Continuing Nursing Education
at Fox Chase Cancer Center

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For additional inquiries please contact Kathy Smith at Joan.Wagner@fccc.edu.

Hospice and Palliative Care Course (PDF)
April 13-15, 2010
FEE: $370

Title of Event:
Your Name:	Please print name and degree as you would like them to appear on your nametag/certificate.
Degree:
Institution/Affiliation:
Preferred Mailing Address
Street Address:	address
City/State/Zip:
Daytime Phone:
Fax:
Email:
Work Address:	address

REGISTRATION IS REQUIRED ATTENTION FOX CHASE CANCER CENTER EMPLOYEES: After completing the registration information, PRINT the registration form, obtain manager’s signature and mail or fax to 215-214-1695. Manager's Signature: ______________________________ FEE: $370 (Partner hospitals deduct 10% from fee) Click Here to Print This Page before Continuing PAYMENT Send a copy of the registration form with check payable to Fox Chase Cancer Center, Attn: Joan Wagner, Office of CNE, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 Cancellations: Read full cancellation policy at General Information and Hotel link.
Special Needs ADA Requirements: If you require auxiliary aids or services as identified in the Americans with Disabilities Act, please note your needs. (Specify)
Dietary Requirements: