2016 ACTheals International Conference
2016 ACTheals International Conference MERCY IN HEALTHCARE A CHRISTIAN MODEL FOR HEALING
Registration Deadline: September 9, 2016 Register online at actheals.org/ or Complete this form and forward with your check to: ACTheals • P.O. Box 4961 • Louisville, KY 40204
Register EARLY and SAVE!!! Completed registration must be received no later than August 9, 2016 in order to receive EARLY Registration discount. p YES! This is my first ACT International Conference
p YES! I am interested in going on the post conference tour to Niagara Falls.
p YES! I am interested in Continuing Education Units. Full Name:
Name on Badge:
Email:
Region:
Specialty Group Preference (circle only one):
Allied Health Psychotherapists
Associates Clergy & Religious Nurses Pastoral Care Physicians/Dentists/Chiropractors/Healthcare Practitioners
Address:
City:
Home Phone:
Work Phone:
State:
Zip:
Fax:
DON’T FORGET YOUR PASSPORT! Check the expiration date to be sure your Passport is current.
FULL REGISTRATION FEES: Meals included: 3 breakfasts, 2 lunches and 3 dinners.
EARLY Registration Through August 9, 2016
STANDARD Rate August 10 - September 16, 2016
USD
CAD
USA
CAD
Member: FULL Registration Spouse of Member: FULL Registration
$515 $515
$550 $550
$550 $550
$600 $600
Non-Member: FULL Registration
$635
$670
$670
$720
Member: SINGLE DAY Rate* Circle ONE: THURSDAY - FRIDAY - SATURDAY
$170
$200
$170
$200
$190
$220
$190
$220
(Meals included: 1 lunch and 1 dinner).
Non-Member: SINGLE DAY Rate* Circle ONE: THURSDAY - FRIDAY - SATURDAY (Meals included: 1 lunch and 1 dinner).
TOTAL REGISTRATION FEE(S):
USD$ _________
CAD$ _________ USD$ _________ CAD$ _________
IC SCHOLARSHIP FUND DONATION
USD$ _________
CAD$ _________ USD$ _________ CAD$ _________
TOTAL AMOUNT (Registration & Donation):
USD$ _________
CAD$ _________
Can’t attend the conference? Consider making a donation or contribution to the IC Scholarship Fund.
*ONLY ONE SINGLE DAY RATE purchase per person. More than one day registration requires purchase of a FULL Registration. Visit our website to meet our speakers, view (downloadable) conference schedule, make hotel reservations, see available Continuing Education Units and get details on post-conference tour.
BECOME A MEMBER TODAY and SAVE on REGISTRATION! Join ACTheals and register as a member. Not only will you receive a host of benefits, you can save money when you register for this conference. To join, go to actheals.org to review our list of Member Benefits and select MEMBERSHIP APPLICATION at the bottom.
REFUNDS AND CANCELLATIONS All cancellations must be made in writing. Written cancellations before September 1, 2016 are subject to a USD$50 processing fee. Refunds are not possible after September 1, 2016 except for emergencies (subject to approval of the ACTheals Leadership). All refunds will be processed after the meeting. ACT reserves the right to cancel any event due to lack of enrollment or other factors.
ACTheals • P.O. Box 4961 • Louisville, KY 40204 • 502.632.3036 x2 • [email protected] • www.actheals.org
Registration Deadline: September 9, 2016 Register online at actheals.org/ or Complete this form and forward with your check to: ACTheals • P.O. Box 4961 • Louisville, KY 40204
Register EARLY and SAVE!!! Completed registration must be received no later than August 9, 2016 in order to receive EARLY Registration discount. p YES! This is my first ACT International Conference
p YES! I am interested in going on the post conference tour to Niagara Falls.
p YES! I am interested in Continuing Education Units. Full Name:
Name on Badge:
Email:
Region:
Specialty Group Preference (circle only one):
Allied Health Psychotherapists
Associates Clergy & Religious Nurses Pastoral Care Physicians/Dentists/Chiropractors/Healthcare Practitioners
Address:
City:
Home Phone:
Work Phone:
State:
Zip:
Fax:
DON’T FORGET YOUR PASSPORT! Check the expiration date to be sure your Passport is current.
FULL REGISTRATION FEES: Meals included: 3 breakfasts, 2 lunches and 3 dinners.
EARLY Registration Through August 9, 2016
STANDARD Rate August 10 - September 16, 2016
USD
CAD
USA
CAD
Member: FULL Registration Spouse of Member: FULL Registration
$515 $515
$550 $550
$550 $550
$600 $600
Non-Member: FULL Registration
$635
$670
$670
$720
Member: SINGLE DAY Rate* Circle ONE: THURSDAY - FRIDAY - SATURDAY
$170
$200
$170
$200
$190
$220
$190
$220
(Meals included: 1 lunch and 1 dinner).
Non-Member: SINGLE DAY Rate* Circle ONE: THURSDAY - FRIDAY - SATURDAY (Meals included: 1 lunch and 1 dinner).
TOTAL REGISTRATION FEE(S):
USD$ _________
CAD$ _________ USD$ _________ CAD$ _________
IC SCHOLARSHIP FUND DONATION
USD$ _________
CAD$ _________ USD$ _________ CAD$ _________
TOTAL AMOUNT (Registration & Donation):
USD$ _________
CAD$ _________
Can’t attend the conference? Consider making a donation or contribution to the IC Scholarship Fund.
*ONLY ONE SINGLE DAY RATE purchase per person. More than one day registration requires purchase of a FULL Registration. Visit our website to meet our speakers, view (downloadable) conference schedule, make hotel reservations, see available Continuing Education Units and get details on post-conference tour.
BECOME A MEMBER TODAY and SAVE on REGISTRATION! Join ACTheals and register as a member. Not only will you receive a host of benefits, you can save money when you register for this conference. To join, go to actheals.org to review our list of Member Benefits and select MEMBERSHIP APPLICATION at the bottom.
REFUNDS AND CANCELLATIONS All cancellations must be made in writing. Written cancellations before September 1, 2016 are subject to a USD$50 processing fee. Refunds are not possible after September 1, 2016 except for emergencies (subject to approval of the ACTheals Leadership). All refunds will be processed after the meeting. ACT reserves the right to cancel any event due to lack of enrollment or other factors.
ACTheals • P.O. Box 4961 • Louisville, KY 40204 • 502.632.3036 x2 • [email protected] • www.actheals.org
