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Fall 2012 Registration Form<br />
CPE Administrator's Workshop<br />
November 1, 2012: 1:00pm - 5:00pm<br />
Complimentary Dinner: 5:30pm - 7:30pm<br />
November 2, 2012: 7:30am - 12:30pm<br />
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ACPE Office<br />
135 S. LaSalle - Suite 4300<br />
Chicago, IL 60603<br />
<strong>First</strong> <strong>Name</strong> <strong>Last</strong> <strong>Name</strong> <strong>Suffix</strong>/<strong>Degree</strong><br />
<strong>Title</strong><br />
<strong>Provider</strong> <strong>Number</strong>:<br />
<strong>Provider</strong> <strong>Name</strong><br />
Telephone Fax Email Address<br />
Complimentary Dinner<br />
Yes, I will attend the complimentary networking dinner at a local restaurant on November 1, 2012 5:30pm - 7:30pm. The restaurant<br />
will be within walking distance of the ACPE office. Please note that ACPE needs to give the restaurant a guaranteed count 72 hours<br />
prior to the dinner. If you decide later not to attend, please let ACPE know prior to the 72 hour deadline.<br />
Thursday, November 1, 2012<br />
1:00pm- 4:45pm: ACPE Standards for CPE<br />
5:30pm - 7:30pm: A complimentary networking dinner will be held.<br />
**Snacks will be served throughout the afternoon<br />
Friday, November 2, 2012<br />
7:30am - 8:30am: Continental breakfast<br />
7:45am - 8:30am: Web Tool Tutorial (Optional)<br />
8:30am - 12:30pm: ACPE Policies and Procedures, Competencies for CPE Administrators, and Standards for Commercial Support<br />
**Please do not make flight arrangements that depart before 2:30pm.<br />
Please list any medical or other special ADA needs<br />
Registration fee for this workshop is $375.00<br />
This fee includes all workshop materials, continental breakfast, snacks and the networking dinner. Full payment must accompany<br />
this registration form to reserve your place at the workshop. Seating is limited to thirty (30) and will be reserved on a first come-first<br />
serve basis. Confirmation of registration will be given, via e-mail, upon receipt of payment (we do not accept credit cards). Please do<br />
not make any non-refundable arrangements until you have received a written e-mail confirmation. The fee is non-refundable, unless<br />
written notice is given to ACPE thirty (30) days prior to the start of the workshop.<br />
Attached is a list of hotels that are within walking distance or a short cab ride from the ACPE office.<br />
To book your overnight accommodations, please contact the hotel of your choice directly.<br />
Please mail your completed registration form (including payment) to:<br />
Accreditation Council for Pharmacy Education<br />
Attention: Cynthia Avery<br />
135 S. LaSalle<br />
Suite 4100<br />
Chicago, IL 60603<br />
Please direct all registration questions to Cynthia Avery at (312) 664-3575<br />
This registration form will serve as your invoice<br />
Check (payable to Accreditation Council for Pharmacy Education) EFT Purchase Order
Suggested Hotels<br />
Hotels (Loop area, short walk to ACPE Office)<br />
Hampton Majestic Hotel<br />
22 West Monroe<br />
Chicago<br />
Phone: 312-332-5052<br />
Web site: www.hamptonmajestic.com<br />
Hotel Allegro<br />
171 West Randolph Street<br />
Chicago<br />
Phone: 312-236-0123 / Toll-free reservations: 800-643-1500<br />
Web site: www.allegrochicago.com<br />
Hotel Burnham<br />
One West Washington Street<br />
Chicago<br />
Phone: 312-782-1111 / Toll-free reservations: 877-294-9712<br />
Web site: www.burnhamhotel.com<br />
JW Marriott<br />
151 W. Adams Street<br />
Chicago<br />
Phone: 312-660-8200/ Toll-free reservations: 888-717-8850<br />
Web site: www.marriott.com<br />
Hotels (cab ride to ACPE office)<br />
Hilton Garden Inn<br />
10 East Grand Avenue<br />
Chicago<br />
Phone: 312-595-0000<br />
Web site:www.hiltongardeninn.com<br />
Hilton Suites<br />
198 East Delaware Place<br />
Chicago<br />
Phone: 312-664-1100<br />
Web site:http:// www1.hilton.com<br />
Wyndham Chicago<br />
633 North St. Clair<br />
Chicago<br />
Phone: 312-573-0300<br />
Web site:www.wyndhamchicago.com<br />
Sheraton Chicago<br />
301 East Water Street<br />
Chicago<br />
Phone: 312-464-1000 / Toll-free reservations: 847-242-2558<br />
Web site:www.sheratonchicago.com<br />
The Silversmith<br />
10 South Wabash Avenue<br />
Chicago<br />
Phone: 312-372-7696<br />
Web site: www.silversmithchicagohotel.com<br />
Hotels (longer walk, or short cab ride to ACPE Office)<br />
Holiday Inn Chicago Mart Plaza<br />
350 West Mart Center Drive<br />
Chicago<br />
Phone: 312-836-5000<br />
Web site:www. martplaza.com<br />
Hotel Monaco<br />
225 North Wabash<br />
Chicago<br />
Phone: 312-960-8500 / Toll-free reservations: 866-610-0081<br />
Web site:www. monaco-chicago.com<br />
Hotel 71<br />
71 East Wacker Drive<br />
Chicago<br />
Phone: 312-346-7100<br />
Web site:www.hotel71.com<br />
Hyatt Regency Chicago<br />
151 East Wacker<br />
Chicago<br />
Phone: 312-565-1234<br />
Web site:www.chicagoregency.hyatt.com<br />
Swissotel Chicago<br />
323 East Wacker Drive<br />
Chicago<br />
Phone: 312-565-0565<br />
Web site:www.swissotelchicago.com
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