Hospital Summit Registration

Registration closes on November 12th.

Contact Name(Required)

First Last

Professional Title(Required)

Hospital Affiliation(Required)

Email(Required)

Phone

Do you have any dietary restrictions/allergies?(Required)

Yes

Please list your dietary restrictions/allergies:

Will you be attending the reception?(Required)

Yes

Reception & Alcohol Acknowledgment

Alcoholic beverages may be available during the reception. Attendees who choose to consume alcohol are responsible for doing so responsibly and for arranging safe transportation. We Are Sharing Hope SC assumes no responsibility for an attendee’s decision to consume alcohol or for actions resulting from alcohol consumption.

I have read and acknowledge the above alcohol policy.

Photo/Video Release

By checking this box, I acknowledge that photographs and/or video may be taken during the event and authorize We Are Sharing Hope SC to use my image, likeness and/or voice for communications, educational and promotional purposes.

I acknowledge and agree to the photography and video release above.