Texas Team Central Texas Region Legislative Summit Registration

Texas Team Central Texas Legislative Summit at the Texas Capitol

1300 N Congress Austin, TX 78701

Wednesday, October 28th, 2015

9:00am to 12:30pm

Registration & Continental Breakfast

8:00am-8:45am

“Nursing contact hours have been applied for through the Texas Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.”

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* 1. First Name

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* 2. Last Name

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* 3. Home Street Address

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* 4. Home Address City

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* 5. Home Address State

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* 6. Home Address Zip Code

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* 7. Email Address

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* 8. Phone Number

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* 9. Birth Month and Day (MM/DD)

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* 10. Employer

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* 11. Please select all that apply:

Student

Other (please specify)

Texas Team Central Texas Region Legislative Summit Registration

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* 1. First Name

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* 2. Last Name

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* 3. Home Street Address

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* 4. Home Address City

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* 5. Home Address State

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* 6. Home Address Zip Code

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* 7. Email Address

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* 8. Phone Number

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* 9. Birth Month and Day (MM/DD)

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* 10. Employer

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* 11. Please select all that apply:

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* 12. If you are an RN, please enter your RN license #. If you are not an RN, please type "N/A"

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* 13. What is the highest degree you have received?