APIC Research Fundraiser Raffle Name: _____________________________________________ Phone: ________________________ E-mail: ___________________________ Address: _______________________________________________ City: _______________________State: _______________ Zip: __________ Signature: ____________________________ Raffle Ticket Numbers Received (to be filled out by APIC staff):__________--_________ Tickets are $5 / each. Please indicate the number of raffle tickets you would like for each item. Directions can be found at www.apic.org/raffle: Prize #1: Free 1-year subscription to APIC Text Online™ + Apple™ iPad (wireless/3G, 32GB) - valued at $878.00 Number of tickets: _______________ The APIC Text Online is the complete, internet-accessible version of APIC Text. The APIC Text – whether in-print or online – is the definitive resource for infection prevention and control in the healthcare setting. It contains 120 chapters – more than 1,700 printed pages -- covering the latest guidelines, research, technology, and clinical standards. A subscription-based resource, the APIC Text Online is fully searchable, updated regularly, and accessible from any computer with an Internet connection. The Apple iPad allows users to view whole internet pages in portrait or landscape on the large 9.7-inch Multi-Touch screen; view / respond to e-mails and view attachments; maintain one’s calendar, contacts and lists; easily create and share photo albums / slideshows and place the iPad in the optional Dock as a digital photo album frame; watch HD movies, TV shows, podcasts, and more; read iBooks (similar to a Kindle); create/deliver presentations, documents, and spreadsheets; download up to 150,000 apps; use the built- in maps application as a GPS; play your iPod music or download music from iTunes AND view the full APIC Text Online at no cost for 1 year. Because the iPad has wireless capability, the winner can walk around a hospital or other healthcare facility viewing the APIC Text Online and responding to e-mails. Prize #2: Hard copy of + Burberry™ handbag - valued at $1,120.00 A P I C T ™ Number of tickets: _______________ t e x The Burberry Nova Check Handbag is a medium-large, coated canvas tote handbag in the Nova check pattern. It has patent leather trim and two patent leather handles with buckle attachments and a top zip closure. The APIC Text of Infection Control and Epidemiology is the definitive source for clinical standards in infection prevention and patient safety. As the essential professional reference for infection preventionists, the APIC Text includes updates on the latest guideline and regulation changes, as well as advancements in technology and clinical practice. Prizes #3 and #4: Free registration to the APIC 2011 Annual Conference + a Harbor-View, Club-Level Room for 5 nights Number of tickets: _______________ at the Renaissance Baltimore Harborplace Hotel – valued at $2,470.00 / per package This prize includes free registration to the APIC 2011 Annual Conference in Baltimore, Maryland for the duration of the conference, including preliminary events and a 5-night stay at the 4-star Renaissance Baltimore Harborplace Hotel. Each package comes with a VIP welcome amenity and Concierge Lounge Access, which includes complimentary breakfast, midday snack, hors d’oeuvres, desserts, non-alcoholic beverages and business services. Cocktails can be purchased at the Concierge Lounge, which features an amazing view of the Baltimore Inner Harbor. This hotel, part of the Marriot Hotel network, features newly renovated guestrooms with flat panel televisions, iPod docking stations, improved wireless high-speed internet, 24-hour Fitness Center and indoor pool with lounge. Just steps away from the area’s most unique sights and attractions, the Renaissance Baltimore Harborplace Hotel gives premier access to the world-famous Inner Harbor, Baltimore Aquarium, the Maryland Science Center, Gallery Mall, Cross Street Market, Baltimore’s Little Italy, and 120 dining and shopping options. For APIC members who are not able to attend the Annual Conference in New Orleans, but who would like to support the APIC Research raffle: Please fill out this form, attach a check or money order h d i i f f l f d for the appropriate amount made payable to “APIC Research”, and mail to: Yolanda Tillery, c/o APIC, 1275 K Street NW, Suite 1000, Washington, DC 20005. W e n e s n n g n y o u r r a e o r m a n i l d i l i l b l h i h b l d f f l i k f l b l h k i l l b i l d b k h d d l i i d t t A P I C M U S T t t I t t t t T M J 2 1 2 0 1 0 p a y e m n o y o u n c u e m a n g a e s w c c a n e p a e c o n r a e c e s a e s a e r n o p e r e s n e p a c a e g w e m a e a c o y o u e e a e n s o n a y u e n , . , . , , . You may also give this completed form + payment to a chapter leader or fellow APIC member who will be attending the Annual Conference. The chapter leader / member who agrees to buy tickets on behalf of the non-attending member, can bring this form + payment to the Exhibit Hall Raffle area booth on Monday or Tuesday (July 12-13, 2010) to purchase these raffle tickets. If mailing labels are included with this package, APIC staff will be able to help with this process. Winners of the raffle do not need to be present in order to win. The raffle drawing will take place on place on Thursday, July 15th at 9:45 am in the General Session Room (Hall I-1) of the New Orleans Morial Convention Center. All proceeds will be used to fund current and future APIC Research studies.