National Hospital Charitable Service Awards Conference
Thank you for participating in the national conference and Awards banquet on Tuesday, February 4, 2014. The event will be held at the St. Regis Atlanta in Buckhead.

Two attendees from nominee hospital programs attend for free. The standard conference fee is $495 per additional attendee.

Please complete the following form for those attending on behalf of your charitable service program. Email any questions to Awards(at)JacksonHealthcare.com.
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Hospital/Organization Name *
Name of Nominated Program *
City *
State *
Contact Name *
First & Last Name
Contact Phone Number *
xxx-xxx-xxxx
Contact Email *
Attendee #1 *
First & Last Name
Attendee #1
Title
Attendee #1
Email
Attendee #2
First & Last Name
Attendee #2
Title
Attendee #2
Email
Attendee #3
First & Last Name
Attendee #3
Title
Attendee #3
Email
Attendee #4
First & Last Name
Attendee #4
Title
Attendee #4
Email
Submit
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