Registration

Midwest Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health

Registration Options:

  • Early Bird – $400 (July 2017 – August 31, 2017)
  • Regular – $450 (September 1, 2017 – November 22, 2017)
  • Onsite – $500 (November 29, 2017 – December 1, 2017)
Midwest Forum Registration Form

Personal Information

Contact Information

Work Address:

Background Information

Additional Questions

To help us better meet your needs during this conference, please respond to the following:

Forum Registration Options

Payment Details

If you owe a registration fee, after clicking "Submit," you will be taken to the Illinois Public Health Institute's PayPal page, where you can complete the payment process.

You will also receive an email confirmation that includes a link to the hotel reservation page, or you can reserve a hotel room via the Hotel Information page.

If you have any issues with payment, please contact Rebeca Gordenstein (rebeca.gordenstein@iphionline.org).