Registration – Fountain National Academy

Name(Required)

First Last

Current Date(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Main Contact Work Phone(Required)

Main Contact Cell Phone(Required)

Employer Name

Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Website

Employer Phone

Employer Fax

Please check the proper category

Catetory 1 - I am licensed or a qualified embalmer in the states listed

I am an apprentice embalmer in the state or country of:

I am a Mortuary Science Student currently enrolled at:

State/Country Where Licensed(Required)

Number of Years You've Been Qualified(Required)

License Number(Required)

Please lists state or country:(Required)

Please list the name of the school where you are enrolled:(Required)

Please Note: Mortuary Science Students must provide a letter from school or photo ID that acknowledges enrollment in an accredited Morturary Science program.

Place a check mark in your attence category. Remember, To qualify for Early Bird Discounted Registration you must register before July 1, 2022.

All persons attending (except non-licensed spouses) will pay a registration fee. The amount will be dependent on their category.

Refund Policy(Required)

If you need to cancel, call FNA at (417) 833-5130 or email Vernie R. Fountain at vrfountain@earthlink.net to request a refund. If you cancel 2 days or more prior to the beginning day (July 28, 2022) of the conference you will recieve a 100% cash refund. If you cancel less than 2 days before July 28, 2022, or at some time after the conference begins, the refund will be prorated. No Show's or no contacts with FNA requesting cancellation will not be elligible for a refund. Refunds will be mailed to you within 30 days of the close of the conference. FNA, may at it's discretion, offer a 100% cash refund for any cancellation situation. In the event of acts of God or conditions out of the control of FNA and the conference is cancelled by FNA a 100% refund of registration fees will be offered. No reimbursement for any other personal expenses will be offered to registrants.

I understand and agree to these terms.

I am registering to attend the 2022 International Embalming and Reconstructive Surgery Conference for Professional Embalmers in Springfield, Missouri, USA and aknowledge that I have read and understand the registration and refund policies for this conference. Clicking the word "YES" below will serve as my electronic signature and will be binding.(Required)

YES

I agree to mail a check, money order, or travelers check payable to Fountain National Academy.(Required)

Address to mail registration fees: Fountain National Academy: 2211 West Norton Road Springfield, Missouri 65803 (Once check is received, FNA will email you a confirmation and receipt.) *Credit cards are accepted, but you mus call FNA at (417) 833-5130 to give your card information.

I AGREE

Additional Information

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Register Today

Place a check mark in your attence category. Remember, To qualify for Early Bird Discounted Registration you must register before July 1, 2022.