Code With Confidence for Your Physician's Clinic Webinar (Archived) Wednesday, July 22, 2009 11:00-1:00 Central REGISTRATION FORM

Complete the demographic information below. Please register each attendee individually.  One registration per attendee.      * Required.

AHIMA ID
* First Name:
* Last Name:
Company:
Job Title:
* Address 1:
Address 2:
* City:
* State:		Texas Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Vigin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon International
* Zip Code:
* Phone:
* E-mail:

2. * Registration Type and Fees

Select the registration type.

	TxHIMA Member
	Non-Member/Cert

Registration Type	Price
TxHIMA Member	$145.00
Non-Member/Cert	$145.00