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1st Annual Phoenix Conference

Extending Life
Setting the Agenda for the Ethics of Aging, Death, and Immortality

CONFERENCE March 6-8, 2008
PRECONFERNCE INSTITUTES March 3-6, 2008
LOCATION The Grace Inn Conference Center, Phoenix, Arizona

There are four ways to register:

  1. Complete the secure online form below.

  2. Call 888.246.3844

  3. Fax 847.317.8101

  4. Or mail the registration form below to:
    The Center for Bioethics & Human Dignity
    Arizona Bioethics Conference
    2065 Half Day Road
    Deerfield, IL 60015 USA


PERSONAL INFORMATION
Dr. Rev. Mr. Ms. Mrs.
Name:
Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Home Phone:
Work Phone:
Fax:
Email:
Occupation: Physician Nurse Clergy Attorney Educator
Social Worker Student (where)
Other
Name and Organization (As it will appear on badge):
Special Needs:
How did you hear about the conference?
If other, please explain:
What most influenced your decision to attend?
   
MEMBERSHIP DISCOUNT
Non-Members can sign up here for a membership in CBHD and receive applicable $30 discount.
        Sign me up for a CBHD Membership! ($75) (Click here for more details about membership.)

Please read carefully and check all that apply.

Debate | Conference Only | Institutes | Keynote Dinner | CME Credit | Academic Fee
A. Debate (Free and open to the public)
Please reserve a seat for me. (Reserved seats will be released 15 min. prior to the debate.)
B. Conference Only (For academic credit, see section F.)
 
$339 Member*
$369 Non-Member
$414 Save $30! Conference + CBHD Membership
     *Membership to CBHD, CMDA, & CLS
C. Institutes (Conference Included. For academic credit, see section F.)
 
Indicate Choice of Institute (Non-Credit):
Intensive Bioethics Institute
Advanced Bioethics Institute

$719 Member*: 4 days plus conference
$749 Non-Member: 4 days plus conference
$794 Save $30! Institute + CBHD Membership: 4 days plus conference
     *Membership to CBHD, CMDA, & CLS
D. Keynote Dinner (March 7, 2008)
 

$   75 / person   Names of people attending:

$700 / *table     Table(s) Should be reserved for:

* There are ten places per table

Meal Options for Keynote Dinner

Please indicate your dinner plate selection(s) as well as the number needed.

Chicken Prosciuto 
     
Salmon with Lobster Sauce 
     
Filet Mignon 
       
Vegetable Napoleon 
     

E. CME Credit for Physicians and Physician Assistants
 
$60 Conference: 11.25 Category 1 CE Units
 $165 Institute and Conference: 32.25 Category 1 CE Units
F. Academic Credit Fees
 

If you desire academic credit now or at some point in the future, you must register for academic credit before the events. Academic credit cannot be earned by signing up after the event. You need not already be in a degree program. Academic credit is awarded by Trinity International University and is transferable to other institutions.

Trinity’s bioethics program does not require students to relocate. Academic credit can be applied later to future degree programs. For further information, call 888.246.3844.

PLEASE SEND MORE INFORMATION ON:
Intensive Bioethics Institute
Advanced Bioethics Institute
Undergraduate Credit Options
 MA Bioethics Degree Program (can be completed from your home location)
Graduate Credit Options (Call toll free 888.246.3844)
METHOD OF PAYMENT
TOTAL CHARGE
(Total of A-E) 		$                                            
Credit Card (check one): Visa MasterCard Discover
Cardholder's Name:
Account Number:
Expiration Date:
Credit Card Billing Zip Code:  

Refund Policy: Cancellations by February 1, 2008 will receive a full refund. Cancellations after February 15, 2008 will be subject to a $40.00 processing fee. Cancellations after February 15, 2008 will receive a 50% refund. No refunds after February 22, 2008.