Registrant InformationRegistrant Information
ATTENDEE E-MAIL (Required. Please—no general company e-mail addresses!) ATTENDEE NAME*
FIRM NAME MEMBERSHIP ID# (must be completed to receive CANA member rate)
ADDRESS CITY STATE/PROVINCE ZIP/POSTAL CODE
TELEPHONE FAX
*If you have others from your company registering for this event, please copy this registration form and have each employee ll out his or her own form. Please contact
CANA Headquarters at 312.245.1077 or info@cremationassociation.org for details.
Event of ChoiceEvent of Choice
o Check made payable to CANA in the Amount of $_________(USD) is enclosed.
o Credit Card: $_________ (USD) o MasterCard o Visa o American Express o Discover
CREDIT CARD# EXPIRATION DATE SECURITY CODE
CARDHOLDER’S NAME
SIGNATURE
Send Payment and Form to:
Checks—mail to CANA, 499 Northgate Parkway, Wheeling, Illinois 60090
Credit Cards—mail to above address, email to info@CremationAssociation.org or fax to 312.321.4098.
PaymentPayment
Visit www.CremationAssociation.org for details.Visit www.CremationAssociation.org for details.
For an up-to-date listing of CANAs upcoming COCP events, please visit our website at www.GoCANA.org.
o In person class
EVENT LOCATION/CITY/STATE EVENT DATE
Online class (before registering, please verify that your state accepts certication/CE credit for the online version of the CANA COCP)
o
Online COCP class o Online COCP plus Alkaline Hydrolysis class
Please select the appropriate course rate below.
o
$495 CANA Member o $595 Non-Member o $195 Student with proof of enrollment in funeral service/mortuary science program
Note: Join CANA now and $100 will be applied toward your annual membership dues. Download a CANA membership application from the CANA
website, complete it, and return it with this registration form and payment.
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