Community Benifit 101

Revenue number: 4990-6002-3

Registration Form

Community Benefit 101
Chase Park Plaza Hotel
St.Louis, MO
Oct 28-29, 2008

2 Ways to Register

Preferred Method: Complete this form and submit online.
Print this form and mail it with payment to CHA:
- Catholic Health Association
- Attention: Registration
- PO Box 500082
- St. Louis, MO 63150-0082

Please register by Monday, Oct. 6, 2008.

Badge Name:*
Prefix:	Job Title:
First Name:*	Organization: *
Middle Initial:	Address Line 1:*
Last Name:*	Address Line 2:
Suffix:	City:*
E-mail:*	State / Province:*
Phone:* (ex: 888-555-1234)	Postal Code:*
Fax: (ex: 888-555-1234)	Country:	*denotes required fields
Special Needs — Please indicate if you have special physical or dietary needs. A CHA representative will contact you. Travel/Accommodations — Please indicate if you have questions about travel or accommodations. A CHA representative will contact you.

Registration Fee*

$425 for CHA Member Registrants
$470 for Ministry Partner Registrants
$515 for Other Registrants

Not sure which type of registrant you are? Please, click here.


Credit Card Type:*
Credit Card Number:*	(no formatting)
Card Verification Number:*	what's this?
Expiration Date:*	/
Promotional Code:

For more information, contact CHA Registrar at CHARegistrar@chausa.org.

Cancellation Policy

To cancel your participation, please e-mail your cancellation request to CHARegistrar@chausa.org. CHA observes the following refund policy:

If the cancellation request is received prior to or by Oct 6, paid fees will be refunded minus a $50 cancellation fee.
If the cancellation request is received after Oct 6, program registrants are liable for the entire registration fee.
There is no charge to send a substitute.

Note: CHA shall have the right in its sole discretion to determine if a registrant meets attendance criteria. If registration is declined, CHA will refund the fees paid.