Creative Health Care Management


Registration



Early Bird
Regular
Daily Rate
5 or more Participants:
$310/person
$330/person
$175/person
Fewer than 5 Participants:
$330/person
$350/person
$175/person
Registration Opens:
03/26/2021
07/27/2021
03/26/2021
Registration Closes:
07/26/2021
10/19/2021
10/19/2021


If you have any questions please contact: registration@chcm.com or call 800-728-7766

Instructions for filling out this form:
-Enter your information using proper case.
-Do not use ALL CAPITAL OR ALL LOWERCASE LETTERS!
-This data will be used to generate your name badge.

Will you be attending One Day
or Both Days of the Summit?

If attending ONLY one-day please choose the day you are attending, (open to all health care workers).
If attending BOTH days, please choose 'Both Days',(open to all health care workers).


Oct. 19 or 20 ($175)
Both Days -(See Pricing Above)
Will you be attending the Summit
In-Person or Virtual?

Do you know the name of this registrant?
Help
Prefix
*Participant First Name
*Last Name
Credentials
*Job Title
*Department
*Organization/Facility
*Address1
Address2
*City/Province
*State
*Zip/PostalCode
*Country
*Phone
- - Ext:
Fax
- -
*Participant Email
*The above address is
*Who may CHCM contact about this registration?
Same as Above
*Email for this contact
*How did you hear about this event?



Submit to Complete Registration Submit and Add Another Participant