2022 Northeast Virtual SIM Conference: PO/Check Registration Form

Please fill out and return this form to

Mail to: KUCRL, Attn: Orders

1122 W Campus Road

Lawrence, KS  66045

Email: orderkucrl@ku.edu  |  Fax #: (785)-864-5728

Name(s) of Attendee(s):

Email Address(es):

Phone Number:

Address: 

Payment includes (per person pricing):

Qty

           $375 Registration(s) by Purchase Order (PO#):                          

Please include a signed copy of the purchase order with this registration form.

           $375 Registration(s) by Check (Check#):                          

Please mail your check with this registration form.

For Registration by Credit Card please visit our online store or call our order desk, 785-864-4780, with your credit card information between 9 am and 4 pm CST.

Refund Policy: 

If you find you are not able to attend the class, notify KUCRL by May 16, 2022 for a refund of your registration minus a $25 cancellation fee.  

For questions regarding registration, please contact simpd@ku.edu, 785-864-0626. For questions regarding payment, contact orderkucrl@ku.edu, 785-864-4780.