Excellence of Caring in Nursing Awards Dinner Registration Form

Reservation & fee required by March 10, 2008
Please feel free to copy reservation forms as needed.
Return to : Centennial AHEC
4650 West 20th Street, Suite A, Greeley, CO 80634
Fax: 970-330-3698
Name of Nightingale or LPN Nominee (No Charge) ___________________________________________________

Choice of Entrée___________________________________________________

Please make dinner reservations at: $39 per person
Please choose one entrée: Chicken Marsala, Salmon Filet in Lobster Sauce, Vegetable Wellington

Name #1___________________________________________________

Ph. # _____________

Choice of Entrée ___________________________________________________