My organization wishes to subscribe to HOSPITALpick. As a representative of the company, we agree to pay in full within thirty days of this subscription being accepted. I understand that "Permitted Use" shall mean use of the HOSPITALpick solely by employees of my company. The HOSPITALpick agreement is non-transferable. As an VBCH Member and HOSPITALpick subscriber (End User), we may provide access and display, including a link, on VBCH's portal site for the purposes of allowing our employees access and use HOSPITALpick. We will receive a company-specific password to begin using HOSPITALpick.

HOSPITALpick RATE SCHEDULE (Rate effective if committed by December 31, 2004:

$250 Annual Setup Fee + $1.50 Per Employee Per Year (PEPY)

HOSPITALpick PEPY fees are based upon the number of full-time-equivalent (FTE) employees at your organization, whether they be local, statewide, or national. Please complete the boxes below:

NOTE: The HOSPITALpick Setup Fee is substantially reduced from what is available on the open market , generally from $20,000 to 80,000 annualy, due to the generosity of VBCH Sponsors and Underwriters.

NUMBER of EMPLOYEES INQUIRY:

VBCH MEMBERSHIP INQUIRY

My organization is a Member of VBCH (requirement to subscribe to HOSPITALpick)

My organization is not a member of VBCH but we want to join. See Member Bensfits Area for more information on Membership.

Please invoice my company for a VBCH Membership (January 1-December 31) in addition to my HOSPITALpick Subscription based on the number of employees in Hampton Roads, and in some cases number of employees in Virginia, that I have declared above at $1 PEPY + Annual Base Fee of $250.