CCIH and GHC 2005 Conference Registration

With this form, you can register for either the CCIH or the Global Health Council conference, or for both conferences. The GHC has offered full registration for their conference to CCIH members at the group rate of $99 (not including the June 2 awards dinner), a reduction of over $250 below the normal registration rate. To be eligible for this special rate, you must be a CCIH member, either as an individual or through your organization, and register through CCIH. Do not use the GHC’s online registration form.

CCIH, which grew out of the Global Health Council in 1987, maintains very close relations with the GHC and encourages people in the faith community to be active in the GHC.  The GHC in turn encourages greater participation by professionals in the faith community and has offered an exceptional conference registration discount to CCIH members.  CCIH encourages those registering for the conference also to become members of the Global Health Council.

On Tuesday, May 31, CCIH and the GHC are co-sponsoring a day-long workshop: Faith-Based Organizations as Pioneers and Partners in Health Systems Development, to be held at the Omni Shoreham Hotel in Washington, DC. If you register for either the CCIH or the GHC conference, you are eligible to attend the May 31st workshop, whether or not you are attending the rest of the GHC conference. Please indicate whether you will attend this workshop in Section IV below.

CCIH is also offering a May 28 pre-conference workshop on Monitoring and Evaluation. You must register for this workshop separately from the CCIH conference, in Section II below.

Please register as soon as possible. After April 29, you will have to register for the GHC conference on-site, although you will still be eligible for the group rate of $99 if you are a CCIH member. After May 21, contact Allison Herling at aherling@ccih.org regarding space at the CCIH conference.
I.  INFORMATION NEEDED FOR BOTH CCIH AND GHC CONFERENCES (* = Required Information)
First Name *
Last Name *
Degrees
Title
Organization
Address 1
Address 2
City
State
Zip Code
Country
Telephone:
Fax:
Email*
Special needs (diet, child care, handicapping conditions):
Prayer requests:
Will you need table space for exhibits on your work? No exhibit space needed
 Yes, please reserve exhibit space
   
II.  REGISTRATION FOR CCIH PRE-CONFERENCE M&E WORKSHOP, May 28, 2005
 For more information about the workshop, including a schedule and list of speakers, click here.

This workshop is now full. Please contact Allison Herling at aherling@ccih.org if you would like to be put on a waiting list.

A. Registration for CCIH Pre-Conference Workshop: Monitoring and Evaluation

 CCIH member* ($60)
 CCIH Non-member ($85)
(*for membership information, see section III.D. below)
B. Lodging, including breakfast Friday night ($47)
C. Meals Friday dinner ($10)
 Sat lunch ($8)
   

III.  REGISTRATION FOR CCIH CONFERENCE, MAY 29-31, 2005
 CCIH is offering free registration to students, recent graduates, developing country professionals, and other low-income participants. Scholarships to partially cover the cost of food and lodging are also available to students and developing country professionals. Contact Allison Herling at aherling@ccih.org for more information. CCIH is not able to provide scholarships for the cost of travel to the conference. Click here for a schedule of the conference.

A. Registration for CCIH Conference (check one only)* Full conference: CCIH member* ($100)
 Full conference: Non-member ($125)
 One day: CCIH member* ($60)
 One day: Non-member ($85)
 Student or low-income participant ($0)
(*for membership information, see section III.D. below)
If one day only, please indicate day:
   

B. Lodging, including breakfast (check one only)*

There are no longer beds available at Wellspring, in the cabins or the tents. Please book a room at a nearby hotel using the link below.

click here for hotel info

No lodging required ($0)
 Saturday, Sunday, and Monday nights ($121)
 Saturday and Sunday nights only ($84)
 Sunday and Monday nights only ($84)
 Saturday night only ($47)
 Sunday night only ($47)
 Monday night only ($47)
Tenting (+ bedding) $20/night
Tenting (no bedding) $15/night
If tenting, enter number of nights:
Other lodging combination desired (enter details)
   
C. Meals (check all meals that you plan to take) Saturday dinner ($10)
 Sunday lunch ($8)
 Sunday dinner ($10)
 Monday lunch ($8)
 Monday dinner ($10)
 Tuesday lunch ($0)
   

D. Tax deductible membership donation to CCIH*

 

 

 

Already a CCIH member
 No thanks
 Regular membership ($25)
 Reduced-rate membership for students, recent graduates, low-income professionals, and developing country participants ($15)

CCIH encourages those who can afford it to make a membership donation of $50 or $100, to support CCIH's expanding ministry. Membership must be renewed once a year.

Additional Donation to CCIH
   
IV. PARTICIPATION IN MAY 31 CCIH/GHC WORKSHOP

"Faith-Based Organizations as Pioneers and Partners in Health Systems Development”*

click here to view a schedule of this event

Yes, I will be attending the May 31 workshop.
 No, I will not be attending the May 31 workshop.
   

V.  REGISTRATION FOR GHC CONFERENCE, MAY 31-JUNE 3, 2005

The April 29 deadline for advance registration for the GHC conference has passed. Please do not use this form to register for the GHC conference. You may register on-site at the GHC conference, and will still be eligible for the $99 CCIH member rate, provided you are a CCIH member.

Please see www.globalhealth.org for more information about the GHC conference and GHC membership, including benefits. There are no refunds for cancellations once you have registered, but substitutions may be arranged.

A. Registration for Global Health Council Conference CCIH member rate ($99)
 No thanks
   
B. Ticket to Awards Banquet (June 2) Purchased before April 1 ($75)
 Purchased after April 1 ($100)
No thanks
   
C. Membership in Global Health Council (check one) Already a GHC member
 No thanks
Professional rate ($120)
Student rate ($60)

Please total the above fees to determine how much to send to CCIH along with your registration information:

IIA + IIB + IIC + IIIA + IIIB + IIIC + IIID + VA + VB +VC = Total to Submit
Total To Submit*
Payment Mode* PayPal
Check
Phone - Credit Card

You may submit this registration form online by clicking above

or

print and mail this form with payment to:

CCIH Registrar, 1817 Rupert St., McLean, VA 22101

 Important Payment Processing Information:

Registration is not complete until CCIH receives payment. You may pay by check or credit card. If paying by check, make checks (U.S. funds only) payable to CCIH, and mail to CCIH Registrar, 1817 Rupert St., McLean, VA 22101.

There are three ways to pay by credit card: 

1) PayPal: You may pay by credit card or by direct withdrawal from your bank account, by clicking the button below. You are not required to open a PayPal account in order to make this payment (although you will be presented the option to create an account at the end of the transaction).  Note: On the PayPal Shipping Information page select "Shipping is not Required."

2) Credit Card via mail: For payment for the GHC conference, you can provide your credit card information by printing out this form below and mailing it to CCIH. You cannot send credit card information online because CCIH does not have a secure web server. (CCIH cannot accept credit card payment for the CCIH conference by this method. You must use PayPal or pay by check.)

 CREDIT CARD INFORMATION (for Global Health Council payments only)

Total amount to be charged:__________________________________ 

Card Number:___________________________________      Expiration Date:___________

Cardholder Name (Please Print):_________________________________________

Cardholder Billing Address:______________________________________________

Cardholder Signature:__________________________________________________

Cardholder Phone Number:______________________________________________

 3) Credit Card via phone: For payment for the GHC conference, you can provide your credit card information by phone to Allison Herling, CCIH Program Associate, at 202-494-8339. (CCIH cannot accept credit card payment for the CCIH conference by this method. You must use PayPal or pay by check.)

 Note:  You may make your CCIH membership donation online through the “Donate Now” icon on the CCIH homepage (www.ccih.org). Please note that you may not use the “Donate Now” link to pay CCIH or GHC conference fees, as legally this service can only be used for charitable donations.

 

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Last Updated: Monday, May 23, 2005