Attendee Registration Form

* Required Information
* Member Type:		Member Non-Member/Cert Student
AHIMA ID:
* First Name:
* Last Name:
Credentials:
Employer:
Title:
Address 1:		if different from AHIMA profile
Address 2:
City:
State:		Select One 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:
* Day Phone:
Fax:
* E-mail:

A pre-registration attendee mailing list and post-convention attendee mailing list will be provided to the 2008 Exhibitors with the information you provide above.

Type	Early Registration On Or Before 6/1/08	Late Registration After 6/1/08
Member	$235.00	$285.00
Non-Member/Cert	$285.00	$335.00
AHIMA Student Member	$110.00	$160.00

Type	Early Registration On Or Before 6/1/08	Late Registration After 6/1/08
Member	$180.00	$230.00
Non-Member/Cert	$210.00	$260.00
AHIMA Student Member	$90.00	$140.00

Type	Early Registration On Or Before 6/1/08	Late Registration After 6/1/08
Member	$180.00	$230.00
Non Member	$210.00	$260.00
AHIMA Student Member	$90.00	$140.00

Type	Early Registration On Or Before 6/1/08	Late Registration After 6/1/08
Member	$180.00	$230.00
Non-Member/Cert	$210.00	$260.00
AHIMA Student Member	$90.00	$140.00

Select One Yes No	I will be attending the Pre-Convention session “Pay for Performance” (Sunday, June 22nd).  Not included in the full or Sunday only registration.  Additional $25
Select One Yes No	I will be attending the Coding Roundtable “Deallionnaire” (Sunday, June 22nd) Not included in the full or Sunday only registration.  Additional $25
Select One Yes No	I will be attending the President’s Reception/Installation Gala (Sunday, June 22nd)
Select One Yes No	I will be attending the Exhibit Hall Grand Opening and Lunch (Monday, June 23rd)
Select One Yes No	I will be attending the Exhibit Hall Vendor Appreciation Hour Reception (Monday, June 23rd)
Select One Yes No	I will be attending the Networking Luncheon (Tuesday, June 24th) (Grand Prize Drawings/Silent Auction Winners Announced)

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Guest Pass

Complete the information below if you will be purchasing a guest pass.

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Emergency Information

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Acceptance of Terms and Conditions

I have reviewed and acknowledge acceptance of the terms and conditions which includes the cancellation policy, insufficient check funds policy, and the credit card terms and conditions.

*     Select Below Yes, I agree to the terms and conditions.

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Confirmation

A confirmation for registration will be mailed or e-mailed to the address on the registration form approximately within 10 days of receipt. Please indicate your attendance to the RSVP events listed below and contact TxHIMA if your confirmation does not accurately reflect your RSVP choices.

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Persons with special needs should contact the TxHIMA Executive Office at least 2 weeks prior to the meeting at 512/392-4716.

The views expressed during the educational presentations are those of the speakers and do not necessarily reflect the policies or opinions of the Texas HIMA Officers, Board, or staff.

If you would like a copy of this completed registration form, please print this page before you select "continue with payment options" .

Payment options include: Credit card and check