#{financialManagerBean.setChoosenInstitutionForAdmin()}
IHE North America Connectation 2011
--
IHE North America Connectathon 2011 Application/Contract
This is an application and contract for participation in the IHE North America Connectathon 2011, to be held Jan 17-21, 2011 in Chicago, IL. Please review carefully the terms of participation before completing (signing) the application.
Company Information
This is information about the organization applying to test its system(s) at the Connectathon ("Participant") as it should appear in IHE publications and promotional materials.
Company Name : #{institutionWrapper.name}
Address : #{institutionWrapper.mailingAddress.addressLine}
City : #{institutionWrapper.mailingAddress.city}
State : #{institutionWrapper.mailingAddress.state}
Zipcode : #{institutionWrapper.mailingAddress.zipCode}
Country : #{institutionWrapper.mailingAddress.country}
URL : #{institutionWrapper.url}
Contact Information
These are the primary Participant contacts who will receive information regarding the administrative, marketing and technical aspects of participation.
${financialManagerBean.prepareContactsForGenerateContractPDF()}
Primary Company Financial Contact
First name : #{curPersonWrapper.firstname}
Last name : #{curPersonWrapper.lastname}
Telephone : #{curPersonWrapper.personalPhone}
Fax : #{curPersonWrapper.personalFax}
Address : #{curPersonWrapper.address.addressLine}
City : #{curPersonWrapper.address.city}
State/Province : #{curPersonWrapper.address.state}
Zipcode : #{curPersonWrapper.address.zipCode}
Country : #{curPersonWrapper.address.country}
Email : #{curPersonWrapper.email}
Primary Commercial/Marketing Contact
First name : #{curPersonWrapper.firstname}
Last name : #{curPersonWrapper.lastname}
Telephone : #{curPersonWrapper.personalPhone}
Fax : #{curPersonWrapper.personalFax}
Address : #{curPersonWrapper.address.addressLine}
City : #{curPersonWrapper.address.city}
State/Province : #{curPersonWrapper.address.state}
Zipcode : #{curPersonWrapper.address.zipCode}
Country : #{curPersonWrapper.address.country}
Email : #{curPersonWrapper.email}
Primary IHE Technical Contact
First name : #{curPersonWrapper.firstname}
Last name : #{curPersonWrapper.lastname}
Telephone : #{curPersonWrapper.personalPhone}
Fax : #{curPersonWrapper.personalFax}
Address : #{curPersonWrapper.address.addressLine}
City : #{curPersonWrapper.address.city}
State/Province : #{curPersonWrapper.address.state}
Zipcode : #{curPersonWrapper.address.zipCode}
Country : #{curPersonWrapper.address.country}
Email : #{curPersonWrapper.email}
Participant System Information for the IHE NA Connectathon 2011:
The sections below present information that Participant has entered into the Connectathon online registration system [i.e., Gazelle] to describe the systems registered for the IHE North America Connectathon 2011. Please review the list for accuracy and, if necessary, use the online registration system to modify your entry and generate a revised application/contract via the online registration tool, Gazelle. The number of systems tested, and the number of IHE Integration Profile/Actor combinations ("Profile/Actors") supported by each system will vary. Please refer to the Terms of Participation below for important qualifications.
#{curSystem.system.name} (Version : #{curSystem.system.version})
This system is registered with the system name #{curSystem.system.name}, which will be used only in the context of organizing the Connectathon.
${iheImplementationForSystemManagerBean.getAllIHEImplementationsForSystemInSession(curSystem)}
| Integration Profile |
Actor |
Options |
Testing Type |
#{iheImplementation.integrationProfile.toString()} |
#{iheImplementation.actor.toString()} |
#{iheImplementation.integrationProfileOption.toString()} |
#{iheImplementation.testingType.name.toString()} |
Summary of Systems
The table below lists your systems, the domains in which they will test and participation fees for the IHE Connectathon. Domain fees are attributed to the organization and not to any single system. Any participation/registration for a showcase or other demonstration is handled separately by the sponsors of that showcase/demonstration. The fees listed below are only for an IHE Connectathon and do not include fees necessary for showcase/demonstration participation. Submission of this application/contract does not register you for an IHE demonstration.
| System Name |
Domain(s) |
System Fee |
Domain Fee |
Demonstration Selections |
#{financialSummaryForOneSystem.getSystemInSession().getSystem().getName()} |
#{financialSummaryForOneSystem.getDomainsForSystem()} |
#{financialSummaryForOneSystem.getSystemFee()} |
NA |
#{financialSummaryForOneSystem.getSystemInSession().getDemonstrationsAsString()} |
Billable domains: #{financialSummary.billableDomainCount}
Total domain fees: #{financialSummary.totalDomainFees}
Terms of Participation
The Sponsors of IHE USA (HIMSS, RSNA) will organize and conduct a testing process called the IHE North American (N.A.) Connectathon 2011. This testing process is an in-person event to be held January 17-21, 2011 at the Hyatt Regency Hotel and Convention Center, Wacker Drive, Chicago, IL, USA.
General Information
This overview provides some information about the terms of participation. By completing this registration form, you are accepting the full IHE North American 2011 Connectathon Policies and Guidelines that are found at http://www.ihe.net/north_america/connectathon_2011_participants.cfm
The purpose of the testing process and Connectathon event is to test implementation of IHE capabilities in commercially available systems. Successful completion of the Connectathon is also a prerequisite for participation in the demonstrations at the HIMSS11 Interoperability Showcase.
The IHE Technical Project Managers coordinate all testing activities in the testing process and Connectathon under the supervision of the Sponsors. The Technical Project Managers are also responsible for ensuring that all participants comply with the terms of participation defined in this document.
The Sponsors have the responsibility for all administrative aspects of the IHE project in North America and are the primary contact points for all such matters.
Participation Fee Details
Participation fees are proportional to the number of systems being tested and the number of IHE domains (see below) in which these systems participate. Participation Fee is $4500 for the first system, $4500 for the following ones. Domain fee is $4500 per domain.
Domains: an IHE Domain is a specific clinical or operational area of healthcare characterized by particular information technology needs and use cases. Each IHE Domain has its own committee structure and produces its own domain-specific Technical Framework. A participant applying to test Actors/Integration Profiles defined in the Technical Framework for a given IHE Domain will be considered to participate in that domain.
Domain fees for the AP, ITI, LAB, PCC, QRPH domains will be waived if the organization submitting this application has registered for at least one other domain.
Should the submitting organization register for some combination of the ITI, LAB, PCC, and QRPH domains and no other domains (e.g., RAD), then the organization will be charged for one domain.
Participating organizations will always incur charges for all registered systems and one or more domains.
The number of company representatives at the connectathon is restricted to (two) 2 persons per system. Additional participants will be required to pay a registration fee on-site with a credit card ($50 per day per participant)
The IHE Review Committee reserves the right to waive fees for one or more domains for one or more participating organizations after the close of registration in order to enable and encourage testing of profiles with low subscription. For the IHE NA Connectathon 2011, the domains with waived fees are as follows.
Anatomic Pathology [AP]
Information Technology Infrastructure [ITI]
Laboratory [LAB]
Patient Care Coordination [PCC]
Quality, Research and Public Health [QRPH]
Participation fees are non-refundable.
Participation fees are due no later than October 15, 2010.
The IHE Review Committee reserves the right to refuse participation to systems containing combinations of Actors it deems to be inappropriate or not reflective of practical systems architecture. The IHE Review Committee will make this determination in consultation with the Project Management Team. Participants may be asked to revise their applications to limit the number and type of IHE Actors included in a single system. The IHE Review Committee is comprised of executive staff and officers of the Sponsors.
Participation Fees
You have registered #{financialSummary.getSystemsInSession().size() } systems for #{financialSummary.getDomains().size()} domains. There are #{financialSummary.billableDomainCount} billable domains.
System fees: #{financialManagerBean.calculateTotalSystemsFee()}
Domain fees: #{financialSummary.totalDomainFees}
Total Participation fees: #{financialSummary.getTotalFeeToPayAsCurrency()}
________ Please check here if you are applying to the Interoperability Research Award Program (IRAP) and submit additional supporting materials as described in section 8 of the IHE North American 2011 Connectathon Policies and Guidelines. To learn more about this program, please visit http://www.ihe.net/north_america/connectathon2011.cfm.
If paying by check, make payable to IHE USA. Checks must be in U.S. dollars and drawn on a U.S. bank. By sending your check to us, you authorize IHE USA to convert your check into an electronic funds transfer. Please be aware that your bank account may be debited as soon as the same day we receive your payment. If your company requires a Purchase Order or Invoice to process, please request in advance of the October 15, 2010 deadline. Contact HIMSS Finance at: financesupport@himss.org and attach a signed copy of the IHE North American Connectathon contract for faster service.
Please return signed copy with payment to HIMSS and retain a copy for your records. Make checks payable to:
IHE USA
25324 Network Place
Chicago, IL 60673-1253
For information on wire transfers, please contact HIMSS Finance at: financesupport@himss.org.
Signature
The Participant agrees to abide by the Terms of Participation of this application/contract, which are made part of this contract by reference and are fully incorporated herein. IN WITNESS WHEREOF, the undersigned representative of the Participant, who is empowered to enter into contracts on behalf of the Participant, has executed this Agreement on behalf of the Participant. This is not a binding contract until signed by representatives of IHE USA.
Faxed copies of this application/contract will not be accepted. Notify us if you need a receipt when submitting application. Applications are not complete unless accompanied by full payment of fees as specified above. Return signed and completed application/contract with full payment no later than October15, 2011 to:
IHE USA
25324 Network Place
Chicago, IL 60673-1253
Return signed and completed application/contract to:
Agreed to for Participation by:
_________________________________________________________________________
Signature of authorized representative Date
Accepted by IHE USA:
_________________________________________________________________________
IHE USA Sponsor Date
_________________________________________________________________________
IHE USA Sponsor Date