Extraordinary Leadership Transforms Networks!








Register for the 2011 NCHN Leadership Summit

Please complete one form per attendee.

Registration Fee (includes Summit materials, beverage breaks, and lunch)

NCHN Members: $125 (add $50 if submitted after September 15, 2011)
Non-Members: $200 (add $75 if submitted after September 15, 2011)

First Name *
Last Name *
Title *
Organization *
Mailing Address *
City *
State *
Zip Code *
Phone *

Email *
Registrant Category *
(Hold down Ctrl while left clicking your selections if more than one applies)


By completing this registration form and registering for the 2011 NCHN Leadership Summit you are giving permission for your name and contact information to be published in any listing of Summit participants that may be prepared and released by NCHN. In addition, by submitting your registration, you are agreeing to pay your registration fee ($125 for NCHN Members before September 15, 2011 and $175 after September 15, 2011; $200 for non-members before September l5, 2011 and $275 after September 15, 2011).

Cancellation Policy
If for some unfortunate reason you should be unable to attend the 2011 NCHN Leadership Summit, after registering, NCHN will refund the registration fee if you meet the following guidelines. The 2011 Leadership Summit Registration fee, minus $50 processing charge, will be refunded after the Summit, if written cancellation is received by Rebecca Davis at rdavis@nchn.org by Monday, September 19, 2011. Unfortunately, if a cancellation request is received after Monday, September 19, 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 Monday, September 19, 2011because NCHN will be committed to the hotel for included meal costs and other cost associated with the management of such a Summit. If you should need to cancel after Monday, September 19, 2011 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 Rebecca Davis at rdavis@nchn.org

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