Dorothy & Associates
2190 Morningside Dr. Emporia, KS  66801  620-341—9878
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REGISTER ONLINE

Online Registration Form - Step 1
(Use only if paying by credit card or PayPal)

 

Registrant's Information:
(All fields are required unless noted.)

 
Date of Seminar Attending:

  Location of Seminar You will be Attending:

First Name

  Last Name
  Street Address
  Street Address (Cont.)
  City
  State
  Zip Code
  Address Type Home          Work
  Daytime Telephone
  Evening Telephone
  Your Email Address:
  Occupation:
  Name of Person Submitting Payment:
  *License Number:
  (*Required for nurses in Alabama and Kansas)  

       
For group registrations: Please complete the registration form for the first person. After the form is submitted, you will be given the opportunity to complete additional forms for other registrants.

 

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