Registration fee of $120 includes: Workshop materials, continental breakfast,
lunch, afternoon snack, and Certificate of Continuing Education.

Include a $10 late fee with registrations submitted after April 1

Registrant

Name:
Title or Degree:
Address:
City:State:Zipcode
Email Address:
Phone #:

Employer or School:

I am (check all that apply):

La Leche League Leader
RN
IBCLC
BSN
RNC
LPN
RD
MD
Other (specify):

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Please indicate here if you or persons in your party have a disability that may require accomodation.
Please indicate your need:

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Please enter the amount you owe in the "Total" column (No $ sign, just the number.) Once you select the Confirm / Pay button, your total will be displayed and you will then have the opportunity to confirm and pay or cancel and return.

Basic Registration	Cost:	Total:
Conference Registration	$120
LLL Leader	$72
LLL Membership	$36
Late fee after April 1	$10

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