EmailMe Form - 2015 NCHN Leadership Summit Registration

Registration Fee ($299 for NCHN members; $399 for non-members)
Please complete one form per attendee.

Your registration fee includes the following:

Leadership Summit materials and 2015 Leadership Learning Community membership, including 6 Community Calls following the Summit (February - August 2015)

Meals:
Monday, January 19th: Breakfast, Lunch, Beach Party Dinner, and 2 Beverage Breaks
Tuesday, January 20th: Breakfast and 1 Beverage Break
First Name *
Last Name *
Title *
Organization *
Mailing Address *
City *
State *
Zip Code *
Phone *
### - ### - ####
Email *
Registrant Category *
NCHN Member ($299)
Not a NCHN Member ($399)
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.

Top 3 Member Benefits (as rated by NCHN members)
1. Networking Opportunities
2. NCHN Conference and Summit (registration discounts)
3. Informational Emails

Find out more (pdf)

If you select Yes below, you will be redirected to the member application after submitting your registration. The NCHN Board reviews all applications. Once approved, your registration fee will be adjusted to the discounted member rate.
Would you like to complete an application to become a NCHN member?
Yes, please direct me to the application form after I submit my registration
No
Not now, but please contact me about membership
Additional Categories (please check all that currently apply)
HRSA Network Development Grantee
HRSA Network Planning Grantee
HRSA HIT Workforce Grantee
HRSA Staff
Meal Preference (NCHN will accommodate when possible):
I prefer a meat-based meal
I prefer a vegetarian meal
It does not matter
Additional Comments & Requests (e.g., dietary restrictions, 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
In submitting this form, I acknowledge that I will be invoiced for the amount due, which is calculated based upon my category of registration ($299 for NCHN Members and $399 for attendees who are not a member of NCHN). By clicking Submit below, I am registering for the 2015 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 2015 NCHN Leadership Summit, after registering, NCHN will refund the registration fee in accordance with the following guidelines: The 2015 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, January 5, 2015. If a cancellation request is received after January 5, 2015, due to commitments to the Hotel, we will be unable to provide a refund.

After clicking the Submit button below, you will receive a copy of your registration via email.
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Registration Fee ($299 for NCHN members; $399 for non-members)

About NCHN Membership

Notes & Cancellation Policy