June 27, 2017
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LAC Nurse Leader Institute Registration

Please complete the entire registration, including the section relating to demographic information.

Pay with Credit Card
For payment with a credit card we will follow-up your submitted registration with a secure web
link to make the payment.
Pay with Check
If you prefer to pay by check, you may send a check to the following:
  Louisiana Nurses Foundation
  Reference Nurse Leader Institute
  5713 Superior Drive
  Suite A-6
  Baton Rouge, LA 70816-8015

  Note: The Louisiana Nurses Foundation is the fiscal agent for the Louisiana Action Coalition.

Hotel accommodations
Hotel accommodations at special rates are available at the Embassy Suites in Baton Rouge.

As part of the Future of Nursing: Campaign for Action leadership initiative, we are collecting
demographic data for the Nurse Leaders Institute. Respondent's anonymity will be maintained,
and all reports will consist of aggregated data. Please complete the questions below to help us
meet our commitment to the Campaign.

Enter the code shown above in the box below