Request Invite

Complete the application below

Convergence Forum Invitation Request
May 14-15, 2019, Wequassett Resort and Golf Club
Conference early bird attendance fee: $1950.00 until 7/31

The Convergence Forum is an invitation-only gathering of company executives, founders, investors and healthcare innovators.  Please submit an invitation request if you would like to attend.  Invitation requests must include background information on the potential attendee, as well as complete contact information. Once your request has been reviewed, you will receive a response regarding your status. Attendees are responsible for making their own lodging arrangements.

Note: The form below is only to request an invitation. It will not register you to attend.  Please contact us for more information or call 617-437-1400.

Attendee Name *
Attendee Name
Phone *
Please place biography of the attendee to be considered here OR include a link to the LinkedIn Profile.
Company Address
Company Address
Your Name
Your Name
Please enter the information for the person submitting the invitation request. Please leave blank if same as above.
Your Phone Number
Your Phone Number