Conference Registration

Registration Form

We look forward to your hospital's participation in 2012 Hospital Charitable Services Conference & Awards Banquet!  

Please complete the form below with all attendee information. Don't forget to include a contact email so we can keep you up-to-date.

This form will register your hospital's attendees for the conference and awards banquet.  Two attendees from officially nominated programs attend for free.
There is a fee of $495 for each additional attendee or for those who did not participate in the 2011 awards program.

In addition to registering here, all attendees are responsible for their hotel room and travel.

Should you have any questions, contact us at awards@jacksonhealthcare.com.

 

Attendee Name
*
Title
Organization
Second Attendee Name
Title
Third Attendee Name
Title
Fourth Attendee Name
Title
Contact Email
*