2022 Annual Conference Registration

Please complete this form to register for the 18th Annual Public Sector HealthCare Roundtable Annual Conference and Business Meeting which will be held at The Alexandrian Hotel, Alexandria, VA from Nov. 9-11, 2022.

Name of Organization*

Principal Contact*

E-mail*

Mailing Address

City

State

ZIP Code

Telephone

Type of Registration

Member* ($600.00 Registration fee per attendee.)Guest Public health Plan ($600.00 Registration fee per attendee – up to two attendees.)Corporate Member ($850.00 Registration fee per attendee – up to two attendees.)Corporate SPONSOR** (Two to five complimentary attendees based on sponsorship level.)Non-Member ($1,500.00 Registration fee per attendee. Maximum of one attendee.)

Payment Type

Check (An invoice will be sent via email for the required amount upon receipt of this form.)Credit Card (The Roundtable will contact the individual listed above to process the payment.)

If you would like to learn more about becoming a member, click here.

* Every health plan that registers at least one attendee, will be eligible to register up to three virtual attendees for an additional fee of $400. Information regarding virtual registration will be sent upon
receipt of this registration.

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

Conference Attendees

Name

Title

E-mail

Phone:

Name

Title

E-mail

Phone:

Name

Title

E-mail

Phone:

Name

Title

E-mail

Phone:

Name

Title

E-mail

Phone:

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Alternatively – download, complete, and return the form via mail or email at the addresses listed within:

Annual Conference Registration Form – Word Document
Annual Conference Registration Form – PDF