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REGISTRATION / PAYMENffi INF.ORMAlilON
D OPTION 1 D OPTION 2
$150 per person/per webinar See group discount payment schedule below
To register on-line with a credit card, g o to HTTPS://ECOMMERCE.NJHA.COM/EVENT/3025
I WILL ATTEND 2020 Coding Clinic Updates {check all that apply)
Session I
Session II
Session Ill
Session IV
Name
Facility
Title
1 nd Quarter 2020 Coding Clinic Updates
2nd Quarter 2020 Coding Clinic Updates
3th Quarter 2020 Coding Clinic Updates
4th Quarter 2020 Coding Clinic Updates
□ April 15,2020
□ July 15, 2020
□ October 14, 2020
□ December 16, 2020
Telephone
PAYMENT: 0 CHECK 0 MASTERCARD □ VISA □ AMEX
Card# Exp Date
Print Name (as it appears on card)
Signature Date Payment$
• If registering 5 or more employees from the same facility, select from the group discount payment schedulebelow; discounted cost is per attendee
• If paying by check, make check payable to NJHA-HBS and mail with your registration form to: NJHA-HBS,P.O. Box 828709, Philadelphia, PA 19182 AND e-mail a copy of your registration form to [email protected]
• No refunds will be issued; individuals unable to attend may assign an alternate
• Program materials will be sent electronically one week prior to the date of the webinar
PAYMENT OPTION 2: Group discount rates
Number of Participants Standard Rate Discount Cost Per Attendee
1-4 $150 0% $150
5-10 $150 20% $120
11 or more $150 30% $105
