JOIN YOUR COLLEAGUES AND ENROLL IN THE STAND UP FOR PATIENT SAFETY PROGRAM TODAY!

Click here to downlaod form (pdf)

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YES, I WANT TO JOIN NPSF'S STAND UP FOR PATIENT SAFETY PROGRAM AS A

• 100+ Beds : $5,000
• 1-99 Beds: $1,500

NAME OF HOSPITAL  _____________________________________________

CONTACT PERSON _____________________________________________

TITLE _____________________________________________

ADDRESS _____________________________________________

CITY ________________________ STATE _________________ ZIP __________

PHONE _____________________ FAX __________________

EMAIL __________________________________________

SIGNATURE _____________________________________

PLEASE MAKE CHECKS PAYABLE TO NATIONAL PATIENT SAFETY FOUNDATION

Please contact The National Patient Safety Foundation for more information about NPSFs Stand Up for Patient Safety Program and how your organization can join.

Email: standup@npsf.org

Fax or mail this form to:
National Patient Safety Foundation
132 Mass MoCA Way, North Adams, MA 01247
Phone: 413.663.8900 Fax: 413.663.8905

Qualified organization insure by AIG for medical liability coverage have a unique opportunity. AIG will support your organization’s participation in the Stand Up program by providing a malpractice insurance premium credit in the amount of the program enrollment or renewal fee.