TSL Web Reg

[Registrant_First_Name] [Registrant_Last_Name]  
Cancellation Policy 
Cancellation is required in writing within the following time frame:  Cancellations received by August 31, 2021 will receive a 50% refund, no refunds will be issued if cancellation is received after August 31, 2021, Refunds will not be given for no-shows.  Cancellations by phone will not be accepted.  Registrants are encouraged to send a substitute. Cancellation due to State survey: the state Surveyors must actually be in the building in order to receive a refund. To receive a refund due to a Survey, Beacon Institute requires a form to be completed. Please send all cancellation request to Annmarie Gordon, <a href="mailto:agordon@lifespan-network.org" rel="noreferrer">agordon@lifespan-network.org</a>.
If you are paying by check this document serves as your invoice.  Make checks payable to:
The Beacon Institute 7090 Samuel Morse Drive Suite 400 Columbia, MD 21046
[Section_Event_Info_Basic] [Section_Registrant_Full_Info] [Section_Questions_All] [Section_Registration_Type] [Section_Additional_Registrants] [Section_Total_With_Other_Fees] [Section_Payment_Current]

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Providers: Skilled Nursing, Rehab Centers, CCRCs, Assisted Living Facilities and Medical Day Service

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Daily rate applies to Providers only.

Description	Price $	Add. Reg. Price $
Member Skilled Nursing, Rehab Centers, CCRCs	$	$
Non-Member Skilled Nursing, Rehab Centers, CCRCs	$	$
Member Assisted Living Facilities/Medical Day Services	$	$
Non-Member Assisted Living Facilities/Medical Day Services	$	$
Member Tuesday Only	$	$
Non-Member Tuesday Only	$	$
Member Wednesday Only	$	$
Non-Member Wednesday Only	$	$
Member Thursday Only	$	$
Non-Member Thursday Only	$	$
Member Friday Only	$	$
Non-Member Friday Only	$	$
Member Associate Business (Exhibiting) - No Booth Rep	$	$
Member Associate Business (NOT EXHIBITING)	$	$
Non-Member Associate Business (EXHIBITING) - No Booth Rep	$	$
Non-Member Associate Business (NOT EXHIBITING)	$	$
SPEAKER	$	$
EXHIBIT STAFF	$	$

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Cancellation Policy

Cancellation is required in writing within the following time frame: Cancellations received by August 31, 2021 will receive a 50% refund, no refunds will be issued if cancellation is received after August 31, 2021, Refunds will not be given for no-shows. Cancellations by phone will not be accepted. Registrants are encouraged to send a substitute. Cancellation due to State survey: the state Surveyors must actually be in the building in order to receive a refund. To receive a refund due to a Survey, Beacon Institute requires a form to be completed. Please send all cancellation request to Annmarie Gordon, agordon@lifespan-network.org.

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Cancellation Policy

1. Do you require Nursing Home Administrator continuing education credits? *	Yes No
2. Enter LHNA# or NONE *
3. Enter NAB Registry ID# or NONE *
4. Dietary Restrictions	Kosher Vegan
5. Is attendee vaccinated for COVID 19?	Yes No
6. Vaccine card or record provided?	Yes No
7. If not vaccinated has negative COVID test been provided	Yes No
8. Attendee waiver signed?	Yes No

For additional registrant 1
1. Do you require Nursing Home Administrator continuing education credits? *	Yes No
2. Enter LHNA# or NONE *
3. Enter NAB Registry ID# or NONE *
4. Dietary Restrictions	Kosher Vegan
5. Is attendee vaccinated for COVID 19?	Yes No
6. Vaccine card or record provided?	Yes No
7. If not vaccinated has negative COVID test been provided	Yes No
8. Attendee waiver signed?	Yes No

For additional registrant 2
1. Do you require Nursing Home Administrator continuing education credits? *	Yes No
2. Enter LHNA# or NONE *
3. Enter NAB Registry ID# or NONE *
4. Dietary Restrictions	Kosher Vegan
5. Is attendee vaccinated for COVID 19?	Yes No
6. Vaccine card or record provided?	Yes No
7. If not vaccinated has negative COVID test been provided	Yes No
8. Attendee waiver signed?	Yes No

For additional registrant 3
1. Do you require Nursing Home Administrator continuing education credits? *	Yes No
2. Enter LHNA# or NONE *
3. Enter NAB Registry ID# or NONE *
4. Dietary Restrictions	Kosher Vegan
5. Is attendee vaccinated for COVID 19?	Yes No
6. Vaccine card or record provided?	Yes No
7. If not vaccinated has negative COVID test been provided	Yes No
8. Attendee waiver signed?	Yes No

For additional registrant 4
1. Do you require Nursing Home Administrator continuing education credits? *	Yes No
2. Enter LHNA# or NONE *
3. Enter NAB Registry ID# or NONE *
4. Dietary Restrictions	Kosher Vegan
5. Is attendee vaccinated for COVID 19?	Yes No
6. Vaccine card or record provided?	Yes No
7. If not vaccinated has negative COVID test been provided	Yes No
8. Attendee waiver signed?	Yes No

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