Healthcare IT Workforce Accelerator

Healthcare IT Workforce Accelerator
TN HIMSS Data Collection and Use Policy

Demographic information is requested as part of the application process. This information is used to validate applicant qualifications for their employer sponsor or for scholarship opportunities. At no time will this information be used to discriminate against program applicants.

From time to time, we may provide reports that include general de-identified information about program participation. We do not disclose personally-identifying information.
Name*

Last NameFirst Name
Preferred Name, if different*
Gender
Ethnicity
Race

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite/CaucasianPrefer Not to Respond
Current Employer/Company*
Title/Position*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone*

Area CodePhone Number
E-mail*

Confirmation Email
Personal Email

Confirmation Emailexample@example.com
LinkedIn Profile
LinkedIn Profile Link
Are you a TN HIMSS member?

YesNo
Is your company a sponsor of the HIT Accelerator Program?*

YesNoDo not know
If yes, is your participation sponsored by your company?

YesNo
Name of person to receive invoice*
Email address for invoice*
Do you plan to apply for a scholarship through TN HIMSS?

YesNo
What is your field?*
Years of experience in your field*
What THREE sessions are you most interested in?*

Intro to the American Healthcare SystemHealthcare Costs, Financing & RegulationInnovation in HealthcareThe Language of HealthcareThe Business of HealthcareData Privacy & SecurityTechnology Implementation & Project PlanningWorkflow Documentation & Lean MethodologiesIT Infrastructure & OperationsCommunicationStrategy & Data AnalyticsInteroperability Standards & Policy Frameworks
What are you most interested in learning in this program?*

0/30
Payment by Check
Mail your check in the amount of $2,495.00 to the address below.
Your registration is not complete until payment has been received.

HIMSS Tennessee Chapter
330 Franklin Rd
Suite 135A-277
Brentwood, TN 37027

http://www.tnhimss.org/

714-310-0633

Refund Policy

>20 working days = Full Refund
15 to 19 working days = 50% Refund
10 to 14 working days = 25% Refund
0 to 9 working days = No Refund

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How did you hear about us?*
Please provide details for previous response:
Please verify that you are human*
Should be Empty:

Healthcare IT Workforce Accelerator

Payment by Check