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Testimonials 2009

Colleen DePadua, Black & Decker

Minister VIP Pass Form

First Name:*

Last Name:*

Title: *

Email :*

Company Name:*

Company Website:

Address:*

Country:*

City/State:

Zip Code:*

Phone:*

Fax:*

What are the reasons you would like to attend the Global Healthcare Reform Ministerial Summit:*

Have you implemented
Healthcare Reform, Are Currently
implementing it, or plan to do so
in the future?:

Have you implemented Compulsory
Health Insurance, Are Currently
implementing it, or plan to do so in
the future?

Are you intersted in a speaking
opportunity at the summit? *

Yes No

A limited number of flights and hotel will be available to buyers at the discretion of the VIP Committee. All flights will be non-transferable, economy flights, subject to restrictions and from specific departure ports. Please select one of the following: (check one only).

	I would like to be considered for a registration pass that would allow me access to all the conferences at Employer Healthcare Congress
	I would like to be considered for my hotel accommodations
	I would like to be considered for a flight (economy class) if one is available
	Only consider my application if a flight and hotel is available for me

2009 Sponsors