Region 1 Conference Registration Form

Region 1 Conference Registration Form

To Register, you may either:

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

  Use TAB or your mouse to advance to the next field.
  DO NOT HIT ENTER UNTIL READY TO SUBMIT THIS FORM.

  Your e-mail:
  Full Name:
  Badge name if different than first name:
  Title:
  Organization:
  Address 1:
  Address2:
  City:
  State:
  Zip Code:
  Phone:
  Fax:
  AAMA Members Is this a new address?		YesNo
  Payment Method:		CheckVISAMCAMEX
  Credit Card No.:
  Expiration date:
  You may mail your check or credit card information to the Academy office under separate cover. Payment may be made by check, Visa, Mastercard or American Express. 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
  FULL PROGRAM REGISTRATION FEES (June 14-15, 2001)
  AAMA  Member  (before 6/1/01)	$55.00
  Non-Members* (before 6/1/01)	$70.00
  *For non-members desiring to join AAMA and take the Credentialing Examination,the conference registration fee will be waived if this registration form,examination registration and the membership application/dues are receivedsimultaneously at Academy Headquarters. (Application may also be completed onour website.)
  CAAMA EXAM June 15
  Exam Registration:	$250.00

  CANCELLATION POLICY
  Attendees may cancel their conference registration up to one-week in advance of the meeting(June 7, 2001) and receive a full refund minus a $10.00 administrative fee. Requests must be received in writing. After June 7, 2001, no refunds will be provided.No shows will be billed.

  EARLY REGISTRATION IS ENCOURAGED

© Copyright 2001 – American Academy of Medical Administrators