Institute for Health Care Governance

2024 Appalachian Health Leadership Forum Registration

The Appalachian Health Leadership Forum will be held on April 26 & 27, 2024 at Stonewall Resort & Conference Center, 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 by April 11, 2024. You will receive a confirmation email to the address provided upon receipt and processing of your registration form.

AHLF 2024 - Appalachian Health Leadership Forum

Name of Individual Completing Registration

First

Last

Organization

Address

City

State/Province

Zip/Postal

Phone

Fax

Are you registering yourself with this submission?

Yes

Attending as a

Continuing Education Units requested for attendance at this event: Continuing Education Units requested for attendance at this event:

Are you registering additional attendees?

Yes

Additional Registrants Information

AHLF 2024 Additional Registrants Information

Please complete the registration information for each conference participant that you are registering.

Click “Add” to add additional registrants. Enter Name and Organization information as it should appear on the registrant’s 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:

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

Early Registration, before March 30th: $300.00

Quantity

Registration

Registration, after March 30th: $350.00

Quantity

One Day Only - Friday

One Day Only: Friday (does not include dinner): $175.00

Quantity

One Day Only - Saturday

One Day Only: Saturday (does not include dinner): $175.00

Quantity

Awards Dinner

Friday Awards Dinner: $60.00

Quantity

Students

Students: Includes both Friday and Saturday Sessions: $125.00

Quantity

Every Fourth Team Member FREE

Fourth Team Member FREE (must register as group prior to March 30th; not available for registrations received after March 30th): $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 $150 processing fee – must be made in writing no later than April 11, 2024. Refunds will be processed within two weeks of the request.

Cancellations made after April 11th 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

If you are human, leave this field blank.

A Program of:
The Center for Rural Health Development
75 Chase Drive
Hurricane, WV 25526
(304) 397-4071
Email Program Manager