3.24.21 CalENA Virtual Leg Day Registration

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Must be ENA member to attend. Click link to join ENA :https://www.ena.org/membership/join
To pay $25.00 deposit refundable upon attendance verification click PayPal link: paypal.me/californiaENA

Email *

Last Name *

First name *

Home Address: Number and Street Apartment Number *

Home Address: City *

Home Address: Zip Code *

Phone Number Including Area Code *

RN License Number for Contact Hours

CalENA Chapter: Must be a member to participate. See link at top of form to join ENA *

Channel Islands

East Bay

Greater LA

Inland Empire

Kern

Loma Prieta

Mid-Valley

Orange Coast

Sacramento

San Diego

San Francisco

Superior

Just joined so unsure

Unsure

Required

$25.00 PayPal Deposit Completed *

Your registration is not complete until PayPal deposit is verified. To pay, use PayPal Link at top of this form, or the PayPal link on CalENA website, or the link in the Leg Day IContact email sent 3.10.21. No Refunds for cancellations after March 19, 2021.

Yes

Not Yet: Note your registration is not complete until deposit is verified

Donate Your Refund to the ENA Foundation once attendance is verified. *

Yes Instead of a refund I want to donate my $25.00 to the ENA Foundation as part of the State Challenge

No Send me the refund

How many times have you previously attended CalENA Leg Day? *

This is my first time

1- 2 times

3- 5 times

More than 5

Are you willing to be a leader for the Legislative visits ? *

Yes

Not this time but maybe in the future

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