What Every LTC Leader Needs to Know About MDS 3.0!

Facility/Company: _____________________________________________________

Cell: ________________________________________________________________

Street: _______________________________________________________________

City/State/ZIP:_________________________________________________________

Phone: (____)_______________________; Fax: (____) ________________________

E-mail: ______________________________________________________________

1st Name: _________________________________ Title: ______________________

2nd Name: _________________________________ Title: _____________________

3rd Name: _________________________________ Title: ______________________

4th Name: _________________________________ Title: ______________________
 

Select one of these 2010 locations and dates: 1. ❑ Tuesday, June 29 – Orlando;
2. ❑ Wednesday, June 30 – Tampa Bay; 3. ❑ Thursday,July 1 – Fort Lauderdale;
4. ❑ Tuesday, August 3 – Jacksonville; 5. ❑ Thursday, August 5 – Tallahassee;
6. ❑ Friday, August 6 – Pensacola

Registration Fee: The fee for non-members is $125/first registrant and
$95 for each additional person from the same facility. FADONA members pay
$95/first registrant and $75 for each additional person from the same facility.

Mail payment to FADONA at 200 Butler St., Suite 305, West Palm Beach, FL 33407.
Indicate that registration is for the MDS 3.0 Intensive.

Onsite Registration: Cash, check or money order payable to FADONA will be accepted
at the door (no credit cards or check cards); however, add $25 per person, to all categories,
for all onsite registrations.

 
                                                                              Total Amount Enclosed $_____________