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2021 Collaborative Care HIT Summit - Registration
2021 Collaborative Care & Health IT Innovations Summit Registration Form
First Name:
*
Last Name:
*
Organization:
*
Job Title:
*
Email:
*
(please type in registrant's email; will be used to login to the virtual event)
Cell:
*
Which of the following best describes your organization?
*
Long-Term and Post-Acute Care Provider
Acute Care Provider
Payer
Technology Vendor, Business, and Consultant
Government
Other
Sharing Contact Information:
*
I agree to the following statement: This is a virtual networking event. By registering for and attending this event, I understand that my contact information may be shared with other registrants and will be visible when using the virtual event platform. I will have the ability to make changes to my individual profile to edit/hide certain information if I choose.
Payment with PayPal/Credit Card:
Note: You will be redirected to a credit card/PayPal payment page. To pay with PayPal, simply login. To use a credit card, skip to select ‘Enter as guest'/pay by credit card.' Receipt will show LeadingAge as the merchant.
Select your ticket. Once you complete the registration process, you will be redirected to PayPal's secure payment page for fee-based tickets:
Required Ticket
*
You must select one ticket from this section before continuing.
Price
Provider
Care provider only, no business firms
1
Free
Non-Provider
Business firm, vendor, payer, consultant, government
1
$595
Speaker
Confirmed summit speakers only
1
Free
Promotional Code:
Calculate Prices
NOTE: You are purchasing a group ticket. Please complete this form on behalf of an attendee and then provide an alternate email below for receiving the group coupon.
Total:
0
*
required
