Health Administration Case Competition Registration

Registration deadline was December 20, 2013. However, if you wish to be placed on the waiting list, please supply the following information and if availability occurs, we will contact you.

University(*)
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Faculty Adviser's Full Name (including degrees Ph.D., DSc, etc) (*)
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Faculty Adviser's Email(*)
Please type your faculty advisor's email address.

Faculty Adviser's Mailing Address(*)
Please add your faculty advisor's address.

Faculty Adviser's City, State Zip(*)
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Team Captain's Name(*)
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Team Captain's Email(*)
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Team Captain's Mailing Address(*)
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Team Captain's City, State Zip(*)
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Team Captain's Cell Phone (include area code but no dashes or parentheses)
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Team Member #2

Name
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Email
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Cell Phone (include area code but no dashes or parentheses)
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Mailing Address
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City, State Zip
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Team Member #3

Name
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Email
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Cell Phone (include area code but no dashes or parentheses)
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Mailing Address
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City, State, Zip
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Faculty Advisers and Student Observers may attend for an additional $100 fee per person.

Does your faculty adviser plan to attend the UAB Health Administration Case Competition?(*)

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How many Faculty Advisers will be attending?(*)
Please enter numeric value.

How many Team Members will be attending?(*)
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How many Student Observers will be attending?(*)
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Name of Student Observer #1:(*)
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Email Address of Observer #1:
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Email Address of Observer 2:
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Name of Student Observer #2
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We will videotape the preliminary rounds and the final round. For an additional $50 per team, you can purchase the video.

Request for Video(*)

Please choose whether you would like to purchase the video.

Payment by Check:
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You may pay with a non-refundable check for the appropriate amount, based on the number of team members, student observers, and faculty members attending. MAKE PAYABLE TO: The University of Alabama at Birmingham. Address for envelope: Attention: Randa Hall, The University of Alabama at Birmingham (UAB), 1705 University Blvd. SHPB-5th Floor, Birmingham, AL 35294-1212.

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Payment with Credit Card:

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Does your university require an invoice?
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Please enter the following characters:(*)
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