The Charge Description Master:  Compliance under APCs Webinar (Archived) 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:
* 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:
* Phone:
Fax:
* 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

Note:  This price includes only one phone line and computer access to the webinar.  If more than one attendee will be accessing the webinar using separate phones and computers, then each attendee will need to register separately and pay the registration fee.