National Health Information Awards

2009 Call For Entries Brochure
(click to download)

Entry Form
Available in PDF format click here.

Instructions:

1. Please type all information below. Print out the form and mail it along with two (2) identical samples of your material(s) to the address below.

2. Submit one form per entry — Choose one Class, one Audience, one Division, and one Category for each entry. If you are submitting multiple entries, please fill out a form for each.

Contact Information

Name:

Title:

Organization:

Address:

City:

State:

Zipcode:

Phone:

Fax:

E-Mail:

Award Information
Enter title of entry and organization as you wish it to appear on a certificate should you win an award.

Title of Entry:

Organization (if different than Contact Organization above):

Class: Type of health information

Audience (General): (REQUIRED)

Specify

Audience (Special Populations): (Optional)

Specify

Division: Type of organization that produced information

Category: Format of entry

Entry Fee
	$49.00 per entry.
	*$20 additional fee for categories marked with an asterisk.
Total Entry Fees: $

Method of Payment:

Credit Card Number:	Exp.Date (MM/YY):
Name of Card Holder:

Signature (required for credit card entries)

Make checks payable to: Health Information Resource Center (HIRC), or use VISA/MasterCard. (Sorry, American Express not accepted.)

The Health Information Resource Center's Federal Tax ID #
is 36-3559293.

Return completed entry forms postmarked no later than
April 10, 2009

Send All Entries to:
2009 National Health Information Awards
c/o The Health Information Resource Center
1850 West Winchester Road, Suite 213
Libertyville, IL 60048-5355

Questions?
Contact us at 1-800-828-8225
e-mail: info@healthawards.com
Fax: 847-816-8662

Call for Judges
Interested in serving as a judge for the National Health Information Awards?
Click here