Welcome to the OR Leadership 2020 Grant Application

Please complete the below form to apply for the Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Michelle Fetterer at 847-423-5127 with any questions. We look forward to reviewing your application!
Event: OR Leadership 2020
 
First Name*
Last Name*
Your Title*
Company*
First Name on Badge if different from above
E-Mail*
Confirm E-Mail*
Work Address*
City*
State (two-letter abbreviation)*
ZIP/Postal*
Work Phone Number*
Cell Number*
Emergency Contact Person AND Phone Number*
 
To verify that you're a real human and not an automated spambot, please answer the following question:
Independence Day is the Fourth of*
 
*These fields are required to have a value.

Please tell us about your organization:

How many hospital beds are in your facility?

How many operating rooms are in your facility?

Tell us about the community your hospital serves:

What's currently going well in your OR/surgery department?

What keeps you up at night regarding your OR/surgery department?

If you could ask a room full of your peers a question or two about their department, what questions would you ask?

If you could have dinner with two or three others in the industry who would you choose?

Sterile processing equipment: What is your department's projected need?

Asset tracking/RFID systems: What is your department's projected need?

Room cleaning systems (UV, air, ect): What is your department's projected need?

OR tables: What is your department's projected need?

Surgical Lights: What is your department's projected need?

PROCUREMENT:

Patient Positioners: What is your department's projected need?

Surgical Tools: What is your department's projected need?

Monitors/Cameras/Video Devices: What is your department's projected need?

Smoke Evacuation Systems: What is your department's projected need?

Fluid Management Systems: What is your department's projected need?

Scrubs/Uniform Rental: What is your department's projected need?

Capital Equipment: What is your department's projected need? Please describe.

Do you have any software needs in the next 12-18 months (data analytics programs, patient communication systems, etc.)?

Do you currently or have future plans to build a hybrid OR?

Will you be building new operating rooms or updating your facilities over the next 12-18 months? If so, please indicate here:

Please tell us about any other acquisition plans over the next 6 to 12 months:

Please list at least one product or service company who you would like to learn more about. You can enter as many as five:

Do you work with any GPOs? Are you part of an IDN? If so, which one(s)?

What is the name and title of your immediate supervisor?

I Agree: If I am selected to attend the OR Leadership Summit, I agree to be present for all sessions, meetings and functions while at the event.

Please Enter a short Bio. If selected, this will be printed in the Summit guidebook.

Please only click the "continue" button once. The application will take a moment to process your responses.
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