AHIMA ID
* First Name:
* Last Name:
Company:
Job Title:
* Address 1:
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:
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Fax:
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Additional Attendees:		If you are registering for more than one attendee, please list the additional names and registration types here.

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3. 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.

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

This workshop is designed to give the candidate guidelines for exam preparation.  Neither the speakers nor TxHIMA representatives know specific questions on the exams. 

 Attendance does not guarantee successful completion of either credentialing exam.

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