EXACTLY AS YOU WANT ATTENDEE'S NAME TO APPEAR ON SEMINAR BADGE (PLEASE CHECK SPELLING) First Name of Attendee Last Name of Attendee Please select one What, if any, license do you hold? CNA CRT LCSW LNHA LPN OT PT RD RDN RN RRT SP Not Applicable Title Email Address OF SEMINAR ATTENDEE Please select one I am directly and actively involved with the healthcare provider under which I registered (e.g. SNF owner/operator, employee, Hospital employee, etc.) I offer products/services to healthcare providers I am directly and actively involved in the non-profit trade association or government agency under which I registered I have a Zimmet pre-approved authorization code to Exhibit I am a conference speaker Other, None of the Above Services Invitation Code
