Hospital Security Forum Application

Application to Attend

January 26-28, 2026, Renaissance Waverly Hotel, Atlanta, GA
For assistance, please call 973-514-5900 ext. 108

This form is for Hospital Security Directors. For Vendor info, call 973-514-5900 ext. 111
Name*

First NameLast Name
Title*
Hospital/Organization Name*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.
Emergency Contact*
Please include name and Phone Number
Nickname for badge (optional)
Eg. Bob for Robert
Tell us about your organization
How many beds does your hospital have?*
If you run a multi-site system, how many total beds are in the system?*
How many hospital EMPLOYEES are in your security department?*
How many CONTRACTOR positions (FTE) does your security dept. use?*
Tell us about what you source
Visitor Management*
Metal/Weapon Detection*
Access Control Systems and Hardware*
Camera and Video Management Systems*
Third-Party Guard Services*
Parking Management*
Staff Panic Buttons*
Infant Protection*
Anything else you're looking to source for your hospital?*
What issues would you like to discuss at the forum?*
Have you or your company attended the Hospital Security Forum Before?

YesNoUnsure
Please tell us which vendors you met at Hospital Security Forum you have done business with
Name AND Title of your immediate supervisor. *

Application Fee*

Application Fee - Hospital Security Forum$199 fee INCLUDES two nights Hotel, Meals, and Event Fees. Airfare reimbursed onsite (up to $599) if you request (see below). Up to 60 days prior to the event, you may receive a refund less a $50 processing fee. After that no refunds will be issued.

$199.00

Enter coupon

Total

$0.00

Credit Card

Upon your approval to attend, we ask that you purchase and submit your paid airline itinerary within 15 days and send a copy to mike@eatonhall.com.
Reimbursement*

I would like airfare reimbursementI will pay my own airfare
Airfare Reimbursement should be made Payable To:
You agree to attend all sessions and abide by the rules of the forum.*

Yes, I agree
Please verify that you are human*
Should be Empty:

Application to Attend

Tell us about your organization

Tell us about what you source

Credit Card