EmailMe Form - 2016 NCHN Leadership Summit Registration

Registration Fee ($250 for NCHN members; $350 for non-members)
Please complete one form per attendee.

Your registration fee includes the following:

Leadership Summit materials; membership in the 2016-17 Leadership Learning Institute, which includes at least 3 Leadership Learning Institute webinars between the 2016 Leadership Summit and the 2017 NCHN Annual Conference, April 25-27, 2017 in Bozeman, MT.

Meals:
Thursday, November 10th: Breakfast, Lunch, and 2 Networking Breaks
Friday, November 11th: Breakfast and 1 Networking Break
First Name *
Last Name *
Title *
Organization *
Mailing Address *
City *
State *
Zip Code *
Phone *
### - ### - ####
Email *
Registrant Category *
NCHN Member ($250)
Non- NCHN Member ($350)
NCHN Staff
Speaker
About NCHN Membership
NCHN is a national professional membership organization comprised exclusively of health networks, alliances, and/or network stakeholders dedicated to supporting the success of health networks. Health networks face unique challenges that only other network leaders know and understand. Through NCHN, networks gain access to resources developed specifically for health networks and to a large pool of leaders who understand, face, and excel under similar constraints, demands, and opportunities. Few organizations function as networks do. NCHN is the only national organization dedicated specifically to supporting health networks.
Additional Categories (please check all that currently apply)
HRSA Allied Health Workforce Grantee
HRSA Delta Network Development Grantee
HRSA Network Development Grantee
HRSA Network Planning Grantee
HRSA Staff
Other - Please Specify
Meal Preference (NCHN will accommodate when possible):
I prefer a meat-based meal
I prefer a vegetarian meal
I prefer a vegan meal
It does not matter
I have other dietary needs/allergies - please specify
Additional Comments & Requests (e.g. seating/viewing needs, questions, etc.)
Optional: Do you have any current leadership concerns, interests, or topics that you would like to see addressed at the Summit?
Notes & Cancellation Policy
Notes & Cancellation Policy

In submitting this form, I acknowledge that I will be invoiced for the amount due, which is calculated based upon my category of registration ($250 for NCHN Members and $350 for attendees who are not a member of NCHN). By clicking Submit below, I am registering for the 2016 NCHN Leadership Summit and agree to pay the applicable registration fee.

Cancellation Policy: If, for some unfortunate reason you should be unable to attend the 2016 NCHN Leadership Summit, after registering, NCHN will refund the registration fee in accordance with the following guidelines: The 2016 NCHN Leadership Summit fee, minus $50 processing charge, will be refunded after the Summit if written cancellation is received by Linda Weiss at lweiss@nchn.org by Tuesday, November 1, 2016. If a cancellation request is received after November 1, 2016, due to commitments to the Hotel, we will be unable to provide a refund.

After clicking the Submit button below, you will be redirected to the 2016 Leadership Summit page of our website where you will find a link to PayPal to pay your registration fee and a link to the hotel to make your room reservations. You will also receive a copy of your registration via email.
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Registration Fee ($250 for NCHN members; $350 for non-members)

About NCHN Membership

Notes & Cancellation Policy