Registration Form for the APHON Chemotherapy/Biotherapy Course

September 26 -27, 2022

The APHON course spans two (2) days and runs from 8 a.m. through 4:30 p.m. both days.

Your Information

Course & Cost Center Info

Name*

First Name

Last Name

Address (home)*

Address Line 1

Address Line 2

City

State

ZIP Code

Facility Name*

Work E-mail*

Home E-mail*

Preferred Phone Number*

RN License Number*

RN License State*

APHON Member Number (if applicable)

Select Course Date

Course Date*

September 26 - 27

Registration Fee/Payment Information

Registration Fee $

Fee covers cost of the book, CEs and instructor time

Name as it appears on credit card*

Credit Card*

COVID-19 Protocols: For the safety of our patients, families and employees, Lurie Children's has visitor COVID-19 protocols that you will be required to comply with. This includes masking at all times and proof of vaccination. Any symptomatic persons are unable to attend. You will be required to complete a screening form the morning of each day that you attend. A link to the screening form will be included in your confirmation email.