National Cooperative of Health Networks: Serving Health Networks since 1995

Register for the 2011 NCHN Annual Conference

2011 NCHN Conference Registration

Registrant Information

First Name *
Last Name *
Title *
Organization *
Mailing Address *
City *
State *
Zip Code *
Daytime Phone *
Email Address *
Confirm Email Address Email Address *
Registrant Category (check all that apply) *
 NCHN Member 
 Not an NCHN Member 
 NCHN Business Partner 
 HRSA Network Planning Grantee 
 HRSA Staff 
If Other, please specify:

Pre-conference Workshops

Two pre-conference workshops will be offered on Sunday, April 17th. Please note that the times overlap, so you can only register for one of these.

$75 for NCHN Members
$125 for non-Members

Enrollment Limits:
The Rural Health Works: A Model for Health Networks session is limited to 20 to 25 participants and will be "first come, first serve."

Pre-conference Workshop selection: *
 Diversified Resource Development Strategies for Health Networks (3:00 - 6:00 PM) 
 Rural Health Works: A Model for Health Networks (1:00 - 5:00 PM) 
 I will not be attending a pre-conference workshop 
Check this box if you are attending a pre-conference workshop ONLY:
 I will NOT be attending the Conference and will only be attending the pre-conference workshop selected above. 

Meal Preferences

Please indicate if you will attend these events and, if you have special dietary requirements, please include them here. We will do our best to accommodate them.

Your registration fee includes the following meals:

  • Sunday Reception (cash bar and appetizers)
  • Monday: Continental Breakfast, Awards Luncheon, Evening Dinner & Entertainment
  • Tuesday: Continental Breakfast, Box Lunch
  • Wednesday: President's Breakfast, Closing Luncheon
Reception at Sky Line Rooftop: Sunday, April 17 @ 7:00 PM *
 I will attend this event 
 I will not be attending the reception 
Monday Evening Dinner & Entertainment: April 18 *
 I will attend this event 
 I will not be attending the Monday evening dinner and entertainment 
Closing Session & Luncheon: Wednesday, April 20 *
 I will attend this event 
 I will not be attending the Closing Luncheon 
Meal Preference (NCHN will try to accommodate when possible): *
 I prefer a meat-based meal 
 I prefer a vegetarian meal 
 It does not matter 

Guest Information

Guests are welcome to attend the Sunday evening reception at Sky Line Rooftop ($25 per person; includes appetizers) or the Monday evening event ($65 includes food and entertainment). Please include name of your guest below.
Guest 1 Name (first and last)

Registration Fees

Use this section to total your registration and guest fees and calculate your total due. You will receive an invoice from within a few days of submitting your registration form.
a. Registration Fee *
($500 for NCHN Members; $600 for others. Add $75 after April 1st)
b. Pre-Conference Workshop *
($75 for NCHN Members; $125 for others. Enter 0 if you are not attending a workshop.)
c. Guest Tickets
($25 for Sunday Reception only; $65 for Monday evening only; $90 for both. Enter 0 if you will not be bringing a guest.)
d. Total Due (a+b+c) *

Notes and Cancellation Policy

By completing this registration form and registering for the 2011 NCHN Annual Conference you are giving permission for your name and contact information to be published in any listing of conference participants that may prepare and release by NCHN. In addition, by submitting your registration, you are agreeing to pay your registration fee ($500 for NCHN Members & Business Partners before April 1, 2011 and $575 after April 1, 2011; $600 for non-members before April 1, 2011 and $675 after April 1, 2011) and any applicable guest fees ($65 per guest attending the Monday evening dinner).

Cancellation Policy
If for some unfortunate reason you should be unable to attend the 2011 NCHN Conference, after registering, NCHN will refund the registration fee if you meet the following guidelines. The 2011 Annual Conference Registration fee, minus $50 processing charge, will be refunded after the conference, if written cancellation is received by Cindy Stinnett at by Monday, April 4, 2011. If a cancellation request is received after April 4, 2011, but before April 8, 2011, NCHN will credit the fee to a future NCHN meeting attended by December 2012. Unfortunately, if a cancellation request is received after Friday, April 8, 2011, NCHN cannot refund the registration fee. If the fee has not already been paid, it will be due upon receipt of an invoice from NCHN. NCHN is unable to provide a refund after April 8, 2011 because NCHN will be committed to the hotel for included meal costs and other cost associated with the management of such a conference. If you should need to cancel after April 8 and wish to send a substitute, NCHN will switch the registration to the new conference attendee, but cannot guarantee that this person will be included in the conference listing of participants and/or have a printed name tag. If you have questions about the cancellation policy, please check with Cindy Stinnett at

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