Annual Board of Directors/MECs Fall Retreat

WakeMed Hospitals

Name *

Preferred Name for Name Badge (if different than above)

Will you attend the retreat? *

10 AM – 5 PM

I plan to attend

I do not plan to attend

Please select preferred T-shirt (unisex) size: *

5:30 PM – 8:30 PM VIVACE 4209 LASSITER MILL ROAD, STE 115 RALEIGH, NC 27609

Will you attend the reception & dinner? *

I will attend

I will not attend

Will your spouse/significant other attend the reception & dinner? *

My spouse/significant other will attend

My spouse/significant other will NOT attend

Spouse’s/Significant Other’s Preferred Name