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ACCA Cardiovascular Administrators’ Leadership Conference

ACCA Cardiovascular Administrators’ Leadership Conference

To Register, you may either:

  • Call our offices directly at 847-759-8601
  • Mail or Fax 847-759-8602 in a Registration form
  • Complete the online registration form below

Entry Instructions: Use tab key or click box to advance to next question.
DO NOT USE “ENTER” KEY UNTIL READY TO SUBMIT FORM.

If you need to inquire about a previously submitted registration, please email registration department; do not submit another registration form

Your conference badge will reflect the information filled in below.

Required fields are in red

Email:
Name:
If Federal Sector:     Rank        Branch  
Designations:  
Badge Name:
Title:
Company:
Address:
              
City:     State:   Zip:    
Country: 
Phone:   Fax:

New Address?:    

*Please note: a selection must be made in each section for the form to be processed

Hurry! Early Bird Rate in effect until Friday, March 11, 2011

AM ACCA Pre-Conference  (Wednesday, April 13, 8:30 am – 12:00 pm)

               Yes,  $175      Yes Non-Member,   $200   No, thank you not attending an AM pre-conference
                  
PM ACCA Pre-Conference   (Wednesday, April 13, 1:30 – 5:00 pm)
 
             Yes,   $175   Yes Non-Member,   $200   No, thank you not attending a PM pre-conference

Full Conference Registration
includes reception April 13, Thursday lunch, continental breakfasts and Thursday-Friday concurrent sessions
             Member, $600  $550
            Non-Member, $735
                          Non-Members who register for the full conference
                          are entitled to complimentary 2011 ACCA membership
                         YES, sign me up for complimentary 2011 ACCA membership!
             Full-time Student (ID required), Member $150  
             Full-time Student (ID required), Non-Member $200  
             Not attending Full Conference

Customized Conference Registration

             Thursday only
            Member, $450 $410         
            Non-Member,  $485    
            Not Applicable

             Friday only
            Member, $250  $210    
            Non-Member, $280    
            Not Applicable

Guest     
includes reception April 13, Thursday luncheon & continental breakfasts
            Yes, $95   Not applicable 
Guest Name:

AAMA Members conveniently renew your 2010 membership NOW!
2011 Annual Membership(valid through December 31, 2011)
          Yes, Renew Now $225      No, thank you  
CAAMA EXAM (Wednesday April 13, 1:00 – 5:00 pm) 
Advance Registration and Payment Required, registration Deadline is March 16, 2011
          Yes,  $250    Not Applicable 

Voluntary tax deductible donation to the AAMA Research & Educational Foundation:
Support excellence in healthcare administration  

The AAMA Foundation is exempt from taxation under section 501(c)3 of the Internal Revenue Code (IRC). Generally, contributions are considered charitable under the IRC section 170 and tax deductible as provided by law. The Foundation is eligible for matching funds. 

Special Needs (ex. Dietary)         

Select Payment Type:

Pay Now with Credit Card
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         Billing address of cardholder:
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               City: 
               State:    2 letter code
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         Registrations received without payment information will be processed as a payment pending status.
          If not submitting payment online, please print a copy of this form to mail or fax with your payment.
      

Print this page and mail or fax it with your check or credit card information to the Academy office. Be sure to include expiration date and signature for credit card payments. Checks should be made payable to “AAMA”.

Please remit to:

American Academy of Medical Administrators
701 Lee St
Suite 600
Des Plaines, IL  60016

Fax: 847-759-8601

ACCA/AAMA CANCELLATION POLICY
 Cancellations must be received in writing by March 26, 2011, to qualify for a refund. A $50 processing fee will be deducted. All no shows will be billed. After March 26, 2011, no refund will be provided. Occasionally changes in the conference may be made due to speaker availability, participant demand or unforeseen circumstances. While ACCA/AAMA will do everything possible to ensure participant satisfaction, AAMA’s liability is limited to the registration fee only.

Headquarters Hotel:  

Doubletree Hotel – Magnificent Mile
300 East Ohio Street
Chicago, IL 60611

General Phone: 312-787-6100
Reservation Phone: 800-222-8733