nahcr image 2015 conference registration brochure
DESCRIPTION
The registration brochure for the NAHCR IMAGE 2015 Conference.TRANSCRIPT
STEP TWO: REGISTRATION – MEMBERS On or Before After PRE-CONFERENCE WORKSHOPS
6/1/15 6/1/15 Pre-Conference Workshop 1 $300 $400 Pre-Conference Workshop 2 $300 $400 Pre-Conference Workshop 3 $300 $400 Pre-Conference Workshop 4 $300 $400
BUNDLE – MEMBERS Conference and Half-Day Workshop $850 $950 Workshops: 1 or 2 or 3 or 4
FULL CONFERENCE ONLY – MEMBERS Member $675 $775
SINGLE-DAY REGISTRATION – MEMBERSWednesday, July 22 $345 $345Thursday, July 23 $345 $345Friday, July 24 $345 $345
Total Member Registration Fees: $__________
REGISTRATION – NON-MEMBERS On or Before After PRE-CONFERENCE WORKSHOPS
6/1/15 6/1/15 Pre-Conference Workshop 1 $450 $550 Pre-Conference Workshop 2 $450 $550 Pre-Conference Workshop 3 $450 $550 Pre-Conference Workshop 4 $450 $550
BUNDLE – NON-MEMBERS Conference and Half-Day Workshop $1150 $1275 Workshops: 1 or 2 or 3 or 4
FULL CONFERENCE ONLY – NON-MEMBERS Non-Member $975 $1075
SINGLE-DAY REGISTRATION – NON-MEMBERSWednesday, July 22 $445 $445Thursday, July 23 $445 $445Friday, July 24 $445 $445
Total Non-Member Registration Fees: $__________
NAHCR Executive Office, P.O. Box 14365, Lenexa, KS 66285-4365 Fax: 913-895-4652 Register Online: www.nahcr.com
Deadline for advance registration is July 1, 2015. Registrations after this date must be completed on-site at the conference.
STEP ONE: REGISTRATION INFORMATION
Please list your name exactly as you would like it to appear on your name badge: (*these items may appear in the registration roster)
I do NOT want my name to appear on the pre-registration roster.
*Name _________________________________________________________________________________________________________________
*Credentials (e.g., RN, BSN, CHCR – limit 3) _______________________________ Title _____________________________________________
*Organization ___________________________________________________________________________________________________________
Address_________________________________________________________________________________________________________________
*City _______________________________________ *State ______________ Zip _____________________*Country _______________________
*Phone _____________________________________________________ Cell Phone _________________________________________________
*Email __________________________________________________________________________________________________________________
SPECIAL NEEDS
I will need assistance with: _______________________________
I have the following dietary requirements: Vegetarian Vegan Gluten-Free Diabetic Kosher Other ______________________________________________
EMERGENCY CONTACT INFORMATION
Name ____________________________________________________
Relationship _______________________________________________
Phone Number ____________________________________________
This is my first IMAGE Conference. I am a new NAHCR Member. I am aware that my photo may be taken during the conference and may be published on NAHCR social media sites, NAHCR’s website and in publications to promote NAHCR and the IMAGE Conference.
2015 IMAGE Conference Registration Form
Name ____________________________________________________
STEP THREE: AWARDS LUNCHEON & RAFFLE TICKETS
Awards Luncheon Tickets (for guests or Friday-Only Registrants) ___ × $69
Guest Name(s) ___________________________________________
Total Awards Lunch Ticket Fees: $__________
Giving for Good – 50/50 Raffle
$1 for 1 Ticket
Total tickets ________ x $1
Total Raffle Ticket Fees: $__________
STEP FOUR: CONCURRENT SESSIONSPlease review the IMAGE Conference schedule and indicate below the concurrent sessions that you think you would be interested in attending. You will not be mandated to attend the sessions chosen below; the information will be used for internal planning purposes only and is subject to change.
STEP FIVE: OPTIONAL EVENTSThe following events are included in your registration fee. Please indicate if you will be attending:
Health Care Recruitment Thought Leader Coffee Chat
Kick-Off to IMAGE Reception sponsored by
Exhibit Hall Opening Reception sponsored by
Awards Luncheon sponsored by (included in conference registration fee; tickets required for Friday-only registrants or guests)
STEP SIX: TOTAL FEES ENCLOSED
Total Registration Fees $__________
Total Awards Lunch Ticket Fees $__________
Total Raffle Ticket Fees $__________
TOTAL ENCLOSED: $__________
All funds must be submitted on a U.S. bank in U.S. funds. NAHCR does not accept purchase orders or invoice for services. NAHCR Tax ID: 75-1650774.
Check made payable to NAHCR – check #__________
Charge payment to the following credit card: VISA MasterCard Amex Discover
_________________________________________________________Credit Card Number
_________________________________________________________Expiration Date
_________________________________________________________Name as it appears on card
_________________________________________________________Signature Date
_________________________________________________________Contact Phone of Cardholder
STEP SEVEN: SUBMIT REGISTRATION FORMPlease return the registration form and total amount due to:Mail: NAHCR Executive Office Overnight Courier Only: P.O. Box 14365 NAHCR Executive Office Lenexa, KS 66285-4365 18000 W. 105th St. Olathe, KS 66061
Fax: Fax completed registration form with credit card payment to 913-895-4652 or register online.
Questions? Contact the NAHCR Executive Office at 913-895-4627 or [email protected].
Cancellations & TransfersCancellations and transfers must be requested in writing and postmarked, faxed or emailed by July 1, 2015. Refunds will be issued following the conference. A $50 administrative fee will be assessed. Cancellation requests must include the reason for the cancellation. If you transfer your registration to another person, please include a completed registration form for that person with your written request. Requests for cancellation postmarked, emailed or faxed after July 1, 2015, are not refundable. If you wish to register after July 1, please bring your completed registration form and payment with you to the conference.
Thursday, July 23
2:00 p.m. - 3:00 p.m. 1A 1B 1C3:05 p.m. - 4:05 p.m. 2A 2B 2C4:10 p.m. - 5:10 p.m. 3A 3B 3C
Friday, July 2410:45 a.m. - 11:45 a.m. 4A 4B 4C
Please log on to www.nahcr.com and update your demographic information. After logging on, click “Member Services,” “My Account” and then “Personal” to place a check in each box that applies to you. Please note that any changes to your name, desig-nation, organization, email or phone will not be updated on your conference registration. You must contact the Executive Office at [email protected] to make any changes to this registration.
2015 IMAGE Conference Registration Form, continued
