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CalConnect Interoperability Test Event
Participant Registration
June 3-5, 2013 - The University of Wisconsin, Madison, Wisconsin


Please use this form to register to participate in the upcoming CalConnect Interoperability Test Event. You have a choice of payment options including check or electronic funds transfer, requesting that the Consortium send you an Invoice for payment, or payment by credit card. If you wish to register to participate in the associated Roundtable as well, please see Roundtable Registration.

You may participate in the event whether your organization is a member of the Consortium or not. Consortium members receive a discount on their registration fee.

Company or
Organization:

Primary Contact for Participation
Name:
E-Mail Address:
Telephone:
Dietary Restrictions?

Additional Participants: (not available for Emergent Vendor members and Individual members)
Name:
E-Mail Address:
Dietary Restrictions?
Name:
E-Mail Address:
Dietary Restrictions?
Name:
E-Mail Address:
Dietary Restrictions?
Name:
E-Mail Address:
Dietary Restrictions?
Name:
E-Mail Address:
Dietary Restrictions?


What Do You Want To Test

Please tell us what your testing interests are for this event (you may see the currently planned testing scenarios at Planned Testing). If you want to test anything not listed, be sure and tell us! We will be happy to include it so long as at least two participants are interested.


We have periodic conference calls to organize and plan for each test event. Please contact Dave Thewlis for information about joining these calls.



Interoperability Test Event Participation Fees

The fee for two participants for the CalConnect Interoperability Test Event for a Commercial Vendor Member is $1,800. Additional participants are $200 per person. The fee for Emergent Vendor members is $800 for a single participant. The fee for non-vendor members is $350 per person. The fee for non-members is $1,800 for the first participant, and $600 for each additional participant. There is no fee for the first two participants from the host member of the event; additional participants are $200 per person. Please see Interoperability Test Event Participation Fees for more information.

If you wish to participate in the follow-on Roundtable as well and you are a representative of a Consortium member or elect to attend the Roundtable as Observers, please register separately for the Roundtable; see Registration and Payment Options.

We regret that we are unable to process both CalConnect Interoperability Test Event and Roundtable Registrations on the same form; however, you may request a combined Invoice for a single payment.



Please enter the total amount for your registration: $


How do you wish to pay?

We do not require an invoice in advance and will send a check or money order, or pay via ACH (electronic funds transfer).
We require an invoice to initiate payment.
If you wish your Purchase Order Number shown on the invoice please enter it here
We will pay via credit card (Visa, Mastercard, American Express) and will call or fax credit card details in the near future.
We will pay via credit card (Visa, Mastercard, American Express) and wish to pay at the event. (Please Note: Our preferred option is for you to pay in advance as it is difficult to arrange the time at the meeting to process credit cards. However if this is the most convenient option for you we're happy to oblige.)
If you are also registering for the Roundtable and wish to receive a single Invoice or execute a single payment transaction covering both this Event registration and the Roundtable registration, please contact us as indicated in the response you will receive to this submission.


CalConnect Interoperability Test Event Confidentiality Agreement

By completing this Event Registration form and paying the appropriate registration fee, your organization agrees to the CalConnect Interoperability Test Event Confidentiality Agreement.

I agree for myself, my organization, and for any other individuals (named above) for whom I am acting in submitting this registration, that we have reviewed and will comply and be bound by the CalConnect Interoperability Test Event Confidentiality Agreement.



Please review your completed registration form carefully. You may use the "CLEAR" button below to clear the entire form and re-enter all information. Once you have pressed the "SEND" button below, you will receive further information for completing the financial transaction according to the type of payment you desire.






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