July 21-22, 2016
Marriott Marquis Washington, DC

901 Massachusetts Ave NW
Washington, DC 20001
Reservations: 202-824-9200 or use the online reservation form.

Workshop Registration Form

First Name  
Last Name  
Name to Appear on Badge  
  State     ZIP  
  Phone     Fax  

$450 per person - CHEA Member Institutions, CIQG Members, Recognized Accreditors and Supporting Organizations
$500 per person - Non-Member Institutions and All Others

Payment Method (Please print and include a completed copy of this form when mailing payment or faxing purchase order.)
Check: Mail to CHEA, One Dupont Circle NW, Suite 510, Washington DC 20036
Purchase order: Fax to CHEA at 202-955-6129
Credit Card
  Name on Credit Card
  Credit Card Type
  Credit Card Number
  Security Code
  Expiration Date
Month:     Year:  
  Billing Address
  Billing Zip Code
  Email Receipt To

Note: The registration fee covers the reception on the evening of July 21, continental breakfast and lunch on July 22 and conference materials. Payment to CHEA must accompany the registration. In the event of registration cancellation, fees paid in advance are refundable less a $50 service charge, provided that written notice is received by CHEA by July 11, 2016. There will be no refunds for cancellations received after July 11, 2016. There will be no refunds for no-shows. All refunds will be processed after the conclusion of the Workshop.