ACHE Display Reservation Form

ACHE Display Reservation Form

To request the use of ACHE's display, please complete all of the information below. The display is available on a first-come, first-served basis. We encourage you to reserve the display as early as possible. Please note that during peak times of the year, spring and fall, a number of events overlap.

* = Required field

Name of requesting Regent:*

E-mail address:*

Name of event:*

Estimated number of attendees:*

Date the display must arrive at its destination:*

Date the display will be shipped back to ACHE:
(Please note that an overnight return label will be included in the packet.)*

Shipping address for display:
Name:*
Title:
Organization:
Address:*

City:*
State:*
Zip Code:*

Outlined below is a list of standard items that will be sent with the display. If you require additional materials—other than those listed—please indicate those items in the space provided.

Member Applications Student Associate Applications Assorted Educational Brochures Health Administration Press Catalogs Assorted ACHE Ribbons Career Resource Center Brochures

Please send the following additional materials:

Please read the following statement. You must click on the box indicated for this request to be accepted.*

I understand that the display may be needed by another Regent immediately following this meeting and that the display must be shipped back to ACHE on the date indicated above.

If you do not receive an e-mail confirmation that this information was received by Regional Services, please contact your regional director.

Click the "Submit" button below to send this request
to ACHE's Division of Regional Services.