ANAE SESSION REGISTRATION FORM First Name:_________________________________________ Last Name:_____________________________________________________ Title:_______________________________________________________________________________________________________________ Company Name:______________________________________________________________________________________________________ Address:____________________________________________________________________________________________________________ City:_____________________________________ State: ___________________ Postal Code:______________________________________ Phone: _________________________Fax: ___________________ E-Mail:______________________________________________________ My Company is a (please check all that apply): Vendor First Time Attendee Please Check Registration Fee Below: ANAE Registration Fees: ______ Expo First Time Attendees: $499 ______ HISCI Member: Early Bird Special (on or before September 4th): $1,595.00 ______ Non-Member: Early Bird Special (on or before September 4th): $3,595.00 Note: Registration fees include access to the ANAE Wednesday morning session as well as all HIGPA International Expo educational and networking sessions. Meals are also included in the registration fees above. Please note that any registrations received after September 4th will be charged an additional $150.00 for late fees. Please check below if you plan on attending the Expo general session meals: Wednesday Chairmen’s Welcome Reception Thursday GPO Executive Breakfast Thursday General Session Dinner |
Payment Methods: (Full Payment is due at the time of registration) Check Credit Card (circle one) Visa MasterCard American Express Credit Card #_________________________________________________________________________ Expiration Date:_________________ Name on the card:_____________________________________________________________________________________________________ Signature:_____________________________________________________________________________Total: $________________________ Cancellation Policy: Refunds will be issued for cancellations received in writing on or before Friday, September 4, 2009. A $250 processing fee applies to all individual Cancellation Policy: Refunds will be issued for cancellations received in writing on or before Friday, September 4, 2009. A $250 processing fee applies to all individual registration cancellations. Group cancellations will be subject to a processing fee equaling 15% of the group payment. No refunds will be issued after Friday, September 4, 2009. If unable to attend the event, registrations may be transferred to another individual within the same organization. Name changes must be submitted in writing. Individuals are responsible for changing their own housing reservations and will be subject to the hotel’s own cancellation policy. Credits for future events will not be given. HIGPA assumes no liability for non-refundable transportation costs, hotel accommodations or additional costs incurred by registrants. HIGPA reserves the right to substitute presenters and reschedule programs due to unforeseen circumstances. Disability Needs: In compliance with the Americans with Disabilities Act (ADA), HIGPA will endeavor to accommodate attendees with a disability that requires any special needs, accommodations or requirements during the 2009 HIGPA International Expo. Please contact HIGPA Headquarters at info@higpa.org with your request and we will assist you with any special arrangements. The deadline for special needs requests is September 18, 2009.
Fax form to: 905-479-9297 or mail form and check to: HIGPA Department 3122, Washington, DC 20042-3122 Please make checks payable to HIGPA | 
JULY 2009
