HCH2019 Organization Representative Agreement Form

Applications due February 28, 2019.

Health Care for the Homeless (HCH) Organization Representative Agreement

As the HCH Organization Representative and as a part of this application for a Consumer Conference Subsidy for the 2019 National Health Care for the Homeless Conference and Symposium in Washington, D.C., from May 22 to 25, 2019, I agree to the following:

  1. I will arrange travel to ensure that the consumer will be in Washington, D.C.  before the NCAB Orientation Wednesday, May 22, 2019 at 5:00 p.m. Eastern Time and will stay through the Conference, leaving after the learning labs end at 12:30 p.m. Eastern Time on Saturday, May 25, 2019.
  2. I agree to send these travel arrangements to Katherine Cavanaugh before Friday, April 19, 2019.
  3. I agree to be responsible for all reservations related to transportation costs including baggage fees, shuttles, and transfers.
  4. I will submit a reimbursement request to the organizational representative with original receipts no later than Friday, June 7, 2019. I understand that any submissions after this date will not be reimbursed by the Council.
  5. I will ensure that the consumer has the necessary funds to pay out-of-pocket travel expenses.
  6. I will ensure that the consumer reads the information packet that is sent out with the notification and if they have questions they reach out to Katherine Cavanaugh or their mentor before they arrive at the Conference.
  7. If our consumer representative is selected for the subsidy, I agree to attend an informational call about the conference and the subsidy with our consumer representative on Monday, April 8, 2019 at 3:00 pm Eastern.
  8. If our consumer representative is selected for the subsidy, I agree to submit a signed acceptance of the award with our organizational Executive Director or Chief Operating Officer affirming our responsibilities by Friday, April 12, 2019.
  9. If we are unable to send the consumer representative after we have signed the acceptance of our responsibilities, the organization agrees to notify Katherine Cavanaugh by close of business Friday, April 19, 2019, and agrees to pay a transfer, cancellation, no-show or change fee of $125.00 to the Council.
    1. Note: If the consumer is unable to attend, you may contact Katherine Cavanaugh to discuss the possibility of switching your consumer subsidy recipient for the Conference.
  10. To the best of my knowledge, the consumer I am recommending can represent my organization and its CAB well and fully participate in all Conference activities.