WYOMING HOSPITAL ASSOCIATION
72nd Annual Meeting and Convention
September 20, 2017

REGISTRATION FORM

Full Name:
First Name
(for badge):
Title:
Address:
City:
State:
Zip:
Institution:
Email Address:
Site:
Registration Fees
$250.00
$375.00
$50.00
 
Total:
 
There is no additional fee to attend these events, but you must state if you will be attending the following activities:

 

Additional Information

Registration fees include: Exhibitor Strolling Lunch; Chairman’s Reception; Awards Banquet, Breakfast on Thurs-day morning; Two (2) breaks on Thursday; Quality Awards Lunch and Educational meeting materials

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 1, 2017. 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 20, 2017. 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
2005 Warren Avenue
Cheyenne, WY 82001

You may FAX your registration to WHA at (307) 632-9347

Click here for the Printable Registration form.