Get Keystone Cluster Registration Form

Completing the Keystone Cluster Registration Form online is a straightforward process that ensures your participation in the event. This guide will provide you with detailed steps to fill out each section of the form efficiently.

Follow the steps to successfully complete the registration form.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in your personal information. Provide your name (first, middle, last), nickname (for name badge), title, organization, address, city/state/zip, phone, fax, and email. Make sure to include your six-character ID number found on your mailing label.
3. Indicate your membership status by checking the appropriate box: ACHE affiliate, board member or medical staff leader attending with ACHE affiliate, nonaffiliate, or if you are attaching a membership application.
4. Select the seminar(s) you wish to enroll in by circling the corresponding rate and entering the total amount at the bottom line for both affiliate and nonaffiliate rates.
5. Complete the method of payment section. Indicate your preferred payment method by selecting check, credit card, or other options, and provide necessary payment information including the amount charged, account number, expiration date, and cardholder’s signature.
6. Once you have filled out all sections of the form, ensure that all information is accurate. Save your changes, and you may choose to download or print the form for your records before submitting.

Register now and complete your Keystone Cluster Registration Form online to secure your spot!