WYOMING HOSPITAL ASSOCIATION
63rd Annual Meeting and Convention
October 1-2, 2008
Little America, Cheyenne, Wyoming

REGISTRATION FORM


Full Name:
 

First Name (for badge):
 

Title:
 

Institution:
 

Mailing Address:
 

  
Registration Fees include the Exhibitor Kick-Off Lunch, Chairman's Reception and Continental Breakfasts. Please note the special meal functions are to be paid for seperately and in addition to the registration fees.
$200.00
$100.00
$300.00
$40.00
$15.00
$30.00
$10.00
$125.00
     
  Total:
     

"Member" registration is available only to those persons employed by an institution that is a member of the Wyoming Hospital Association. Advanced registration will be accepted by FAX, mail, online or by phone until September 28, 2008. After that date, a late registration fee of $20.00 will be assessed.

**Cancellation Policy: Registration fees are non-refundable unless WHA receives notice of cancellation by September 28, 2008. This applies to telephone/FAX registrations as well. You will be billed whether or not you attend the program. If after registering for the meeting, you find yourself unable to attend, you may send a person in your place provided they are employed by the same institution as you.

Please make checks payable to: Wyoming Hospital Association
P.O. Box 249
Cheyenne, WY 82003

You may FAX your registration to WHA at (307)632-9347 - Your hospital will be billed.

CODE:  

A. Hospital CEO
B. Assistant CEO
C. Trustee
D. Nursing Service
E. Financial Mgmt
F. Personnel
G. Auxilian
H. Engineering
I. Materials Mgmt
J. Quality
K. Volunteer Svcs
L. Admin. Asst.
M. Guest/Spouse
N. Other