Institute for Health Care Governance

2025 Appalachian Health Leadership Forum Registration

The Appalachian Health Leadership Forum will be held on May 1 & 2, 2025 at Stonewall Resort & Conference Center in Roanoke, WV. For additional details about the Forum, including the agenda and room block information, please click here.

To register for the Forum, please complete the form below before registration closes on April 25, 2025. You will receive a confirmation email to the address provided upon receipt and processing of your registration form.

2025 AHLF - Appalachian Health Leadership Forum

Name of Individual Completing Registration

First

Last

Organization

Address

City

State/Province

Zip/Postal

Phone

Fax

Attendees Information

2025 AHLF - Appalachian Health Leadership Forum - Attendees Information

Please complete the registration information for each Forum participant that you are registering. You will need to include your information from above again if you are registering yourself. .

Enter Name and Organization information as it should appear on the Attendees conference name tag.

Full Name

First

Last

Organization

Mobile Phone

Attending as a

Address

City

State/Province

Zip/Postal

Continuing Education Units requested for attendance at this event:

Do you have dietary restriction or food-related allergy?

*Please note that not all dietary restrictions will be able to be accommodated.

Do you have any accessibility requirements or request any special accommodations (such as a lactation room, etc.)

Click “Add” to add additional attendees.

Add Remove

Additional Information: (For example, if you are registering multiple people and some are attending the full conference and others are attending only one day, please use this section to state which individuals are attending which dates.)

Payment Information

Early Registration

Full Conference Registration (price includes breakfast and lunch on both days and evening reception on May 1st): $300.00

Quantity

May 1st Only

May 1st Only (includes breakfast, lunch and evening reception): $175.00

Quantity

Reception

May 1st Evening Reception Guest Ticket: $20.00

Quantity

May 2nd Only

May 2nd Only (includes breakfast and Awards Lunch; does not include Thursday evening reception): $165.00

Quantity

Awards Lunch

May 2nd Awards Lunch Guest Ticket: $60.00

Quantity

Students

Student Full Conference Registration Rate (includes both Thursday and Friday sessions): $150.00

Quantity

Every Fourth Team Member FREE

Fourth Team Member FREE (must register as group): $0.00

Quantity

Total Payment

Payment Method:

Credit Card (via PayPal) *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.

Check (via Mail)

Substitutions/Cancellations:

If you cannot attend the Forum you can send a substitute, even at the last minute. If you must cancel entirely, your request for a refund – minus a $60 processing fee – must be made in writing no later than April 17, 2025. Refunds will be processed within two weeks of the request.

Cancellations made after April 17th are not eligible for a refund.

You will receive a confirmation email to the address provided upon receipt and processing of your registration form.

For registration questions or to register by phone, please contact:
The Center for Rural Health Development, Inc.
Phone: (304) 397-4071
Email: jill.clemente@wvruralhealth.org

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A Program of:

The Center for Rural Health Development

75 Chase Drive

Hurricane, WV 25526

(304) 397-4071

Email Program Manager