2013 Congress on Healthcare Leadership - (Page 72)
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Congress Express Registration Form Wednesday and Thursday Only
SECTION 5: Dinners Purchase Modern Healthcare Dinner r I would like to attend the Modern Healthcare Health Care Hall of Fame award presentations and dinner on Sunday, March 10. The fee is $185 per person. Guest name(s) Total fee for Modern Healthcare event $ SECTION 7: Personal Information Please PRINT your name as it appears on your ACHE record or your mailing label.
LAST FIRST MIDDLE
NICKNAME (How you would like your first name to appear on your Congress badge) TITLE ORGANIZATION ADDRESS CITY/STATE/ZIP PHONE FAX COUNTRY
Purchase Thomas C. Dolan Tribute Dinner I would like to attend the Thomas C. Dolan Tribute Dinner Supporting Diversity in Executive Leadership on Tuesday, March 12. # of tickets r Dinner Supporter: $300 (ticket includes a charitable gift) of tickets r Dinner Ticket: $150 (ticket does not include a charitable gift) # Guest name(s) Total fee for Tribute Dinner event $ (See page 50 for details about table hosting opportunities.) SECTION 6: Purchase Special Events I would like to attend the following special events: r Annual Fun Run/Walk (Wed.): $10 (Proceeds go to the Fisher House™) r CEO Circle Session (Wed.): FREE to CEO Circle members; $145 for all other CEOs Total fee for special events $ GRAND TOTAL FOR EXTRA ACTIVITIES (Total for Sections 2–6) $
EMAIL SIX-CHARACTER ID NUMBER from upper left-hand corner of your mailing label
Is this your
r Home or r Business Address?
SECTION 8: ACHE Status/Basic Registration Fee My ACHE status/Congress basic registration fee (for events in Section 1) is: r Member $850 r Nonmember $1,050 r Physician or board member attending with ACHE member $850 r Membership application attached $850 plus membership fee Calculate your fees here Basic registration fee (Section 8) Extra activities fee (total from Sections 3–6) Promotional code: (enter code number and subtract amount) Total Registration Fee Fees $ $ $ $
SECTION 9: Payment Payable in U.S. dollars or equivalent Canadian currency. Purchase orders are accepted from the Department of Veterans Affairs/uniformed services only. r I have enclosed a check made payable to the Foundation of the American College of Healthcare Executives. OR I would like to charge the fees on my: r Visa r MasterCard r American Express r Discover
AMOUNT CHARGED
ACCOUNT NUMBER
EXP. DATE
CARDHOLDER’S SIGNATURE
OR I am associated with the Department of Veterans Affairs/uniformed services and: r My purchase order is attached. r I will pay on-site. Mail this registration form with your payment to: Foundation of the American College of Healthcare Executives, 3376 Eagle Way, Chicago, IL 60678-1033
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Table of Contents for the Digital Edition of 2013 Congress on Healthcare Leadership
2013 Congress on Healthcare Leadership
Contents
How to Use This Brochure
Congress Highlights and New Events
ACHE Social Responsibility
2013 Premier Corporate Partners
Schedule of Events
Pre-Congress Seminars
Boot Camps
General Sessions
Luncheons
Fellows’ Forums
Breakfast Sessions
Masters Series
Seminars
Continuing Education Credit
Student Track at Congress
Orientations and Receptions
Other Special Events and Activities
Membership Activities
Management Innovations Poster Session
Career Development Programs and Activities
Employment Referral Service
Uniformed Services/Department of Veterans Affairs Activities
Hotel Accommodations
Chicago Highlights
Registration Checklist
Registration Information
Registration Form
Congress Express Registration Form
Student Associate Registration Form
Faculty Index
2013 Congress on Healthcare Leadership
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