• iCU HEALTH SUMMIT: PARTICIPANT FORM

    Tuesday, September 22, 2026 | 1:00–5:00 PM | Harper College, Palatine, IL Complete all sections. Select N/A for anything that does not apply to you. Registration deadline: Saturday, August 15th

  • Contact Information

  • Format: (000) 000-0000.

  • Organizational Partner Details

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  • How Would You Like to Be Involved?*
  • Partnership Willingness*
  • What area of wellness would you concentrate in?

  • Participant Details

  • Your support helps make this free community event possible. Whether you are a vendor contributing a table fee or a community member who would like to donate, every contribution matters.
  • I would like to:
  • Preferred payment method:
  • Our team will follow up with payment details and the applicable amount based on your participation type. Vendor table fees and donation amounts will be confirmed during your follow-up conversation.

  • If you are offering healthcare screenings, please describe your screening type below so we can coordinate your space assignment appropriately.

  • Type of products or services you will offer
  • If you do not get a room, do you require electrical access for your table?

  • Venue & Room Information

  • The iCU Community Health Summit will be held at the Wojcik Conference Center at Harper College. Please review the available rooms and space setups below. This will help with determining the best space for your presentation, workshop, or activity.

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  • W201 Small Breakout Room

    Ideal for: Intimate workshops, small group discussions, breakout sessions.
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  •  Technology & Features:

    • Height-adjustable podium with built-in computer, desktop, and DVD/Blu-Ray player
    • VGA and HDMI connectivity
    • Presenter mode capability
    • Hybrid capability available

    Setup Capacities:

    • Classroom: 32 seats
    • U-Shape: 20 seats
    • Square Shape: 26 seats
    • 4 Pods:  6 seats

  • W214 / W216 - Large Breakout Rooms

    Ideal for: Workshops, group discussions, and breakout sessions.
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  • Technology & Features:

    • Height-adjustable podium with built-in computer, desktop, and DVD/Blu-Ray player
    • VGA and HDMI connectivity
    • Presenter mode capability
    • Microphone capability
    • 2 entrance/exit doors
    • Hybrid capability available

    Setup Capacities:

    • Classroom: 64 seats
    • U-Shape: 36 seats
    • Square Shape: 40 seats
    • 8 Pods:  6 seats

  • W120 Amphitheater

    Ideal for: Keynote presentations, large panel discussions, main stage programming
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  • Technology & Features:

    • Height-adjustable podium with built-in computer, desktop, and DVD/Blu-Ray player
    • VGA and HDMI connectivity
    • 20-foot drop-down projector screen
    • Presenter mode capability
    • Microphone capability
    • 2 entrance/exit doors
    • Hybrid capability available

    Setup Capacity: 250

    NOTE: W120 is reserved for the Main Stage Orientation & Panel Discussion. 

  • Important: Kidney Health Screenings (National Kidney Foundation of IL) are available by appointment only. Each screening is approximately 30 minutes. Pre-register to secure your spot at: mobilescreening.nkfi.org/preregistration — or register through www.icu-community.org or Eventbrite.

  • W116 Dining Room

    To be Reserved by the National Kidney Foundation of IL
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  • Technology & Features:

    • Portable podium
    • Waterside view
    • Laptop connection capabilities
    • Drop-down projector screen
    • Microphone capability
    • 2 entrance/exit doors
    • Hybrid capability available

    Setup Capacities:

    • Capacity: 190
    • 19 rounds: 10 seats
  • Based on the images and descriptions of the rooms above, which space(s) are you interested in?
  • Which track(s) are you available to participate in?*
  • Which topic area(s) would you like to speak on?*
  • Preferred format*

  • Workshop Facilitator Details

  • Availability

    Select a Wave that works for you. Both Waves are the same exact program duplicated.
  • Which workshop rotation slot(s) can you facilitate? (select all that apply)*
  • Should be Empty: