Ped SANE Registration

Pediatric SANE Registration

Treatment Center reserves the right to cancel the course.

Pediatric SANE Registration

	Your registration form must be filled out completely to be processed.
	Payment of $700.00 must be sent at the time of registration unless prior arrangements are made with conference coordinator.
	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 November 1, 2010.

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 $700.00 for a 5-day course. Registered Nurses must complete the 5-day course.
	Tuition for non-medical participants such as victim advocates, prosecutors, and law enforcement officers is $350.
	Tuition is $140.00 daily for disciplines that choose to attend on a daily basis.
	Registration must include full payment to be accepted.
	Registrations must be received by November 1, 2010.
	Tuition fee is non–refundable, no exceptions.
	Training registrations may be transferred to another person without penalty, after notifying the Registration Coordinator.
	Your preceptor letter and copy of SANE certificate must be sent with your registration.

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 November 1, 2010, a $625.00 refund will be returned. The $75.00 application fee is non-refundable. Any cancellation after November 1, 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 information About a SANE Certificate

Click here for Pediatric 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