Registration Type * UnitedHealth Group Registration Vendor/Industry Registration UnitedHealth Group Business * Optum UnitedHealthcare UnitedHealth Group Other First Name * Last Name * First Name Preferred on Badge * Credentials for Name Badge (e.g. MD, RN) Medical Director * Yes No Degree Hold down the control (ctrl) key while clicking to select more than one choice. AASANASBABSDCDODPTLPNMDMPTMSMSWNPPAPCPPharmDPhDPTRNRPhNA/Other Area of Practice * - Select -Case ManagerCertified CoderChaplainChiropractorDieticianLicense Professional CounselorManaged Care NurseMarriage and Family TherapistNurse PractitionerNurseOccupational TherapistPharmacistPharmacy TechnicianPhysical TherapistPhysician AssistantPhysicianPsychologistSocial WorkerSpeech TherapistTransplant CoordinatorNA/Other Specialty * Hold down the control (ctrl) key while clicking to select more than one choice. Allergy/ImmunologyAnesthesiologyCardiologyChiropractic MedicineCritical CareDermatologyDiabetes & EndocrinologyEmergency MedicineFamily MedicineGastroenterologyGeneral SurgeryGeneticsGeriatricsHematology/OncologyHepatologyHIV/AIDSHospitalistInfectious DiseaseIntegrative MedicineInternal MedicineMedical StudentNeonatologyNephrologyNeurology & NeurosurgeryNurse PractitionerNursingNutritionObstetrics/GynecologyOccupational MedicineOncologyOphthalmologyOrthopedicsOsteopathic MedicinePalliative and Hospice CarePathologyPediatricsPharmacyPhysician AssistantPsychiatry & Behavioral SciencesPsychologyPublic Health & PreventionPulmonary MedicineRadiation OncologyRadiologyRadiology-Nuclear MedicineRheumatologySleep DisordersSocial WorkSports MedicineSurgeryTransplantUrologyWomens HealthNA/Other Company * Title/Position * Address * Address 2 City * State * Select "Other" at the end of the list of States if you are a registrant outside the U.S. - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingOther State Other Zip/Postal Code * Country * USAOther... Country Other... Phone (e.g. 555-555-5555) * Email * Email Confirmation * Alternative Email If you have special accessibility needs or allergies/dietary restrictions, please describe Add to our email list * The information you provide will be listed and supplied to our program sponsors. If you would not like to have your information listed, click the "Please do not list my information" button. You may list my information. Please do not list my information. I will attend Tuesday, June 12, 2018 * Yes, I will attend the Reception and/or Dinner No thanks Tuesday, June 12, 2018 * To help ensure accurate headcounts and control costs, please carefully select the meal functions you will attend. 5:00-7:00 p.m. Welcome Reception 7:00-8:30 p.m. Group Dinner I will not attend Tuesday evening. Are you bringing a guest Tuesday evening? * UnitedHealth Group Employees Only: Please indicate if you are bringing a guest. The cost for a guest to attend the reception and/or dinner is $150 and payable by credit card only. Credit card payment instructions will be sent to the email address listed on this registration. Please note: UHG policy states this is a personal expense. No Guest Yes, I am bringing a guest. I understand the cost for my guest is $150 and payable by credit card only. I will attend Educational Sessions on Wed., June 13, 2018 * Yes No Wednesday, June 13, 2018 * 8:00 a.m.-5:00 p.m. Educational Sessions 11:30 a.m. Lunch 5:00-7:00 p.m. Reception & Exhibits I will attend Business Sessions on Thur., June 14, 2018 * These UnitedHealth Group Enterprise Update Sessions are for Employees. Supporters may attend all Enterprise Sessions deemed "open to the public." Yes No Thursday, June 14, 2018 * 8:00 a.m.-1:00 p.m. Enterprise Sessions 1:00 p.m. Grab-N-Go Lunch (provided) Box Lunch Confirmation * For attendees' convenience, grab-n-go lunches will be available following the last session at 1 p.m. Please confirm your order. - Select -Yes, please order a grab-n-go lunch for me. I understand it will be available at the close of the last session (1 p.m.)No thank you. UHG Travel Alert Your registration confirmation will include this travel alert and instructions. AIR TRAVEL ALERT FOR OPTUM, UNITEDHEALTHCARE, UNITEDHEALTH GROUP EMPLOYEES: To bypass the pretrip approval process, DO NOT BOOK THROUGH CONCUR. 1. Call BCD Travel Desk at 1-800-238-9047 a. BCD Travel Business Hours are M-F 7am-6pm CDT 2. Reference Group # UHG1033818 3. DO NOT BOOK through Concur Air and hotel reservation details are available on the conference website: https://www.optumhealtheducation.com/mdf2018/uhg-travel Comment to/from OptumHealth Education Leave this field blank