American Recovery & Reinvestment Act of 2009 CD REGISTRATION FORM

Complete the demographic information below. A confirmation will be sent to the address or email address given below.      * Required.

AHIMA ID
* First Name:
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* How Did You Hear About the Audio Conference?		Select One Alabama HIMA Alaska HIMA Cancer Registrars of New England Florida HIMA Georgia HIMA HIM of New York City Healthcare Quality of New Jersey Iowa HIMA Maryland HIMA Maine HIMA Missouri HIMA New Jersey HIMA Oncology Registrars of New Jersey PA Cancer Registrars Pennsylvania HIMA Tennessee HIMA Texas HIMA West Virginia HIMA Wyoming HIMA Not Applicable

2. Registration Type and Fees

Select the registration type.

	TxHIMA Member
	Non-Member/Cert

Purchase	Price
CD	$145.00