Regency Conference Center, O’Fallon, Illinois August 21, 2014 HFMA HFMA Please return registration forms by Tuesday 19, 2014 Non- Members Members Full Day Half Day Full Day Half Day Name Organization $135.00 $100.00 $160.00 $125.00 Email address: Return completed form with payment to: Make checks payable to: HFMA HFMA 6063 Eagle Way Chicago, IL 60678-1060 Fax: 708-531-0665 Or pay with credit card: Card type: Visa MasterCard American Express Discover Card Number: Expiration Date: Verification number (on the back of the card): Name on card: Billing Street Address: City: State: Zip: Signature:
Regency Conference Center, O’Fallon, Illinois August 21, 2014 Please return registration forms by Tuesday 19, 2014 HFMA Members HFMA Non- Members Name Organization Full Day $135.00 Half Day $100.00 Full Day $160.00 Half Day $125.00 Email address: Return completed form with payment to: Make checks payable to: HFMA HFMA 6063 Eagle Way Chicago, IL 60678-1060 Fax: 708-531-0665 Or pay with credit card: Card type: Visa MasterCard American Express Discover Card Number: Expiration Date: Verification number (on the back of the card): Name on card: Billing Street Address: City: State: Zip: Signature:
August%202015%20HFMA%20Program_S%20IL%20event.docx