BEST PRACTICES IN LEAN & SIX SIGMA APPLIED TO HEALTHCARE REGISTRATION FORM


Monday, October 24, 2011 | Children’s Medical Center at Legacy - Plano | Dallas, TX THROUGH


OCTOBER 14


IIE MEMBER NON-MEMBER DALLAS CHAPTER


CHILDREN’S MEDICAL CENTER - ASSOCIATE


STUDENT MEMBER STUDENT NON-MEMBER


A team discount does not apply.


CHILDREN’S MEDICAL CENTER-ASSOCIATE – Enter the code for the discounted rate: ____________ DALLAS CHAPTER - Enter the code for discounted rate: _______________


REGISTER ONLINE AND SAVE TIME www.iienet.org/LSSHealthcare


Please complete: Mr. Mrs. Ms. Dr.


Last/Surname First: Preferred fi rst name on badge: Title: Company: Address: City:


Country: Please check one: Phone:


Company address Fax:


Email: Yes, I require special assistance services. Email your request to cs@iienet.org.


Method of Payment: (Conference fees are due in full at registration in U.S. currency only.) Check – made payable to IIE


A check for $


Credit card – Please charge $ Visa


MasterCard Credit card #


Signature: Name of cardholder (print):


Cancellations and Substitutions: Cancellations must be made in writing and faxed to (770) 263-8532 or mailed to IIE, 3577 Parkway Lane, Suite 200, Norcross, GA 30092. See website for deadline for refund. Contact customer service at cs@iienet.org or (770) 449-0460x102 or (800) 494-0460.


WWW.IIENET.ORG/LSSHEALTHCARE | 9 is enclosed. Check # to my: American Express Exp. Date:


$249 $399 $149


$149


$49 $99


ON-SITE AFTER OCTOBER 14


$399 $549 $299


$299


$49 $99


State/Prov Zip: Home address


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