AHAA 59 th Convention and Annual Meeting October 4 6, 2017 Embassy Suites 11301 Financial Centre Parkway Little Rock, AR Registration Form WEDNESDAY, OCTOBER 4, 2017 Please type or print all information. Registration Fee applies to every auxilian attending ANY function. This applies to Directors of Volunteer Services also. Guests are those only attending a meal function. Pay the listed meal price. AHAA Past Presidents are guests of the Thursday Awards Luncheon. They must register if attending any other function. First Convention: Mark the appropriate box if this is your first time to attend an AHAA Convention. Special Dietary Requirements: Contact Suzanne Hackney at 870-243-4221 or srhackney@suddenlink.net Cancellation Policy: Refunds on registration fees and meals will be issued if written cancellation notice is postmarked or emailed by September 1, 2017, minus a $5 processing fee. Refunds are not issued if notice is received after the registration deadline. Bus Transport to/from Marriott for AHA/AHAA Open Session: o Mark Bus Transport if using the transport service provided by AHA. o Thursday, 8:15 am buses will load from lobby of Embassy Suites. o Each bus rider will receive a colored ticket with Bus Captain Information on it. o Retain this ticket for your return trip. The colored ticket will coordinate with a designated bus. o You will return on the same bus. o Contact your Bus Captain immediately if you become ill or will not be able to return to the bus in time for departure back to Embassy Suites o Buses will begin departing from Marriott at 11:45 am. o If you miss your bus, it will be your responsibility to find a return method to Embassy Suites. Breakfast is complimentary for hotel guests Wednesday and Thursday. The Courtyard serves from 6:30 am to 9:30 am. 8:00AM 5:30 pm Registration Diplomat 8:00 am 5:30 pm Vendors Mini-Mall Ambassador V - VII Service Organization Booths Hallway 12:15 pm 1:00 pm AHAA Board Meeting Ambassador III - IV 1:15 pm 2: 00 pm General Business Meeting Ambassador III - IV 2:00 pm 2:45 pm Memorial Service Ambassador III - IV 3:00 pm 3:45 pm Legislative Advocacy Ambassador III IV 3:45 pm 4:30 pm DVS Presentation Ambassador III - IV 4:45 pm 5:30 pm Gift Shop Ambassador III - IV THURSDAY, OCTOBER 5, 2017 PLEASE WEAR YOUR UNIFORM 7:30 am 8:15 am Registration Diplomat 8:15 am Transportation to Marriott Embassy Suites Lobby 9:30 am 11:30 am AHA/AHAA Opening Session Marriott Hotel Speaker: Ben Nemtin, Author, Co-Star of MTV s The Buried Life, Vancouver, Canada 11:45 am Transport to Embassy Suites Marriott Lobby 12:30 pm 8:00 pm Silent Auction Ambassador I - IV 12:30 pm 2:00 pm Awards Luncheon Ambassador I IV 2:15 pm 3:45 pm Leadership Ambassador I IV 6:00 pm 10:00 pm Dinner / Entertainment Ambassador I - IV Silent Auction & 50/50 Results For reservations: 501-312-9000 or 1-800-EMBASSY embassysuites.com 11301 Financial Centre Parkway Little Rock, AR Room Rates: $122.00 + tax single/double Parking Garage $10/day $132.00 + tax 3 People Surface Parking $5/day $142.00 + tax 4 people Charged to room if Embassy guest RESERVATION DEADLINE: SEPT. 1, 2017 Theme: Campfire Memories FRIDAY, OCTOBER 6, 2017 9:30 am Brunch & Officer Installation Ambassador I - III
EMBASSY SUITES CHECK POLICY: The hotel will accept checks for the guest sleeping room (room and tax) at check-in at the front desk. NO personal checks will be accepted. A valid credit card must be presented at check-in to access ancillary services. Due to increases in our expenses at the Embassy Suites, we regret that we must raise the Registration Fee to $45.00 AHAA 59 th Convention and Annual Meeting Registration Form October 4 6, 2017 Embassy Suites, Little Rock, AR Registration Deadline: September 1, 2017 Make checks payable to AHAA. Mail registration payment and form to: Melissa Williamson 5913 N. Hills Blvd. 501--834-4212 NLR, AR 72116 catmom1949@sbcglobal.net Auxiliary: Preparer s Name: Email: Phone: Name Reg. Fee $45 Thu Lunch $28 Thu Dinner $42 Fri Brunch $26 1 st Convention GS Buyer / Fundraiser Bus Transport AHAA Past Pres. Guest Total attending each function Total due each function Total Auxilians attending Total Payment Enclosed $
ARKANSAS HOSPITAL AUXILIARY ASSOCIATION CONVENTION AND ANNUAL MEETING OCTOBER 4-6, 2017 EMBASSY SUITES, LITTLE ROCK, AR DELEGATES CREDENTIALS FORM Each AHAA member auxiliary in good standing is entitled to one (1) vote. If the person designated as the voting delegate cannot perform the duties of that appointment, the alternate will serve. The members of the Auxiliary (please write in the full auxiliary name) in the District have elected the following two (2) people to serve as their delegates at the 2016 Annual Meeting. Voting Delegate (please print or type) Alternate Delegate (please print or type) Signature of Voting Delegate Signature of Alternate Delegate Signature of Auxiliary President Please complete and return this form no later than September 11, 2017 to: Mary J. Frauenhoff 107 Elfen Glen St. Van Buren, AR 72956 479-474-6306 / 479-414-6196 mmfrau@swbell.net
Item # (Committee Use Only) SILENT AUCTION GIFT FORM NAME OF AUXILIARY (no abbreviations): CITY: DESCRIPTION OF GIFT: RETAIL VALUE OF GIFT: CONTACT INFORMATION: NAME: CELL PHONE #: HOTEL ROOM NUMBER: ALTERNATE CONTACT INFORMATION: NAME: CELL PHONE #: