2012 NCHN Leadership Summit Registration Form
Please complete one form per attendee.
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  • 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 ($175 for NCHN Members, $250 for non-NCHN Members who are HRSA/ORHP grantees in one of the Network Development Programs; and $275 for attendees who are not a member of NCHN or a HRSA Network Development grantee). By clicking Submit below, I am registering for the 2012 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 2012 NCHN Leadership Summit, after registering, NCHN will refund the registration fee in accordance with the following guidelines: The 2012 NCHN Leadership Summit fee, minus $50 processing charge, will be refunded after the Summit if written cancellation is received by Christy Sullenberger at csullenberger@nchn.org by Tuesday, September 11, 2012. If a cancellation request is received after September 11, 2012, due to commitments to the Hotel, we will be unable to provide a refund.
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