HCA Advocacy Day - Albany, New York - Legislative Office Building

REGISTRATION

Please take a moment to complete the form below to register for HCA's State Advocacy Day on February 5, 2020 in Albany, New York. Details will be emailed to you as soon as your registration is confirmed. For questions, please call us at 518-426-8764.

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* 1. Please provide your information below:

Name: *

Title: *

Company:

Email Address: *

Phone Number:

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* 2. Please indicate if you are bringing additional participants (i.e. additional staff from your organization, patients and/or their family members, etc.)

Yes

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* 3. If Yes, please indicate the number of additional registrants:

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* 4. Please enter the name and email address for each additional registrant:

Registrant 1/Name and Email

Registrant 2/Name and Email

Registrant 3/Name and Email

Registrant 4/Name and Email