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Senior Healthcare Facilities Forum

July 14-15th, Philadelphia

Please book my place at the Nursing Home & Assisted Living Facilities Forum to be held at the Marriott Hotel, Philadelphia. I can confirm that I have the responsibility for reviewing/selecting potential service providers.
Name:
Organization:
Position:
Address:
Zip Code:
Tel No:
Cell:
Fax No:
Email:
Web Site:
Annual Care Homes Spend:

No. of homes in group:
Are you a:	Skilled Nursing Home Nursing Home Assisted Living Independent Living Facility
What is your role or responsibility within the organization?

Who else is involved in the buying decision?
Name:
Position:
Who would come, as your replacement should you be unable to attend?
Name:
Position:
Tel No (If different):
Email:
Briefly, explain your company activity?

Please check those services & products that you wish to discuss with suppliers at the Forum:
	Air Conditioning/Heating	Patient Security
	Infection/Mold/Odour Control	Access Control
	Access Control	Alarms bed/floor
	ID Smart Cards	ID Smart Cards
	Beds	Wandering
	Linen	Software:
	Mattresses	Financial
	CCTV	Energy Management System
	Building/Construction	Scheduling
	Architectural Services	Training
	Engineering Services	Transportation
	Interior Design	Medical:
	New Construction	Cardiac Equipment
	Remodeling	Defibrillators/Monitors
	Lighting	Clinical Waste Management
	Roofing	Durable Medical Equipment
	Consultancy - Facility	Bathing Aids
	Financial/Funding	Mobility Aids & Accessories
	Decor - Aesthetics	Rehab & Training Aids
	Disaster Planning/Recovery	Hygiene Services
	Employee Benefits	Incontinence Management
	Training	Personal Hygiene Products
	Recruitment	Infection Control
	Uniforms	Lifts & Patient Handling
	Equipment:	Emergency Nurse Call
	Bath/Spa	Nurse Call Systems
	Cleaning	Pharmacy Dispensing Equip
	Exercise/Rehab	Med Carts
	Kitchen	Ostomy & Urology
	Laundry	Respiratory Care
	Flooring	Purifiers - Humidifiers
	Carpet	Allergy Control
	Food Services/Suppliers	Electrostatic & Air Filters
	Housekeeping Services	Oxygen Concentrators & Oxygen Supplies
	Facility Insurance	Nebulizers & Aerosol Therapy
	Employee Insurance	I.V. Equipment and Supplies
	Janitorial/Sanitation Supplies	Wound Care
		Prevention
		Treatment
Terms and Conditions If any client attending the Forum is there to sell their Company's product and services, does not keep to their pre-agreed itinerary, or does not have genuine purchasing responsibility, the organizer reserves the right to charge such client for accommodation, meals and the cost equivalent to exhibiting at the Forum. When booking your place at the Forum you will be asked to provide a replacement name if you are unable to attend. If within 28 days of the Forum you cancel and your replacement is unable to attend, then a charge may be imposed of $1500. If you cancel within 48 hours your fee doubles. All cancellations must be in writing. I have read and accepted the terms & conditions of this booking and understand that a charge may apply should I cancel after June 13th 2008 (and my replacement is also unable to attend).
	By submitting this booking form I am agreeing to these terms and conditions