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2018 Immunization Summit Registration






 


In Partnership with the KidStrong Conference

June 21 and 22, 2018
Charleston Civic Center


The Annual West Virginia Immunization Summit is an action-oriented event targeted toward public and private sector organizations with an interest in improving immunization rates in West Virginia. A variety of sessions at the Summit will be targeted toward healthcare and public health professionals, educators, students, business leaders, and others interested in reducing vaccine-preventable diseases in West Virginia.

The 2018 Immunization Summit agenda, continuing education, and lodging information can be found here.
 
Annual WIN Awards Luncheon:

The Annual WIN Awards Luncheon will be held at the Civic Center on June 21st at from 11:45am to 1:00pm. Purchase of the full two-day Immunization Summit registration or Day 1 Registration includes entrance to the Annual Awards Luncheon. Those wishing to purchase tickets for other guests, may purchase tickets to the Awards Luncheon for $25. For more information at the Annual Awards Event or to submit a nomination, please click here.

Adult Immunization Clinic:

An Adult Immunization Clinic, hosted by the Kanawha-Charleston Health Department, will be held during the Immunization Summit and KidStrong Conference. Hepatitis A & B, Tdap (Tetanus, diphtheria, and pertussis), HPV, and pneumococcal vaccines will be offered. Please note in the registration form below if you would like to receive one or some of these vaccines at the conference. If so, please bring the following documents with you to the clinic: your insurance card (or a copy of it) and a copy of your immunization records (if available).

Registration Fees:
  • Advance registration (until June 15th): $50  for one day; $90 for two days

  • Late Registration (June 16th and after): $60 for one day; $110 for two days

  • Student rates: $25 for one day; $45 for two days.

  • Annual WIN Awards Luncheon ticket: for those who are not attending the Immunization Sumit/KidStrong Conference or for additional guests: $25
  • Given that some WIN members are facing budgets cuts at this time, we are offering a limited number of scholarships to cover 50% of the registration fee for those who need it this year. If you would like to request one of these scholarships, please email the WIN Program Manager stating the reason for requesting this scholarship and the number of scholarships requested.
To register, please complete the registration form below.

Cancellations and Substitutions:

If you cannot attend the Immunization Summit you can send a substitute, even at the last minute. If you must cancel entirely, your request for a refund—minus a $30 processing fee—must be made in writing no later than June 15, 2018. Refunds will be processed within two weeks of the request. Cancellations made after June 16th are not eligible for a refund.

Please note that school nurses and school-based health clinic personnel should register with the KidStrong Conference and are welcome to cross-over into some or all of the Immunization Summit sessions. If you have already registered for the KidStrong Conference, you do not need to complete a separate Immunization Summit registration.
 

Name:
Organization:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Email:
Is the organization with whom you are employed a VFC provider?:
Do you request CEU's for your attendance at this conference?:
If so, which CEU's will you request: Physician CMEs, Pharmacy, Nursing, Counseling, Social Work?:
If you plan to receive vaccinations during the Adult Immunization Clinic, please list the vaccines you would like to receive. (Choose from Tdap, Hep A, Hep B, Hep A/B Combo, HPV, Pneumococcal PCV13 and PPSV23):
If you are registering more than one person, please enter their names here:
Payment Description Amount Due Quantity Amount Paid
Full Conference Registration (includes two days of Immunization Summit): $90 $
Annual WIN Awards Luncheon (free for those purchasing the Full Conference Registration or One Day Registration): $0 $
Day One Registration Only (includes Awards Luncheon): $50 $
Day Two Registration Only (includes lunch): $50 $
Student Full Conference Registration (For Both Days): $45 $
Student Registration (Day One): $25 $
Student Registration (Day Two): $25 $
Annual WIN Awards Luncheon Ticket (for those who are not registering for the Immunization Summit or KidStrong Conference): $25 $
Total Amount Due $
Payment Method:

*Please note: there will be no additional fees assessed when paying through PayPal and you do not need a PayPal account to pay this way.

For more information, please contact:

The Center for Rural Health Development, Inc.
75 Chase Dr.
Hurricane, WV 25527
Phone: (304) 397-4071
Fax: (304) 397-4076
Email

 
 
 
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