* First Name
Middle Initial
* Last Name
* Specialty
Degree (MD, DO, PA, NP, etc.):
Affiliation:
Are you in a Private Practice?
Yes
No
If yes, what is the size of your practice?
1-10 physicians
More than 10 physicians
* Address
Home Business
* City
* State
* Zip Code
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
None
* Email
Phone Number
* How did you hear about the Business of Medicine Summit?
Please select an option
Association Meeting
Business of Medicine Website
Colleague
Door Drop/Reg Bag Insertion
E-mail invitation
Exhibitor Booth
Facebook
Institute Website
Medical Economics Website
MedPage Today
Other
Outbound Call
Poster/Sign
Print Advertisement
Print invitation in the mail
Twitter
Special physical, dietary, or other needs/requests:
(ADA accommodations will be made in accordance with the law. If you require such accommodations, please indicate your needs at the time of registration in the box provided above.)
If you experience technical issues with this registration site, please contact the Institute for Continuing Healthcare Education at group_meetings_ICHE@ICHE.edu or call 215-446-8088, ext 1123.
Price
2-Day Pass: $550.00
1-Day Pass : $300.00
Discounts
Student Discount Available with Valid Student ID
please contact Sandra Davidson at sdavidson@iche.edu or 215-446-8023 for more information.
Group Discounts
We are offering substantial volume discounts as outlined below.
3+ registrants 10% discount
5+ registrants 15% discount
10+ registrants 20% discount
To take advantage of these group discounts please contact Sandra Davidson at sdavidson@iche.edu or 215-446-8023.
CANCELLATION POLICY
Space is limited for this activity. Please notify us as soon as possible if you need to cancel so that space can be made available to others. To cancel, you may send an email to group_meetings_ICHE@ICHE.edu with the word “CANCEL” in the subject line, or fax your registration confirmation to 215-592-9085 with the word “CANCEL” on top.
A fee of $100 will be charged to cover administrative expenses should you cancel your registration at any time.
If you cancel by Tuesday, January 15th 100% will be refunded (less the administrative fee), up to 50% refund if you cancel by Friday, January 25th. There will be no refunds after February 1st.
ADDITIONAL INFORMATION
Attendees must arrange for their own hotel and travel accommodations. Please refer to the Location Page to access directions, hotel, and parking information.