Conference Materials

TO REGISTER: CALL 800 417 2035 • FAX 866 678 5755 • REGISTRATION@BECKERSHEALTH- CARE. COM OR VISIT www.regonline.com/registration/Checkin.aspx?EventID=2082181 112+ LE ADING SPE AKERS FROM HE ALTH S YS TEMS, 130+ SPE AKERS TOTAL , 80+ SESSIONS REGISTRATION INFORMATION REGISTRATION FEES REGISTRATION FORM Photocopies are acceptable. Please print or type below. Please use a separate registration form for each attendee. 112+ Health IT and Clinical Leaders from Hospitals and Health Systems Speaking, 130+ Speakers total 80+ Great Sessions - A Great Combination of Health IT's Impact on Clincal and Business Issues Jam-Packed Networking and Education Opportunities Over 2 Days HOTEL RESERVATIONS The Swissotel Chicago has set aside special group rates for conference attendees. To make a reservation, please visit: https://aws.passkey.com/event/49531187/ owner/1461/home The Swissotel Chicago 323 East Wacker Drive Chicago, IL 60601 (888) 737-9477 CONFERENCE QUESTIONS For additional information regarding the conference, exhibiting or sponsoring please contact: Becker's Healthcare Phone: 800 417 2035 Fax: 866 678 5755 Email: registration@beckershealthcare.com ADA REQUEST If you require special ADA accommodations, please contact us at 800 417 2035. ONLINE REGISTRATION www.regonline.com/registration/Checkin. aspx?EventID=2082181 ONE REASONABLE PRICE Come for as much of the conference as you would like! TO REGISTER: CALL 800 417 2035 • FAX 866 678 5755 • REGISTRATION@BECKERSHEALTHCARE.COM OR VISIT www.regonline.com/registration/Checkin.aspx?EventID=2082181 COMPLETE REGISTRATION FORM AND MAIL OR FAX AS FOLLOWS: Online: http://www.regonline.com/needtoupdate Fax: Fax registration form with credit card information to 866-678-5755 Call: Call 800-417-2035 to register by phone Email: registration@beckershealthcare.com Cancellation Policy: Written cancellation requests must be received within 120 days of transaction or by March 1, 2018, whichever is first. Refunds are subject to a $100 processing fee. Refunds will not be made after this date. Multi-Attendee Discount Policy: To be eligible for the discount, your hospital must be registered at one time and work at the same address. Just copy the registration form for each attendee. Employees from a second location are not eligible for the discount. Becker's Health IT + Clinical Leadership 2018 MAY 10-11, 2018 • SWISSÔTEL – CHICAGO, ILLINOIS ANNUAL CONFERENCE & EXHIBITS – One reasonable registration price - come for as much of the conference as you would like! Receive multiple registrant discounts. The more people you send, the greater discount you receive. The prices listed below are per person. Your registration includes all conference sessions, materials and the meal functions. MAIN CONFERENCE ONLY FEES AMOUNT FEES AMOUNT (Before 4/1/18) (After 4/1/18) 1st Attendee $800 $ __________________ $900 $ _______________ 2nd Attendee $750 $ __________________ $850 $ _______________ 3rd Attendee $700 $ __________________ $800 $ _______________ 4th Attendee or more $650 $ __________________________ $750 $ _______________ (Ask about larger group discounts) TOTAL ENCLOSED $________________________________ c I authorize to charge my: c c c Credit Card Number: __________________________________ Expiration Date: _____________________ Printed Cardholder Name: _____________________________ Zip Code: ___________________________ Cardholder Billing Address: ___________________________ City/State/Zip:_______________________ Signature: ______________________________________________ CVV#/3-digit #:______________________ First/Last Name: ________________________________________________________________________________________ Degree/Designations (As you wish it to appear on your badge): _______________________________________ Title: ___________________________________________________________________________________________________ Facility/Company: _____________________________________________________________________________________ Address: _______________________________________________________________________________________________ City/State/Zip: _________________________________________________________________________________________ Phone:__________________________________ Fax: ________________________________________________________ Email:__________________________________________________________________________________________________ GENERAL INFORMATION TO REGISTER PAYMENT INFORMATION

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