American College of Healthcare Executives Online Seminar

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					American College of Healthcare Executives Online Seminar Registration Form—2011
Online program format:

Each program is six weeks long. you will be required to complete assignments online and from your program material before each session.
The seminar faculty will post a question to be answered and discussed during the week, and a summary of key points from previous sessions’
questions will be provided. Faculty also will be available for one week following the conclusion of the sixth session to answer any final questions.
At the end of the course, participants will be asked to complete an evaluation of the online program.

To expedite registration and reserve your place in these popular programs, please fax this form with your payment information as soon as possible.
How to register:                                                                Personal information:

• if paying by credit card, please register online through the online
  Seminars link in the Education area of, contact the Customer         nAME
  Service Center at (312) 424-9400 to register over the phone, or com-
  plete the registration form below and fax it to (312) 424-9405.               TiTlE
• if paying by check, first complete the registration form below
  and fax it to (312) 424-9405 with a copy of your organization’s check         orgAnizATion
  request or a copy of your personal check, payable to the Foundation
  of the American College of healthcare Executives. Then mail the check         ADDrESS
  and registration form to the Foundation of the American College of
  healthcare Executives, 3376 Eagle Way, Chicago, il 60678-1033.                CiTy/STATE/zip

For your convenience, remember:
                                                                                phonE                                        FAx
• registrations are accepted in the order they are received.
• payment is required at the time of enrollment. if you are paying
  by check, a copy of the check request or personal check will be
  accepted for registration via fax.                                            yoUr Six-ChArACTEr iD nUMbEr (SEE UppEr lEFT-hAnD CornEr oF yoUr MAiling lAbEl)

• To cancel your participation in the seminar, please contact the
                                                                                Method of payment:
  Customer Service Center at (312) 424-9400. please note: For a
  full credit or refund, you must notify AChE in writing at least 14            To expedite enrollment, please fax payment information to
  days before the program. After that time, all fees are forfeited;             (312) 424-9405 and use the following payment options for
  however, substitutions are permitted.                                         U.S. dollars or equivalent Canadian currency only.
Please enroll me in:
                                                                                    Check enclosed, payable to Foundation of the American
(Check program name/date and registration fee.)                                     College of Healthcare Executives.

  Community Health Assessment            Management Mistakes, Moral                 y Visa                                 [ MasterCard
  and Your Organization                  Dilemmas and Lessons Learned
  (6 Category i (AChE Education)
                                                                                    q American Express                     t Discover
                                         (6 Category i (AChE Education)
  credits)                               credits)
  Wednesday, September 21 –              Wednesday, September 28–
  november 2, 2011                                                              AMoUnT ChArgED                   ACCoUnT nUMbEr                     Exp. DATE
                                         november 9, 2011, (price includes
     $465 Affiliates                     book).                                 $
     $540 nonaffiliates                     $515 affiliate
                                                                                CArDholDEr’S SignATUrE
  Strategic Planning That Works:            $590 nonaffiliate
  Integrating Strategy with              Exceptional Leadership
  Performance                                                                       purchase order, accepted from the Department of Veterans
                                         (6 Category i (AChE Education)             Affairs/uniformed services only.
  (6 Category i (AChE Education)         credits)
  credits)                               Wednesday, August 31 – october
  Wednesday, September 14 –              12, 2011(price includes book).         pUrChASE orDEr nUMbEr
  october 26, 2011                          $515 Affiliates
    $465 affiliate                          $590 nonaffiliates                  Please complete and return the registration form above.
    $540 nonaffiliate
                                         A Review of Health Law
  Health Information                     (9 Category i (AChE Education)                            Continuing Education Credit
  Technologies and Their                 credits)
  Application in Healthcare              Wednesday, october 19 – December       6-9 Category I (ACHE education) credits toward advancement and
                                         07, 2011                               recertification in ACHE
  (6 Category i (AChE Education)
  credits)                                  $710 Affiliates
                                                                                in addition to the Category i (AChE education) credits assigned to
  Wednesday, october 12 –                   $810 nonaffiliates
                                                                                these programs, AChE is accredited by other organizations to provide
  november 23, 2011
                                         Superior Productivity in               continuing education credit.
    $465 affiliate
                                         Healthcare Organizations
    $540 nonaffiliate                    (9 Category i (AChE Education)         For more information, please refer to or contact
                                         credits)                               the Customer Service Center at (312) 424-9400.
                                         Wednesday, october 26 – December
                                         14, 2011                                                                                           CC onlinEW11
                                            $710 Affiliates
                                            $810 nonaffiliates

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