2011 AAMA Annual Conference Registration Form

To Register, you may either:

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

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

If you would like to send us information regarding a previously submitted registration, please email our registration department. Do not complete 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/Credentials:
Badge Name:
Title:
Company:
Address:

City:        State:   Zip:
Country: Phone:
Fax:
New Address?: Yes   No

AAMA Membership

New Member Introductory Offer: Attend the full conference at the non-member rate and enjoy complimentary 2012 AAMA membership.

To qualify for a complimentary 2012 AAMA Membership, registrant must not have been an AAMA member since 2008

Members, conveniently renew your 2012 membership dues now $230
Renew Now Yes No thank you, not at this time

Conference package options:

Early bird rates listed are valid for registrations with full payment received by Friday, 10/14/2011.

AAMA Conference
Includes Wed-Fri sessions, all continental breakfasts, Wed-Thurs lunch, Wed reception, all breaks.
$800 Member $1025 Non-member Not attending full conference

AAMA One Day only – Wednesday
Includes Wed sessions, Wed continental breakfast, Wed lunch, Wed reception and Wed breaks.
$410 Member $490 Non-member Not attending Wednesday Only

AAMA One Day only – Thursday
Includes Thurs sessions, Thurs continental breakfast, Thurs lunch and Thurs breaks.
$410 Member $490 Non-member Not attending Thursday only

AAMA One Day only – Friday
Includes Fri sessions, Fri continental breakfast and Fri break.
$210 Member $290 Non-member Not attending Friday only

AAMA Conference Full-time Student (ID required)
Full-time student rate applies to individuals enrolled full time in a 4-year or graduate level health services program and not currently employed in a healthcare management position or holding a commission in military medical service for which full pay and allowances are received. Must submit proof of student status.

Includes Wed-Fri sessions, all continental breakfasts, Wed-Thurs lunch, Wed reception, all breaks.
$150 Member $200 Non-member Not attending as a Full-time student

Guest: $95 Guest Yes No
Guest fee includes Wed reception, all continental breakfasts & Thurs lunch.
Guest refers to a personal friend, not a business associate or staff member
Guest Name:

CAAMA EXAM Tuesday, November 15, 2011 1:00 – 5:00 pm or
Friday, November 18, 2011 12:00 – 4:00 pm
Registration Deadline is Friday, October 14, 2011

Exam Registration: $250 Yes No, I will not be taking the CAAMA Exam
Advance Registration and Payment Required

Special Needs (ex:Dietary)

Select Payment Type:

Pay Now with Credit Card
               Enter information below:
              Credit Card:
                       (Please enter numbers only. No separators.)
              Credit Card #:
            Expiration Date: mm/yy
              First Name:
              Last Name:
         Billing address of cardholder:
             Street:
               City:
               State: 2 letter code
               Zip:

Pay Later with Check or Credit Card
Registrations are not considered finalized until paid in full.

If you are associated with the Department of Veterans Affairs/Uniformed Services and request Pay Later / deferred payment: I understand that I do not qualify for the early-bird rate unless full payment is received by Friday, October 14, 2011. Payment onsite will be at the full member/non-member rate.

You can also mail your check or credit card information to the Academy office under separate cover. Checks should be made payable to “AAMA Foundation”.Be sure to include expiration date, State, Zip Code and signature for credit card payments.

Please remit to:
AAMA Research & Educational Foundation
701 Lee St
Suite 600
Des Plaines, IL 60016

CANCELLATION POLICY
Cancellations must be received in writing by October 21, 2011, to qualify for a refund. A $50.00 processing fee will be deducted. Non-Members canceling before October 21, 2011, will be charged the $50.00 processing fee; the complimentary 2012 membership will be voided. After October 21, 2011, no refunds will be provided. No shows will be billed. Occasionally, changes in the conference may be made due to speaker availability, participant demand or unforeseen circumstances. While AAMA will do everything possible to ensure participant satisfaction, AAMA’s liability is limited to the registration fee only.

EARLY REGISTRATION IS ENCOURAGED
Reservations at our hotel cannot be guaranteed after October 14, 2011.

Note: By registering for this event, registrants agree that any conference photographs that include them as attendees may be used in future AAMA communications or promotional materials.

Headquarters Hotel:
The Scottsdale Plaza Resort
Scottsdale, AZ

You will receive your registration confirmation after clicking the Submit button. A receipt will be provided in your registration packet.