EmailMe Form - 2013 NCHN Leadership Summit Registration Form

Registration Fee

Registration includes breakfast, lunch and networking breaks on Tuesday; and breakfast and networking break on Wednesday morning.

In addition, the fee includes Leadership Summit materials, 2013 Leadership Learning Community membership, which includes six additional modules devoted to leadership between the Summit and June 2014; and participation in NCHN & LoneStartNow “Maintain, Not Gain Stealth Challenge” a popular and effective strategy to create and meet realistic goals during the treacherous 10-week gauntlet of excess between Halloween and New Year’s.

First Name *

Last Name *

Title *

Organization *

Mailing Address *

City *

State *

Zip Code *

Phone *

### - ### - ####

Email *

Registrant Category *

NCHN Member ($275)

Not a NCHN Member ($375)

Additional Comments & Requests (e.g., dietary restrictions, questions, etc.)

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 ($275 for NCHN Members and $375 for attendees who are not a member of NCHN). By clicking Submit below, I am registering for the 2013 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 2013 NCHN Leadership Summit, after registering, NCHN will refund the registration fee in accordance with the following guidelines: The 2013 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 Monday, September 23, 2013. If a cancellation request is received after September 23, 2013, due to commitments to the Hotel, we will be unable to provide a refund.

After submitting, you will be redirected to the 2013 NCHN Leadership Summit page at http://www.nchn.org/event/2013-leadership-summit.html