Customized Program Request - KP International | Kaiser Permanente International

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Today's Date*

Organizer's Contact Information

Your name*

First Last

Job title*

Organization*

City*

Country*

Email*

Please describe your role in this visit. Are you a consultant, study tour leader, government official, or employee of the sponsoring company?*

How did you hear about Kaiser Permanente?*

KP International email
KP International website
A colleague in my country
A previous visit to Kaiser Permanente
Someone I know at Kaiser Permanente
A Kaiser Permanente speaker at a conference
International Federation of Health Plans (iFHP)
Other

Have you visited Kaiser Permanente before? Please briefly mention where and when.

Participant Information

Please give the total number of people who will attend the customized program, including any tour guides or interpreters.*

Please list the country or countries the participants are from.*

What is the English language level of the participants? (Choose more than one response if applicable.)*

Advanced level or native speaker
High level
Intermediate level
Beginner level or no English

Are you bringing interpreters to the customized program? If so, will the interpretation be simultaneous (with headsets) or sequential?*

Please identify the type(s) of organization(s) the participants work for. (Check all that apply.)*

Health plan
Hospital or clinic (inpatient or outpatient facility)
Government
Independent association
Consultant
Vendor
Investor
University

Please describe the participants' learning objectives for the customized program.*

Which other companies or conferences will the participants visit during their stay in the United States?*

Program Options

Please select which type of customized program your group is interested in.*

One-day program (interactive sessions and discussion only; no site visits)
Two- or three-day program (may include site visits as well as interactive sessions and discussion)
Not sure / unknown

Which location(s) are you considering for the customized program? You may indicate more than one response. (Please note that hotels should be booked well in advance.)*

Oakland, California (San Francisco Bay Area)
Southern California (Los Angeles area)
Washington, DC
Not sure / unknown

First choice date for the customized program (start date, if a multi-day program)*

Second choice date for the customized program (start date, if a multi-day program)*

Additional comments or questions