Attendee Registration

Transcription

1 Attendee Registration THE 2016 CENTRAL NEW YORK APRIL 6 SHERATON SYRACUSE UNIVERSITY HOTEL SYRACUSE Building Excellence in Behavioral Health hosted by Syracuse Behavioral Healthcare

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3 M AY 1 3 T H E H O L I D AY I N N L I V E R P O O L In an effort to improve access to evidence based practice, and to increase collabutilizing Humor & Wellness in a Rapidly Changing Healthcare World oration within our healthcare community, Syracuse Behavioral Healthcare is pleased to announce the second annual CNY Behavioral Healthcare Conference. The theme of the 2016 Central New York Behavioral Healthcare Conference is Building Excellence in Behavioral Health. As peers, clinicians, doctors, and administrators, excellence is the standard we strive for when serving our patients. With this in mind, this year s event is intended to offer a forum to highlight best practices in these professions. Both clinical and administrative tracks will be offered at this conference. You are invited for a day of learning, networking and professional growth. Mr. Jake Poore will deliver the keynote address on the importance of customer service in healthcare, and presentations have been gathered from a diverse set of practitioners. Speakers include Mr. Greg Allen (NYS Medicaid), Mr. Rob Kent (NYS OASAS), and clinicians from Syracuse Behavioral Healthcare, St Joseph s Hospital, and Belvedere Health Services. Jason Page CNY Behavioral Healthcare Conference Planning Committee Building Excellence in Behavioral Health

4 THE 2016 CENTRAL NEW YORK A P R I L 6 S H E R AT O N S Y R A C U S E U N I V E R S I T Y H O T E L S Y R A C U S E Building Excellence in Behavioral Health Keynote Speaker For our 2016 Keynote speaker we are pleased to introduce Mr. Jake Poore, President and Chief Experience Officer for Integrated Loyalty Systems. Unlike typical speakers, Jake spends most of his time in the trenches of healthcare institutions. You may find him shadowing a physician in the emergency department, learning the needs of the sterile processing department, or delivering food with the food service team. As Founder and President of ILS, Jake knows what it takes to create and maintain a worldclass service organization. He spent nearly two decades at the Walt Disney Company helping to train and align 65,000 employees toward one end: creating memorable experiences for individuals, not masses. Jake Poore Jake has spent the past 15 years fine tuning those blueprints by adding best practices from leaders in service, like Southwest Airlines and Ritz-Carlton Hotels, and applying them to more than 100 top healthcare organizations.

5 Conference Attendee Registration LAST NAME: FIRST NAME: ORGANIZATION: JOB TITLE: PROFESSIONAL LICENSE/CERTIFICATION: ADDRESS: STATE: ZIP CODE: PHONE: CONTINUING EDUCATION UNITS (CEU S) NEEDED? YES NO If yes which CEU s you would like to collect: (please check the type(s) of CEU s) NYS SOCIAL WORK NYS OASAS CASAC RENEWAL CTRS (PLEASE INCLUDE AN ADDITIONAL $10.00 CEU PROCESSING FEE) Full Conference Registration PROFESSIONAL (01/04/16-01/31/16: $ /01/16-03/28/16: $145. DAY OF: $155) STUDENT* (01/04/16-03/28/16: $125. NO DAY-OF-REGISTRATION DISCOUNT) *PROOF OF FULL TIME STUDENT STATUS MUST ACCOMPANY REGISTRATION FORM AND PAYMENT NO REFUNDS WILL BE GIVEN FOR THIS EVENT UNLESS THE CONFERENCE IS CANCELLED BY SBH OR ITS APPOINTED REPRESENTATIVE. SIGNED: DATE: 2016 hosted by Syracuse Behavioral Healthcare

6 Payment Options SBH will accept the following payment options for the 2015 CNY Behavioral Healthcare Conference (indicate your payment method by checking the appropriate box): CHECK Checks should be made payable to Syracuse Behavioral Healthcare. Please write Conference Registration on the check. Checks can be mailed or brought to the SBH administrative offices, along with this registration form, to: Jason Page CNY Behavioral Healthcare Conference Syracuse Behavioral Healthcare, Suite North Salina Street Syracuse, NY CASH Cash can be brought into our administrative offices along with this form and payment can be made in person. Do not mail cash. CREDIT CARD Credit card payments can be made by completing the information below and returning this form to the address detailed above. BILLING ADDRESS: CITY: STATE: ZIP: CARD TYPE: MASTERCARD VISA AMEX DISCOVER NAME ON CARD: CARD NUMBER: SECURITY CODE: EXPIRATION DATE: CHARGE AMOUNT: $ hosted by Syracuse Behavioral Healthcare

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8 2016 hosted by Syracuse Behavioral Healthcare