2022 Immunization Summit - day of - Registration - The Center for Rural Health Development

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Registrant 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.

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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

2022 Immunization Summit

2022 Immunization Summit (includes Awards Lunch): $50.00

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Student Rate Immunization Summit

Student Rate Immunization Summit (includes Awards Lunch): $30.00

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Annual WIN Awards Luncheon Tickets

Annual WIN Awards Luncheon Tickets (for those who are not registering for the Immunization Summit: $25.00

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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)

I acknowledge that each registrant has read and understands the following:

Acknow - Warning

WARNING: The Center for Rural Health Development (“Center”) hereby warns all potential attendees that there is an inherent risk of exposure to COVID-19 existing in any public place or event where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. It is strongly recommended that all attendees be fully vaccinated, including any available boosters, before attending Center’s event. Further, the Center requires all attendees to follow posted instructions, including masking and social distancing requirements.

Acknow - Risk

ASSUMPTION OF RISK AND WAIVER OF LIABILITY: By registering for this in-person event and as a condition of my attendance and participation in this event, (1) I acknowledge that I have read and fully understand Center’s warning concerning COVID-19 and the risk of contracting COVID-19 at any in-person event; (2) I hereby choose to accept the risk of contracting COVID-19 in order to attend Center’s event; and (3) I hereby expressly waive any rights against and release and hold harmless Center and any of its officers, employees, affiliates, presenters, contractors, vendors, agents, heirs, legal successors, and assigns (collectively “Center”) from and against any and all claims, suits, demands, losses, damages, expenses, or liability of whatever kind or nature (collectively “liability”), under any theory of law or equity, that may arise during or as a result of my presence at the premises, including but not limited to any such liability related to or arising out of illness, injury, or death associated with infection of COVID-19 or complications, symptoms, or other effects resulting from contracting COVID-19. I further understand, acknowledge, and agree that Center does not assume any responsibility or obligation to provide financial or other assistance, including but not limited to medical, health, or disability assistance in the event of injury or illness. In the event that I or my family member is injured, becomes ill, or suffers complications due to COVID-19, allegedly as a result of my participation in Center’s event, I hereby release and hold harmless Center in the same manner and to the same extent as set forth above.

Substitutions/Cancellations:

If you cannot attend the 2022 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 6, 2022. Refunds will be processes within two weeks of the request. Cancellations made after June 6th are not eligible for a refund.

For more information, please contact:

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

2022 Immunization Summit - day of - Registration