Registration – Fountain National Academy

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Register for Fountain National Academy's 7th International Conference for Professional Embalmers: Thursday, July 25 - Sunday, July 28, 2024.(Required)

PLEASE READ: While entering information on this form, please read each selection carefully and follow the instructions listed for each part. By selecting the "I agree" box, registrants agree to fill out only their own information, and each participant will need to submit their own registration form. If registrants desire to bring spouses or partners whom are not licensed or qualified, they do NOT have to register, but may be subject to meal fees outlined on the following forms. If registrants elect to bring children, we at FNA highly discourage their participation in all classroom activities or presentations due to the graphic nature of this profession, and meal fees will apply. We look forward to seeing you all in July!

I agree to enter my own information and to read instructions carefully.

Categories & Pricing:(Required)

Category 1: Licensed or Qualified Embalmers
$695 (before July 1)
$795 (after July 1st)
$495 / Day (daily rate)

Category 2: Mortuary Science Students
$295 (before July 1st)
$395 (after July 1st)
$175 / Day (daily rate)

Category 3: Apprentice Embalmer
$495 (before July 1st)
$595 (after July 1st)
$250 / Day (daily rate)

Category 4: All Other Persons not in Categories 1, 2, or 3
$695 (before July 1st)
$795 (after July 1st)
$490 / Day (daily rate)

I have read and understood the pricing for each category, and will select only the category that applies to me.

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 select the proper category:

Category 1 - I am licensed or a qualified embalmer in the state or country of:

Category 2 - I am a Mortuary Science student currently enrolled at:

Category 3 - I am an apprentice embalmer in the state or country of:

Category 4 - I do not fall into any of these categories - All other persons

State(s)/Country Where Licensed(Required)

Number of Years Qualified(Required)

License Number(Required)

Please list state(s) 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 Mortuary Science program.

Name of person or company you are apprenticing under:(Required)

Upload verification of current apprenticeship or student status:

Drop files here or

Accepted file types: jpg, gif, png, pdf, docx, heic, Max. file size: 64 MB, Max. files: 4.

Please Note: Acceptable forms of verification include school-issued ID, acceptance letter, recommendation letter from qualified professor or employer, etc.

Please select the category that applies to you. Remember, to qualify for early bird discounted registration, you must register prior to July 1, 2024.

All persons attending (except non-licensed spouses/partners) will pay a registration fee. The amount will be dependent on your 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 23, 2024), you will recieve a 100% cash refund. If a refund is requested less than 2 days before July 23, 2024, or at some time after the conference begins, the refund will be prorated. No Shows 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, the conference can potentially be cancelled, and a 100% cash 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 2024 International Embalming and Reconstructive Surgery Conference for Professional Embalmers in Springfield, Missouri, USA and acknowledge that I have read and understand the registration and refund policies for this conference. Clicking "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. Credit cards are accepted, but you must call FNA at (417) 833-5130 to give your card information.(Required)

Address to mail registration fees: Fountain National Academy: 2211 W Norton Road, Springfield, Missouri 65803 (Once check is received, FNA will email you a confirmation and receipt.) *Credit card payments will be subject to a transaction fee, and must be called into FNA at (417) 833-5130. We accept all major credit card brands: Visa, Master Card, American Express, Discover, JCB, and Union Pay.

I AGREE

Additional Information

Please list anything the FNA Staff would need to know prior to your arrival, examples include but are not limited to: Questions regarding this event, additional meal quantities, dietary restrictions, or ADA compliant hardware (wheelchairs, ramps, lifts, etc.).

Any Supporting File(s) Not Uploaded on Previous Pages

Drop files here or

Accepted file types: jpg, gif, png, pdf, heic, Max. file size: 64 MB, Max. files: 4.

Please provide any supporting documents not uploaded above, which includes proof of apprenticeship, student status, and any other additional documents you feel are relevant.