Two grants are available for each Health Action Council Member located outside the state of Ohio. Please complete the following steps:

Step 1) Register for the conference online by clicking HERE.
Step 2) Complete the grant application below and submit.
Step 3) Come to Cleveland in February 2022!



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* 1. Member Company Name

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* 2. Attendee Name

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* 3. Attendee Title/Position

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* 4. Attendee Office Phone

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* 5. Attendee Cell Phone

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* 6. Attendee Email

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* 7. The grant recipient agrees/disagrees to the following terms:

Make a $50 payment toward your lodging at the Hilton Downtown Cleveland.  Payment can be made upon check-in.  The remainder of the lodging bill will be paid by Health Action Council.  Please advise of lodging needs below.  Health Action Council will complete the reservation for our room block and provide the confirmation number.

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* 8. Please choose lodging dates needed:
Note: You may select more than one answer.

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* 9. Submit a receipt for cost of roundtrip airfare to Yaakov Sussman at ysussman@healthactioncouncil.org.  Health Action Council will send a reimbursement check for $250 within 2 weeks of attendance at the conference.

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* 10. Will you be attending the conference member dinner on February 23rd at 7pm?

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* 11. Attendee will be responsible for ground transportation to and from the airport and any additional expenses not approved here.

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* 12. Please verify you have completed your conference registration online.

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* 13. Please confirm all information by electronically signing. (type your complete name)

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