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Registration Form Instructions
If you encounter any questions when completing your Registration Form, please reference the instructions below for an explanation or additional information on each section. Should you have any additional questions, please feel free to contact CSHP either by phone at (916) 447-1033 or by clicking here.
Section 1: Attendee Information
Please print your full name, degree, name as you wish it to appear on your badge and your CSHP member number. If you are not a member of CSHP but a member of CPhA, please provide us with your member number and a copy of your current membership card.
Section 2: Guest
If you will be bringing a guest, please provide us with their full name and name as they wish it to appear on their badge. Please fill in the total. Be sure to carry the total over to the reverse side of the form so that it can be incorporated into your grand total.
Section 3: Contact Information
Please provide us with your most current contact information. This information will be used solely to help us update our database and ensure that all of our records are current. Please note: the emergency contact person is someone we can contact in case of an emergency during Seminar 2009. If you are indicating someone who will be travelling with you, please provide a cell phone number. This information will only be used if an emergency situation involving you or your guest should arise.
Section 4: Payment
Please select method of payment. CSHP gladly accepts Visa, MasterCard, American Express, and Discover cards and check payments. Please make checks payable to: California Society of Health-System Pharmacists.
Section 5: Renew Your Membership
If you are a current member and your membership is about to expire then CSHP will gladly accept renewals made using the Seminar Registration Form. Please select your member type and fill in the total. Be sure to carry the total over to the reverse side of the form so that it can be incorporated into your grand total. If you need to change your membership type, please contact the CSHP office directly at (916) 447-1033.
Section 6: Registration Fees
Please place a check mark in the box next to the registration class that applies to you. Please indicate your registration choice by circling the price. If you are not registering for all four days, please be sure to indicate which days you wish to attend on the line provided. If you are a non-member, your registration entitles you to a one-year free membership with CSHP. Please be sure to place the sub-total for that section in the space indicated.
Important information regarding the Early Bird registration rates: To obtain the discounted rates, your payment and registration form must be received on or before August 20, 2009. Registration forms that are received without payment will not be processed and will not be eligible for the Early Bird rates if the deadline passes without payment being received.
Section 7: Hospitality Events
Please place a check mark in the box next to the event you wish to attend. This will assist us in ordering food, arranging for room set-up, and in ensuring ample room for attendees to network. Please select events for only those days in which you are registered. Please note that while some events are included in your registration, others require an additional fee. Please reference the registration form for pricing, and be sure to place the sub-total for that section in the space indicated.
Section 8: Sponsor a Technician
If you are interested in sponsoring one of CSHP's technician members (all selections must be current members of CSHP), please complete this section of the Registration Form. If you are unsure of a specific technician but still want to contribute, please check the appropriate box to request that CSHP randomly select a technician on your behalf. Please be sure to indicate if you are sponsoring a technician or technicians to attend as a full registrant or one-day registrant. Also, be sure to place the sub-total for that section in the space indicated.
Sponsors will be provided with the name of their sponsored technician when they receive their Seminar 2009 confirmation (If randomly selected, technicians and sponsors will be notified of the selection two weeks prior to Seminar).
Section 9: Sponsor a Student
If you are interested in sponsoring one of CSHP's student members (all selections must be current members of CSHP), please complete this section of the Registration Form. If you are unsure of a specific student but still want to contribute, please check the appropriate box to request that CSHP randomly select a student on your behalf. To request a student to be selected from a specific school, please name the school of your choice in the appropriate space. Please be sure to place the sub-total for that section in the space indicated.
Sponsors will be provided with the name of their sponsored student when they receive their Seminar 2009 confirmation (If randomly selected, students and sponsors will be notified of the selection two weeks prior to Seminar).
Section 10: Logowear
If you would like to purchase a Seminar 2009 polo shirt, please complete this section of the Registration Form. Please indicate shirt size and quantity. Please place the sub-total for this section in the space indicated. Please note that Seminar logowear will be distributed on-site and can be collected at the Seminar Bookstore.
Additional Information
NOTICE: CSHP, its event planners and sponsors refute all liability for the actions of any vendor, exhibitor or sponsor during Seminar 2009. CSHP also refutes all liability for the safety of any attendee in transit to or from Seminar 2009. CSHP, its event planners and sponsors reserve the right to cancel this event without penalty. The amount of any liability incurred by CSHP, its event planners and sponsors is limited to a refund of registration fees (including additional events, courses, or the like).
Hospitality Events: Please note that because of limited space, specific hospitality events require pre-registration to attend. Please see the registration form for details on dates, times and any charges that may apply.
Registration Cancellation and Refunds: All cancellation requests must be submitted in writing two weeks prior to Seminar 2009. Refunds will not be made if notification is received during or after Seminar. A $40 administrative fee will be charged for all refunds unless otherwise stated.
Special Assistance: If you or your registered guest require special assistance (reasonable accommodations as defined by the Americans with Disabilities Act, Section 12182) in order to fully participate in this event, please check the appropriate box on the front page of the registration form. You will be contacted by CSHP to make appropriate arrangements.
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