2021 Annual Conference Registration

Please complete the form below to register for the 17th Annual Public Sector HealthCare Roundtable Annual Conference from Nov. 1-3, 2021.

We will send you an invoice for the registration fees. If you have any questions or would prefer to register by phone, please call (978) 835-5424.

Name of Organization

Number of People Attending

Type of Registration

Member ($300 Registration fee per organization - up to five attendees)Guest Public Health Plan ($300 Registration fee per organization – up to two attendees.)Corporate Member ($250 Registration fee per attendee – up to two attendees.)Corporate SPONSOR* (Up to five complimentary attendees based on sponsorship level.)Non-Member ($500 Registration fee per attendee. Maximum of one attendee.)

Contact Person

Name

Title

Address

City

State

ZIP Code

Telephone

E-mail

Will This Person Be Attending the Conference?YesNo

Other Attendees (If Any)

Name

Title

Address**

City

State

ZIP Code

Telephone

E-mail

Name

Title

Address**

City

State

ZIP Code

Telephone

E-mail

Name

Title

Address**

City

State

ZIP Code

Telephone

E-mail

Name

Title

Address**

City

State

ZIP Code

Telephone

E-mail

Name

Title

Address**

City

State

ZIP Code

Telephone

E-mail

Comments or Questions

* Corporate Sponsors will be contacted directly to confirm sponsorship level and to determine the number of complimentary attendees.

** Please include the address where the attendee is currently working (home or office). The Roundtable will send a pre-conference gift to this address prior to the opening of the conference.

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