MHA Event Registration

IN-PERSON
2023 MHA Leadership Forum
Thursday, June 22, 2023 through Friday, June 23, 2023

Event Details

D05279 420028*50*00

Registrant's Information

First Name:		Last Name:
Job Title:		Credentials:
Work Email:		CC Email:
Phone Number:
**PLEASE NOTE: Confirmation and additional information will be sent to the email address indicated on the registration form.

Hospital/Organization

Hospital/Organization Name: (Please do not abbreviate.)
Address:
City:	State:	ZIP Code:

Registration Fees


$450 for MHA Members - after March 31
$550 for Non-Members
Please carefully review and select the options below regarding your plans to attend the social:
I plan to take the shuttle provided to the Networking Social at Negro Leagues Baseball Museum
I also need shuttle transportation for my guest.
I plan to provide my own transportation to the Networking Social at Negro Leagues Baseball Museum
I do not plan to attend the Networking Social at the Negro Leagues Baseball Museum
Discount: $0.00
Total:

Payment Options

Coupon No:
*If you have a coupon, please enter in box above.
Check Make check payable to: MHA Health Institute P.O. Box 60, Jefferson City, MO 65102-0060. Checks payable to other entities will be returned. Credit Card

Security Check

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