Be_A-Bridge

Regional Summit
September 29, 2008
Pittsburgh Marriott North
Cranberry Township, PA

Dialogue on Disparities:
Addressing Tobacco-Related Chronic Disease

This form to be used for online registration only. For a complete program brochure and to register by fax or mail, please print the PDF version of the brochure.

There is no fee to attend the Summit, however, all registration forms must be received no later than September 22, 2008 to pre-register for this conference.
Registrations received past this date will be considered walk-in registrations. We cannot guarantee space in any program for those registrations received past the cut-off date.

* Prefix: (Mr., Mrs., Ms., Rev., etc)
* First Name:
* Last Name:
Suffix: (Jr., Sr., etc)
Credentials: (MPH, MSW, etc.)
Name Badge: (if different than above)

* Organization:
* Street Address:
* City:
* State/Province:
* Zip/Postal Code:
* Work Telephone:
Fax:
* Email:

How did you hear about this conference?


* Dietary Requirements:

Breakout Session Preferences:
Each attendee will have the opportunity to attend two breakout sessions. Please choose the breakout session you wish to attend in order of your preference (1, 2, 3, 4). To guarantee placement in your preferred session, please register as soon as possible. If you do not select any preferences, you will be assigned to breakout sessions based on availability.

1st2nd3rd4th
Breakout Session A
How can I use technology to get the most out of my program?
Dean Graham, NPower PA

1st2nd3rd4th
Breakout Session B
How can I make my program known in the community and reach specific audiences to further my program's goals?
Laura Line, MS, National Nursing Centers Consortium

1st2nd3rd4th
Breakout Session C
How can I measure the progress and outcomes of my program?
Tania Bogatova, MBA, MA, KeyStone Research Corporation

1st2nd3rd4th
Breakout Session D
How do I fund my program? (Intro level)
Anita Leonard, RN, MPH, CHES, Monongahela Valley Hospital

Confirmation of Registration
A valid email address is required to confirm online registration. When registering online, a confirmation email should follow within 30 minutes. If you have any questions regarding your registration, please contact Meeting Resources Unlimited, 724-744-1772.

* Membership
Are you interested in becoming a BE-A-BRIDGE Member?
Yes (Membership is FREE)
Maybe, I need more details
I am already a member
No

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Online registration services provided by Meeting Resources Unlimited and Interteq.com