Event Registration - Personal Information

PFS Road Show - Modesto
Sep 23, 2010 - Sep 23, 2010

Kaiser Foundation Hospital, 4601 Dale Road, Modesto, CA

REGISTRATION DEADLINE: Sep 21, 2010

Personal Information:     All inputs are mandatory EXCEPT the Membership #.

First Name: Last Name:
Badge Name: Title:
Organization: HFMA Mbrshp #:
Work Phone:


Mailing Address:

Address:
City:
  State:    Zip: 
E-Mail:


Membership Information:

NCA Corporate Sponsor:        
HFMA Membership Status:      
Additional Membership Info:    

Teams Faculty Officer
Board GAMA Member Chapter Photographer
CPA CPAR Exhibitor ++
Lifetime Member NCA Past-President Non-NCA Past President
Chairperson of Education Content / Logistics / Registration committee.

++ Exhibitors please refer to and coordinate with the vendor exhibition material.




General Fee Information:

We accept checks by mail, pay on-site, or online credit card transactions.

REGULAR
(7/29/2010 - 9/21/2010)
Member($35.00)
Non-Member($45.00)
ON-SITE REGISTRATION
If your registration is not received
by 9/21/2010 you must pay on-site fees.
Member$35.00
Non-Member$45.00
Group Discount Rates
For a group of at least 3 registrants 10 $ Off