Outpatient Surgery Magazine

OR Excellence Session Previews - June 2015

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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4 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U N E 2 0 1 5 Registration Form Marriott San Antonio Rivercenter San Antonio, Texas October 14-16, 2015 REGISTRATION INFORMATION First Name: ______________________________________________________ Last Name: _________________________________________________ Degree(s): _______________________________________________________ Title: ______________________________________________________ Facility/Company: ____________________________________________________________________________________________________________ Address: ________________________________________________________ City/State/Zip: _______________________________________________ Phone: __________________________________________________________ Fax: _______________________________________________________ E-mail: __________________________________________________________ Website: ___________________________________________________ TO REGISTER, COMPLETE FORM AND MAIL OR FAX AS DIRECTED: • Mail: Make checks payable to Herrin Publishing Partners, LP. Mail to Herrin Publishing, 255 Great Valley Parkway, Suite 100, Malvern, PA 19355 • Fax: Fax registration form with credit card information to (610) 240-4919 • Phone/Internet: (888) YOUR-ORX (888-968-7679) to register over the phone; www.orexcellence.com to register online. Please print or type the information below and use a separate registration form for each attendee. HOTEL RESERVATIONS The Marriott San Antonio Rivercenter has set aside discounted rates for conference attendees. Please contact the hotel directly to make your reservation. Be sure to mention you are attending the OR Excellence Conference and Exhibits to receive the discounted group rate of $195 (Single/Double). The group rate is exclusive of applicable state and local taxes. The discounted group rates will be offered until September 30, 2015, or until all rooms in the group block have been reserved, whichever occurs first. Reservations received after this date are subject to space and rate availability and may not be available. Please make your reservations early in order to receive the group rate. A credit card will be required to guarantee your reservation. You may also register online at www.orexcellence.com. Marriott 101 Bowie Street, San Antonio, Texas 78205 Reservations: resweb.passkey.com/go/orexcellence2015 or call 877-622-3056 Group Name: OR Excellence Conference Group Rate: $195 (Single/Double) CONFERENCE QUESTIONS For additional information or questions regarding the conference, please contact: Phone: (888) YOUR-ORX Email: orxmanager@outpatientsurgery.net PAYMENT INFORMATION ❑ Enclosed is a check payable to Herrin Publishing Partners, LP ❑ Check #: _____________ Please include a copy of this form with your check ❑ I authorize Herrin Publishing Partners, LP, to charge my: ❑ American Express ❑ Mastercard ❑ Visa ❑ Discover **Guest Policy: Significant others and guests of attendees are welcome to participate in our evening events. However, guests may not be surgical market vendors or consultants. There will be a strict "no soliciting" policy for guests. Commercial passes are available for vendors and consultants wishing to meet exhibitors and guests. Credit Card Number: ______________________________________________ Expiration Date: ___________ 3 or 4 Digit Security Code: ________ Printed Cardholder Name: __________________________________________________ Signature: _______________________________________________________________ Type your name if completing online Cancellation Policy: If your cancellation is received in writing on or before August 21, 2015, your refund will be granted less a $50 administration fee. If your cancellation is received between August 21, 2015 and September 25, 2015, your refund will be granted less a $150 administration fee. There will be no refunds after September 25, 2015. CONFERENCE REGISTRATION AND PAYMENT INFORMATION (If you register more than one (1) person from the same facility you will receive the multiple registrant discounts as listed below. The first registrant will be charged the first registrant fee listed and the additional registrants will be charged the discounted fee.) FULL CONFERENCE REGISTRATION FEES* # Attending Price until 8/21/15 Full Conference (1st Registrant) ______ $675 pp $ __________ Full Conference (2nd or Add'l Registrants) ______ $575 pp $ __________ Wed AM Workshops (pick one - no charge): ❑ A. Outpatient Total Joint Workshop ❑ B. Tough Staffing Challenges Workshop ❑ C. Doctor-Nurse Relationship Workshop ❑ Check here if you need AEU credits for CASC Guest** Passes for Exhibit Hall Events (Included for the Registrant. Please only purchase if bringing an additional guest to the exhibit hall): Wine Tasting/Martini Madness ______ $49 pp $ __________ Guest's Name (First/Last): _________________________________________ Total Registration Fees Due $__________ *Please call us for partial rates at (800) YOUR-ORX or visit our website at www.orexcellence.com. O

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