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Register for Healthy Safety Net 2024: A Blue Cross Symposium
This is a free event.
Attendee Information
Yes, I will attend Healthy Safety Net and I would like to receive future email communications regarding updates and special announcements from Blue Cross Blue Shield of Michigan and Blue Care Network.
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Title
First Name*
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Last Name*
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Job Title*
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Email*
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Confirm Email*
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Clinic or Organization*
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Address*
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Address 2
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City*
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State*
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Zip Code*
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Region*
Choose one
Upper Peninsula
Northern Peninsula
West Michigan
Central Michigan
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Other
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Website
Daytime Phone*
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Cell Phone
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Fax
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Which type of organization do you represent?
Free clinic
Federally qualified health center
Rural health center
Hospital
Other health care safety net organization
Other educational or community organization
Other :
Other
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I give and grant to Blue Cross Blue Shield of Michigan and its subsidiaries (Blue Care Network of Michigan, BCN Service Company, Blue Cross Complete Michigan) the right to use and publish my name, picture, video or story in any print, electronic or media.
I agree that all photographs, videos and statements of me used and taken by BCBSM are owned by them and they may copyright material containing same. If I should receive any print, negative or other copy thereof, I shall not authorize its use by anyone else. No advertisement or other material need be submitted to me for any other approval and BCBSM shall not be liable to me for any distortion or illusionary effect resulting from the publication of my picture, portrait, video or likeness.
I warrant and represent that this license does not in any way conflict with any existing commitment on my part. I have not authorized nor will I authorize or permit the use of my name, picture, portrait, video or likeness or testimonial statement in connection with the advertising or promotion of any product or service competitive to or incompatible with BCBSM.
Nothing herein will constitute any obligation by BCBSM to make use of any of the rights set forth herein.
I agree to the terms above.
I don't agree to the terms above.
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