TAPS ANNUAL CONFERENCE
“Enhancing the Patient Experience Through Advocacy:
Connecting the dots for better patient outcomes”
September 25– 26, 2014
DoubleTree By Hilton Austin, Austin, Texas
REGISTRATION FORM
(One person per form – photocopy as needed)
Name
Credentials
Title
Friends Call Me
Organization
Address
City
Phone (
State
)
Cell Phone (
)
Zip
Fax (
E-mail
Special needs per the Americans with Disabilities Act?
Special diet needs? Describe
Is this your first TAPS conference?
REGISTRATION FEES
Member
Non-Member
Early Bird Special before 8/1/14
$250
$350
Full registration after 8/1/14
$300
$375
One Day Only & Guest Registration
Thursday (includes lunch & networking event) $125
$200
Friday (includes lunch)
$125
$200
Guest ticket: Thursday Networking Event
$ 35 x
Sponsorship Registration: Company
Membership Dues (9/1/13 – 8/31/14)
Active Member (employed by a health care institution)
$ 95
Associate Member (vendors, consultants, others)
$150
Affiliate Member (students, educators, non-voting)
$ 50
[TAPS tax ID # 03-0467983]
TOTAL DUE TO TAPS
)
Yes
Yes
Yes
Reg Fee
$
Please let us know if you will attend the following (check all that apply):
Networking Event, Thursday, September 25, 2014
Lunch on Thursday, September 25, 2014
Lunch on Friday, September 26, 2014
PAYMENT INFORMATION
My check #
payable to TAPS in the amount of $
is enclosed.
Please charge my:
Visa
MasterCard
Am Express Exp Date
/
Card Number
Verification Code
Billing Zip Code
Print cardholder’s name
Signature
Please email or fax this form by September, 20, 2014
Kyle Whitaker, TAPS Executive Director
P.O. Box 121959
Arlington, TX 76012
Phone: 512.508.8277; Fax: 512.355.1930
TAPSAdmin@TAPS-online.org
No
No
No