Registration Form s21

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Registration Form s21

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r e Crucial Confrontation®! Seminar Fees (Please select Only One) & AACN Members: Member Number: ______Join Region 12 &15 for ___ $40.00 Crucial Conversation only ___ $40.00 Crucial Confrontations only Chapter Collaboration ___ $75.00 Both Sessions

Non-member: ___ $50.00 Crucial Conversations only ___ $50.00 Crucial Confrontations only ___ $90.00 Both Sessions

Students (undergraduates only – must have ID) ___ $30.00 Crucial Conversations only ___ $30.00 Crucial Confrontations only ___ $50.00 Both Sessions Holiday Inn Select Regional Collaborative Evening Event Friday, November 14, 2008 5701 South Broadway 6:00pm-12:00pm Tyler, Texas ___ $40.00 Collaborative Night of Fun

Registration Deadline: November 1, 2008 November 14, 2008 No refunds after deadline Chapter Collaborative Make checks payable to GET-AACN and return November 15, 2008 this completed form to: GET-AACN Crucial Conversations and P.O. Box 131685 Tyler, Texas 75713-1685 Confrontations Course Description: Event Schedule: November 15, 2008 Crucial Conversations® Training drives AM Session Accreditation: results by learning to speak with complete Crucial Conversations Trinity Mother Frances Health System provides 3.5 candor and respect, no matter the issues or contact hours per session for completion of this 7:30-8:00 am Registration educational activity. the individuals involved. Create alignment, Trinity Mother Frances Health System is an approved resolve disagreements, surface the best ideas, 8:00-11:30 am Presentation provider of continuing nursing education by the Texas and make decisions with unity and Breakfast is provided Nurses Association, an accredited approver by the conviction. American Nurses Credentialing Center's Commission on Accreditation. Crucial Confrontations™ Training ensures PM Session: This activity meets Type I criteria for mandatory Crucial Confrontations continuing education requirements toward relicensure flawless execution with a step-by-step as established by the Board of Nurse Examiners for the process for improving accountability and 11:00-11:30 am Registration State of Texas. addressing performance gaps. Achieve the 12:30-3:30 pm Presentation results you want by learning to motivate Speaker: Hayden M. Hayden without using power and to enable without Lunch is provided Hayden M. Hayden has more than 28 years of taking over. experience in corporate management and team Tuition: building and understands first hand the conflict Tuition includes beverage breaks, breakfast management and communication challenges that with AM Session OR lunch with PM session, businesses face. Hayden is a Master Certified CEU certificate. No confirmation letters will Trainer in both Crucial Conversations® and be sent to registrants. Crucial Confrontations® and is passionate about working with teams using a Crucial Conversation The display of merchandise or the giving of free lab format. materials does not constitute endorsement by Mother Frances Hospital or the American Nurses Credentialing Center’s Commission on Accreditation (ANCC) or the American Association of Critical Care Hotel Accommodations: Nurses (AACN) Holiday Inn Select 5701 South Broadway Regional 12 & 15 Collaborative Event Tyler, Texas Event Schedule: November 14, 2008 (903) 561-5800 Registration starts at 5:30 pm For your convenience a block of rooms have been reserved at the above hotel which 6:00-6:45pm AACN Board Update includes special pricing. DON’T delay, Regional 12 & 15 Collaborative Meeting Julie Miller, RN, BSN, CCRN Come enjoy an evening of network and fun Director American Association of Critical reserve your room today! with Region 12 & 15 members. Enjoy an Care Nurses 6:45-7:30 pm Region 15 Advisor Update evening of information from Region 15 local Jamai Freeman, RN, CCRN AACN Board member & Region 15 Chapter Chapter Advisor – Region 15 Questions call Merci at 903 531 8849, Advisor. Plan to stick around for the 7:30-8:30 pm Chapters Share Best Shelly at 903-520-6415, or Seleria at entertainment filled night with a live band! Practices 903-531-5879. 8:30-11:30 pm Fun & Entertainment

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