Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/685863
J U N E 2 0 1 6 O R E X C E L L E N C E . C O M 3 Registration Form Hyatt Regency Coconut Point, Bonita Springs, Florida • October 12-14, 2016 First Name: __________________________________________________ Last Name:________________________________________________ Degree(s): ___________________________________________________ Title: ____________________________________________________ Facility/Company: _______________________________________________________________________________________________________ Address: _____________________________________________________________________________________________________________ Address: __________________________________________ City/State/ZIP: _______________________________________________________ Phone: ____________________________________________ Attendee's E-mail: ____________________________________________________ To register, please print or type the information below and mail or fax as directed. Please use one form per attendee. • Online: Please visit www.orexcellence.com to register online. Please call (888) YOUR-ORX with any issues or questions. • Mail: Make checks payable and mail to Herrin Publishing Partners, LP, 255 Great Valley Parkway, Suite 100, Malvern, PA 19355 • Fax: Fax registration form with credit card information to (610) 240-4919 WORKSHOPS (pick one from each group - there is no additional charge): Wed AM Workshops: Thurs PM Workshops: ❑ A. Post Your Prices Online ❑ A. 25 Cost-Saving Solutions ❑ B. Total Joints ❑ B. High Reliability Organization ❑ C. Central Sterile ❑ C. Infection Control Disasters CASC ATTENDEES ❑ Check here if you need AEU credits for CASC HOTEL RESERVATIONS The Hyatt Regency Coconut Point has discounted rates for attendees. Please contact the hotel directly to make your reservation. Be sure to mention the OR Excellence Conference to receive the discounted group rate of $199 (Single/Double). The rate is exclusive of state and local taxes. The discounted group rates will be offered until September 16, 2016, or until all rooms in the group block have been reserved, whichever occurs first. Reservations received after this date are subject to space and rate availability and may not be available. Please make your reservations early in order to receive the group rate. A credit card will be required to guarantee your reservation. You may also register online at ww.orexcellence.com. Hyatt Regency Coconut Point 5001 Coconut Road, Bonita Springs, FL 34134 Reservations: https://resweb.passkey.com/go/osx2016 or call (888) 421-1442 Group Name: OR Excellence Conference Group Rate: $199 (Single/Double) PAYMENT INFORMATION ❑ Enclosed is a check payable to Herrin Publishing Partners, LP Check #: _____________ ❑ I authorize Herrin Publishing Partners, LP, to charge my: ❑ American Express ❑ Mastercard ❑ Visa ❑ Discover Credit Card Number: ______________________________________________ Expiration Date: ___________ 3 or 4 Digit Security Code: ________ Printed Cardholder Name:______________________________________________ Signature: __________________________________________________________ Type your name if completing online Cancellation Policy: If your cancellation is received in writing on or before August 19, 2016, your refund will be granted, less a $50 administration fee. If your cancellation is received between August 19, 2016 and September 23, 2016, your refund will be granted, less a $150 administration fee. There will be no refunds after September 23, 2016. CONFERENCE REGISTRATION AND PAYMENT INFORMATION Please complete one form per attendee. A multiple attendee discount is offered for registrants from the same facility. Check the appropriate box below (please only check one box). FULL CONFERENCE REGISTRATION FEES* Price until 8/19/16 ❑ I am registering for myself or as the primary attendee from my facility $675 pp $ ___________ ❑ I am registering as an additional attendee from my facility $575 pp $ ___________ Primary attendee's name: __________________________________________ Guest** Passes for Exhibit Hall Events (Exhibit hall events are free for attendees. Please only purchase if bringing an additional guest to the exhibit hall): Exhibit Hall Guest Pass (# guests) _____ @ $50 pp $ ___________ Guest's Name (First/Last): __________________________________________ Total fee for your registration, and guest fee, if any. $ ___________ If you are paying for additional attendees from your facility, please enter the total charges for them here. $ ___________ Grand total to be charged $ ___________ *If registering through our website, you'll be given a list of partial/daily rates. Please visit our website at www.orexcellence.com or call us for additional information. **Guest Policy: Significant others and guests of attendees are welcome to participate in our exhibit hall events. However, guests may not be surgical market vendors or consultants. There will be a strict "no soliciting" policy for guests. Commercial passes are available for vendors and consultants wishing to meet exhibitors and guests. CONFERENCE QUESTIONS For additional information or questions regarding the conference, please email us at orxmanager@outpatientsurgery.net or call (888) YOUR-ORX PREFERRED