Families USA: Registration

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To foster dialogue and better interaction between participants and speakers, we limit the number of participants to 35. If you’d like to register, we encourage you to do so early to ensure that you have a spot. If you apply before June 26, you will receive the "early bird" discount All applications are due before September 3, 2013.

Early Bird Registration: $35 by June 26, 2013

Regular Registration: $75 after June 26, 2013

There are a limited number of fellowships available. If you would like to be considered, please indicate your needs on the application form. You must submit your application by July 26 to be considered for a fellowship.

Questions?
For any questions regarding the program, contact Elizabeth Prescott at eprescott@familiesusa.org, or Airrion Andrews at aandrews@familiesusa.org, or call 202-628-3030.

Cancellations
If you need to cancel your registration, please send us a written notice two weeks before the event, to receive a full refund of the registration fee. No refunds will be provided after that date. If you are awarded a scholarship and proper notification of any changes is not provided, you will be responsible for reimbursing Families USA for any expenses incurred.

Please fill out the application form below and return it to eprescott@familiesusa.org or fax to 202-347-2117.

First Name
Last Name
Nametag (if different)
Name of Media Outlet
Type of Media Outlet (Newspaper, TV, Magazine, Radio, Other)
Street Address
City
State
Zip
Daytime Phone (Ex. 123-123-1234)
Cell Phone (Ex. 123-123-1234)
Email Address
Web Address
How often do you cover health care stories?
How long have you been covering the health and/or medical beat?
Why are you interested in attending this workshop?
If you need special accommodations for a disability (please specify):
Meals
We have a limited number of fellowships available. The deadline to apply is July 26, 2013.
Please describe the type of financial assistance you need.
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