2013 Congress on Healthcare Leadership - (Page 74)
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Student Associate Registration Form
SECTION 4: Purchase Pre-Congress Activities I would like to attend one of the following pre-Congress activities: r Aggressively Improve Cost, Quality and Throughput ($1,325 members/ $1,530 nonmembers) r Strategic Planning: From Formulation to Action ($1,325 members/ $1,530 nonmembers) r Baldrige Boot Camp ($850 members/$999 nonmembers) r Middle Manager Boot Camp ($680 members/$825 nonmembers) r New Healthcare Leader Boot Camp ($680 members/$825 nonmembers) Total fee for pre-Congress activities $ 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 $ GRAND TOTAL FOR EXTRA ACTIVITIES (Total for Sections 2–6) $ 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 EMAIL SIX-CHARACTER ID NUMBER from upper left-hand corner of your mailing label 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 Women Healthcare Executives Breakfast (Tues.): $60 r International Member Reception (Tues.): $25 r Annual Fun Run/Walk (Wed.): $10 (Proceeds go to the Fisher House™) r Special Federal Sector Activities (Networking Program and Reception on Sunday and Morning Program and Awards on Thursday): $80 Total fee for special events $
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 Student Associate, including Luncheon $495 r Student Associate, without Luncheon $415 *Anyone holding a compensated position in healthcare management should register using the Registration Form on pages 69–70. Calculate your fees here Basic registration fee (Section 8) Extra activities fee (total from Sections 2–6) 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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