Registration & Tuition Payment Process
Thank you for your interest in Cleveland Clinic Executive Education. The process begins when you complete this registration form and ends with the submission of your tuition payment. A successfully submitted registration form will generate an automatic e-mail confirmation.
Cleveland Clinic assures each registrant that this is a secure process. Moreover, the information you provide will only be used for purposes of Cleveland Clinic Executive Education.
Business Contact Information
*Address (Line 1):
Address (Line 2):
Administrative Assistant Contact Information
Check if this section is not applicable:
*Copy assistant on program-related materials?
Healthcare/Business Information and Professional Experience
*Your Business Title:
Your organization/company specializes in:
Years with company (whole numbers only):
Number of employees:
Annual Revenue (USD):
Is your company funding this program fee?
*How did you hear about this program? (check all that apply)
Please make a selection
Cleveland Clinic Executive Education Website
*Session Selection (select one session please)
Patient Experience Leaders Forum Sessions
November 3-5, 2015
6 seats left
March 1-3, 2016
25 seats left
Executive Visitors Program Sessions
December 9-11, 2015 with Quality & Patient Safety
5 seats left
December 9-10, 2015
10 seats left
Expenses covered by your tuition payment:
The 3-Day program includes three nights hotel accommodations, all meals during the program, a private dinner with Clinic executives, and all course materials.
The 2-Day program includes two nights hotel accommodations, all meals during the program, a private dinner with Clinic executives, and all course materials.
subject to change
by Cleveland Clinic and changes become effective on the date enacted.
For any questions regarding tuition, please call Dena M. Mooty at 216.445.9284.
Select payment method
There are three (3) payment options. Please select from the following and complete the process.
If paying with a credit card, you will be automatically redirected to a secure PayPal site for payment processing.
If paying by check or wire, please select the corresponding radio button. Once selected, an e-mail will be sent to you with processing instructions.
If an issue arises, you will receive an e-mail or phone call requesting additional information.
Program fees are not refundable. However, if a cancellation e-mail is received by Dena M. Mooty at
at least 30 days before the event, the registrant can apply the tuition fee toward one of the next two programs. If a cancellation email is received by Dena M. Mooty at
at least 120 days before the event, half of the payment will be refunded.
A submitted registration form will receive an automatic email confirmation.