2024 Quality Management Summit Hotel Requests and Breakout Sessions

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Thank you for your interest in the 2024 Virginia Ryan White Quality Management Summit. You will use this survey to:

Request hotel accommodations (if needed)
Let us know of any dietary restrictions and ADA needs
Select your regional breakout session
Enter CEU information (if needed)

Please make sure you complete every field of this survey.

Incomplete surveys are not able to be processed.

Please note: Completion of this survey does not guarantee acceptance into the summit or hotel accommodations. All registrations and accommodation requests will be reviewed by summit staff and funders. Accepted participants will be notified by email by October 18th of their breakout session and hotel confirmation (if accommodations were requested). Additionally, this program is only open to providers and consumers under the Ryan White program. Thank you.

Attendees coming from more than 25 miles away may request a hotel room to be provided at no cost on the evening of November 1st. Rooms are limited and may sell out before the deadline listed below, so register early.

IMPORTANT: THE DEADLINE TO REQUEST HOTEL ACCOMMODATIONS IS:

FRIDAY, SEPTEMBER 30TH, 2024

If you have questions about hotel accomodations please contact Ryan Persaud at ryan.persaud@vcuhealth.org.

First Name

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Last Name

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Agency Name

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What is your work email address?

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What is your work phone number with area code?

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What is your job title?

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Hotel Accommodations:

Hotel accommodations are available for those traveling more than 25 miles, under the following guidelines:

The cost of this room will be covered by VDH. However, incidentals, room services charges, damage to the room, etc will be your responsibility.
You will be required to provide a credit or debit card at check in to cover incidentals.
If you request a room and then do no attend without giving us at least 7 days' notice, you / your agency will be charged the state rate for that room.
If you bring a family member with you, you will be responsible for the dual occupancy charge in your room.

By signing below and selecting "yes," to the following question, you are confirming your understanding and agreement of these conditions.

Are you requesting a room be reserved for you at the Virginia Crossings Hotel & Conference Center on Thursday, November 7, 2024?

(Reminder: only those whose work location is more than 25 miles away are eligible for a room)

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Yes No

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Please sign here attesting that you agree to the conditions of hotel accommodations.

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Add signature

Do you need ADA accessible accommodations?

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Yes No

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If yes, please provide information about accommodations you are requesting.

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Do you have any dietary restrictions? (Select all that apply)

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I do not have any dietary restrictions

Vegetarian

Vegan

Lactose Intolerant

Gluten Free

No Shellfish

No Nuts

No Pork

Other (please specify)

If "Other," please describe.

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Please select your first choice for your breakout session.

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Please select your second choice for your breakout session.

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Certificate of Attendance and Continuing Education Units

In the next section, you wil indicate if you would like a general certificate of attendance or continuing education units. The event has been accredited through VCU Health for social work, nursing and physican credits. Individuals requesting CEUs will need to provide additional information and attend the entire conference as this event has not been approved for partial credits. If you have questions about the CEU process, please email ryan.persaud@vcuhealth.org

Accreditation:

In support of improving patient care, VCU Health Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Note: This program is only funded to provide CEUs for Physicians, Nurses, or Social Workers directly funded by Ryan White programs.

Medicine: VCU Health Continuing Education designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing: VCU Health Continuing Education designates this activity for a maximum of 6.5 ANCC contact hours. Nurses should claim only the credit commensurate with the extent of their participation in the activity.

Social Work: As a Jointly Accredited Organization, VCU Health Continuing Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 6.5 continuing education credits.

What type of certificate are you requesting

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As indicated above, this event is not approved for partial credits. Attendance for the entirety of each session is required for CEUs. Those requesting CEUs will be "signed in" and "signed out" of each session. You will then need to turn your signature sheet into event staff at the end of the summit to be submitted for CEUs.

At the end of the summit all individuals requesting CEUs will also be required to complete a program evaluation with questions requested from the accrediting body.

Please sign below to confirm your understanding of these requirements.

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Add signature

Please list your degree applicable to the CEU being requested (BSN, BSW, MSN, MSW, etc)

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Please provide your legal name and the complete mailing address where you would like documentation of your CEUs to be mailed.

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