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 CANA’s 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 certication/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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