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2013 Program Registration

Thank you for your interest in participating in the 2013 Best Places to Work in Healthcare program. Registration is simple, however we encourage you to read the Assessment Process information carefully before submitting your registration form.

To participate, all companies begin by filling out and submitting a registration form either online or by downloading the PDF Registration Form and faxing it to 717-412-7307.

Registration Deadline: May 17, 2013

Once the registration information is received by Best Companies Group, companies will receive a confirmation email which will include additional instructions.

 

Participation fees: Participation is free unless you need us to administer the survey via traditional paper surveys (fees are for printing, shipping and processing of the surveys). 

Number of Employees
# Employees Surveyed
Online
Paper Fee (1)
25 - 99 All
 FREE $285
100 - 199
All
FREE
$415
200 - 499
Up to 250 (2)
FREE
$495
500 - 2499
350 (2)
FREE
$595
2500 +
400 (2)
FREE
$750

(1) A nominal non-refundable paper fee to cover the cost of printing, processing and shipping the paper surveys.
(2) Employees are randomly selected

Added Value: Upon completion of the assessment process, all participating companies will receive an Employer Benchmark Summary which contains a sample of company averages on standard employee benefits and best practices.

Once the registration is received, Best Companies Group will send the company (according to the Timeline): 

  • The Employer Benefits & Policies Questionnaire (employer questionnaire)
  • The Employee Engagement & Satisfaction Survey
  • Survey distribution instructions
  • Other supporting materials and instructions (see Best Companies Assessment Process for more details).
Company Participation Registration Form

Please complete the following information and submit this form. Once the Best Companies Group receives this form, you will be sent a confirmation email and detailed information about the survey process.

* required fields!
Company Name/Trade Name:
(Name as it should appear in print)
*
Legal Name of the Company:
(If different than listed above)
Federal Employer Identification Number (FEIN): *
Mailing Address:
(No home addresses) 		*
City:
 *
County: *
State:
Zip Code: *
Company Web Site URL: *
Industry: *
If applicable, what is the name of your Parent Organization or Parent Healthcare System, Parent City, Parent State.
Parent Organization or Parent Healthcare System:
Parent City:
Parent State:
Primary Contact (This person will be the main contact for questions throughout the entire process and the recipient of all communications (via emails, phone and letters), employee surveys for distribution, feedback reports, etc.)
Salutation: *
First Name: *
Last Name: *
Title: *
Mailing Address:
(No home addresses) 		*
City: *
State:
Zip Code: *
Direct Dial Phone Number:
(No home or cell phones please)
*
Fax Number: *
Email Address: *
Secondary Contact (This person will be the contact for questions if the primary contact is unavailable.)
Salutation:
Name:
Title:
Direct Dial Phone Number:
(No home or cell phones please)
Email Address:
CEO, President, Manager, Etc. (Highest-ranking position of the nominated workplace.)
Salutation:
Name:
Title:
Mailing Address:
(No home addresses)
City:
State:
Zip Code:
Direct Dial Phone Number:
(No home or cell phones please)
Email Address:
IT Contact (This person will be the contact for any technical systems questions regarding online surveys - for all employer questionnaires and online surveys for employees - regarding filtering, spam content, white-listing, etc.)
Salutation: *
Name: *
Title: *
Direct Dial Phone Number:
(No home or cell phones please) 		*
Email Address:
*
Marketing/PR Contact (This person will handle any marketing and/or public relations questions for your company.)
Salutation: *
Name: *
Title: *
Direct Dial Phone Number:
(No home or cell phones please) 		*
Fax Number: *
Email Address:
*
* Additional Company Information
Total number of employees in the United States (EXCLUDING temporary/seasonal and per diem employees).
Total Employees:
Full-time Employees:
Part-time Employees:
* Participation is Free (1)
Please select the survey type and the corresponding amount of employees that your company has. For paper surveys, the primary contact will be invoiced according to the size of the company for the paper survey method.
Number of
Employees
# Employees
Surveyed
Online
Fee
Paper Fee (1)
  
25 - 99
All
FREE
$285
100 - 199
All
FREE
$415
200 - 499
Up to 250 (2)
FREE
$495
500-2499
350 (2)
FREE
$595
2500 +
400 (2)
FREE
$750

(1) A nominal non-refundable paper fee to cover the cost of printing, processing and shipping the paper surveys.
(2) Employees are randomly selected.
* Survey Type
Please verify the survey type you would like to receive.
Free Online Survey (Electronic)
Paper Survey (Hard Copy)
There is a nominal participation fee to cover the costs associated with the paper surveying process (printing, processing and shipping the paper surveys).
Does your company need alternate
language surveys?*
* We offer employee surveys in a variety of languages. Additional languages are available at $195 per survey translation. If you need alternate language surveys, please select this button and you will receive additional information.
 
If Other

Is your company interested in customizing the job role and department category demographics on the employee survey?
Yes, I am interested in receiving more information. There is a fee to customize. What is this?

Special Offer
Purchase your Employee Feedback Report Now and Save 10% off the price.* This report details the results of your company’s specific survey results to each of the 72 survey questions. The report also includes national benchmarking as well as the employee comments transcribed exactly as submitted by employees. Similar reports can cost thousands of dollars if initiated independently.

Number of
Employees
Pre-survey Pricing (10% discount)
Regular Pricing
Savings
  
25 - 99
$725
$805
Save $80
100 - 199
$825
$915
Save $90
200 - 499
$880
$980
Save $100
500-2499
$950
$1,055
Save $105
2500 +
$965
$1,075
Save $110

*After May 17, 2013 the reports go back to regular pricing.
 
Questionnaire
How did you hear about the program?
If Other
 
Did you participate last year? *
If yes, Name of the company if it is
different than above:
   
Please be aware that as part of the “Best" program, a certain threshold of employee survey responses must be received in order for the analysts to consider the survey data valid.  If a company does not meet this threshold, their full consideration for the “Best” list may be jeopardized, even resulting in elimination.  In the rare case a company’s response rate is extremely low, a statistically valid Participation Report or Employee Feedback Report (if purchased) will not be presented.
Name of person completing this registration form:
Your Name:
 *
Your Title:
 *
Your Email Address:
*
Are you authorized to enter your
company into this process:
 *
Commitment:
 * I understand that by clicking this submit button, our company is entered into the "Best Places to Work in Healthcare" program. I am committing to meet all deadlines and complete both portions of the assessment process. If at any point we choose to withdraw from the process, we will notify a representative of Best Companies Group at 1-877-455-2159 immediately. Companies withdrawing after May 17, 2013 will incur a $250 withdrawal fee in addition to the total fees incurred for any special requests (customization orders, language translations, paper survey processing, etc.)
In order to submit this form, please input the verification code as listed below. Once the code is entered, please click the area outside the box in order for the submit button to become available. Please note that the page will time out if you have had the page open for an extended period of time. Should this occur, please print this page and fax to 717-412-7307 or email the form to ValerieG@BestCompaniesGroup.com.

* Check the information you have entered, then click Submit

 
IMPORTANT: If any of the contact information changes at any point in the process, please notify Valerie Garghill at ValerieG@BestCompaniesGroup.com immediately.
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