Becker's Hospital Review

Becker's Hospital Review August 2013 Issue

Issue link: https://beckershealthcare.uberflip.com/i/148059

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To regisTer, call 800-417-2035 • Fax 866-678-5755 or email: registration@beckershealthcare.com www.beckershospitalreview.com/novhospitalevent.html RegistRation foRm Photocopies are acceptable. Please print or type below. Please use a separate registration form for each attendee. Becker's Hospital Review Annual Chief Executive Officer Strategy Roundtable November 14th • Chicago RegistRation inFoRMation geneRal inFoRMation First/Last Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ hotel ReseRVations Degree (As you wish it to appear on your badge): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Facility/Company: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City/State/Zip: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Fax: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ RegistRation Fees annual ConFeRenCe & exhibits Receive multiple registrant discount(s). 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 (Before 10/1/13) 1st Attendee $700 aMount (After 10/1/13) $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $800 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2nd Attendee $650 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $750 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3rd Attendee $625 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $725 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4th Attendee or more $600 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $700 $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ritz Carlton Chicago has set aside special group rates for conference attendees. To make a reservation online: Website: http://www.fourseasons.com/chicagorc/ Step 1: Clink link to "Make a Reservation" Step 2: Enter Dates traveling, # of people Step 3: Click on "Corporate/Promo Code" and type in the code AS1113 and then "Find Rooms" Step 4: Becker's Hospital Review information will appear with the rate of $335 showing. Click on "Select Room" and follow prompts to confirm reservation. Ritz Carlton Chicago 160 E. Pearson St. • Chicago, IL (312) 266-1000 Group Room Rates: $335 ConFeRenCe Questions For additional information or questions regarding the conference please contact: asC Communications Phone: (800) 417-2035 fax: (866) 678-5755 email: registration@beckershealthcare.com For Becker's Hospital Review and exhibitor/ sponsorship questions contact 800-417-2035 (Ask about larger group discounts) TOTAL ENCLOSED $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ PayMent inFoRMation q Enclosed is a check, payable to ASC Communications q I authorize to charge my: Check #: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ q q q Credit Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Expiration Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Printed Cardholder Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Zip Code: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Cardholder Billing Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ City/State/Zip: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CVV#/3-digit #: _ _ _ _ _ _ _ _ _ _ _ _ _ to RegisteR CoMPlete RegistRation FoRM anD Mail oR Fax as Follows: Mail: Fax: Call: Email: Web site: Make checks payable to ASC Communications Fax registration form with credit card information to 866-678-5755 Call 800-417-2035 to register by phone registration@beckershealthcare.com www.BeckersHospitalReview.com Cancellation Policy: Written cancellation requests must be received by Sept. 1, 2013. Refunds are subject to a $100 processing fee. Refunds will not be made after this date. RegisteR online at: www.beckershospital review.com/ novhospitalevent.html 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 2nd location are not eligible for the discount. asC Communications, inc. 800-417-2035 aDa ReQuest If you require special ADA accommodations, please contact us at 800-417-2035 online RegistRation www.beckershospitalreview.com/ novhospitalevent.html Register before october 1, 2013, and saVe on registration! For information on exhibiting and sponsorships, call 800-417-2035 For more information about becker's Hospital review visit www. beckershospitalreview.com or call us at (800) 417-2035 Visit www.beckershospitalReview.com.

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