete registrations not accepted.
	Please make your own hotel reservations.
	Registration deadline for the class is September 6, 2010. For those RN's who have already attended a full SANE Course, the FWSATC will open Tuesday, September 14 and Wednesday, September 15, as a refresher. Cost is $200.00. Attach copy of original course certificate with registration.

For more information, call (260) 423-2222 or fax (260) 423-2220.

Registration Information

	Make checks payable to the Fort Wayne Sexual Assault Treatment Center.
	Tuition is $600.00 for a 5 day course. Registered Nurses must complete the 5-day course.
	Registration must include full payment to be accepted.
	Tuition fee is non–refundable. No exceptions
	Training registrations may be transferred to another person without penalty after notifying the Registration Coordinator.

Registration Requirements

	Current licensure to practice as a Registered Nurse must be in good standing. License number should be provided at time of registration.
	Course materials will be provided to those participants who are registered and attend the conference.
	Registrations will not be processed without payment unless special arrangements are made with conference coordinator.
	Registrations are processed on a first come, first served basis.

Cancellation Policy

All cancellations must be received in writing. If received before September 6, 2010, a $525.00 refund will be returned. The $75.00 application fee is non-refundable. Any cancellation after September 6, 2010 will not receive a refund for any reason, as tuition is dedicated to the production of this event. The Fort Wayne Sexual Assault Treatment Center reserves the right to cancel the course.

Click here for Adolescent / Adult SANE Course Logistics

TO REGISTER ONLINE WITH A CREDIT CARD COMPLETE THE FOLLOWING STEPS:
1. Complete this registration form for each attendee:
Attendee Information
First Name:		Last Name:
Title:		Organization:
Address:		City:
State/Province:		Country:
Postal Code:		Phone Number:
Fax Number:		Email Address:
RN License #:		Course

2. Complete this checkout process to complete the credit card payment process.

Conference or Course Fee

Registration and payment can be completed by mail by following the following step:

1. Include the following information:

	First Name, Last Name and Title
	Address including city, state and zip code
	Phone number, fax number and e-mail address
	RN license number
	Course title

2. Mail above information to:

Sharon Robison, CAO

Fort Wayne Sexual Assault Treatment Center

2270 Lake Avenue, Suite 201

Fort Wayne, IN 46805

Fort Wayne Sexual Assault Treatment Center

2270 Lake Avenue, Suite 201

Fort Wayne, IN 46805

Phone: (260) 423-2222 Emergency: (260) 430-0369 Fax: (260) 423-2220 E-Mail: ftwsatc@verizon.net