CBISA™and IRS Form 990H Educational Workshop

 

Please indicate which educational workshop you would like to attend

	Date and Location	Time
	August 20, 2008 - Orlando, FL-Canceled	9:00 am to 12:00 pm
	August 20, 2008 - Orlando, FL-Canceled	1:00 pm to 4:00 pm
	August 21, 2008 - Dallas, TX	9:00 am to 12:00 pm
	August 21, 2008 - Dallas, TX	1:00 pm to 4:00 pm
	August 22, 2008 - Las Vegas, NV	9:00 am to 12:00 pm
	August 22, 2008 - Las Vegas, NV	1:00 pm to 4:00 pm
	August 26, 2008 - Atlanta, GA	9:00 am to 12:00 pm
	August 26, 2008 - Atlanta, GA	1:00 pm to 4:00 pm
	August 27, 2008 - Philadelphia, PA - FULL	9:00 am to 12:00 pm
	August 27, 2008 - Philadelphia, PA	1:00 pm to 4:00 pm
	August 28, 2008 - New York City, NY-CLOSED	9:00 am to 12:00 pm
	August 28, 2008 - New York City, NY	1:00 pm to 4:00 pm
	September 10, 2008 - Seattle, WA	9:00 am to 12:00 pm
	September 10, 2008 - Seattle, WA	1:00 pm to 4:00 pm
	September 11, 2008 - San Francisco, CA	9:00 am to 12:00 pm
	September 11, 2008 - San Francisco, CA	1:00 pm to 4:00 pm
	September 12, 2008 - Los Angeles, CA - FULL	9:00 am to 12:00 pm
	September 12, 2008 - Los Angeles, CA	1:00 pm to 4:00 pm
	September 17, 2008 - Detroit, MI	9:00 am to 12:00 pm
	September 17, 2008 - Detroit, MI- FULL	1:00 pm to 4:00 pm
	September 18, 2008 - St. Louis, MO	9:00 am to 12:00 pm
	September 18, 2008 - St. Louis, MO - FULL	1:00 pm to 4:00 pm
	September 19, 2008 - Chicago, IL	9:00 am to 12:00 pm
	September 19, 2008 - Chicago, IL	1:00 pm to 4:00 pm
	October 2, 2008 - Orlando, FL - Rescheduled from 8/20/08	10:00 am to 2:00 pm

Attendee and Billing Information

Name
Organization
Street Address
City
State/Province
Zip/Postal Code
Country
Work Phone
Fax
Email

 

$195 $150.00 (for each additional team member from your hospital) Total number attending: ____________________

Invoice my facility OR Bill my charge card (complete info below)

Mastercard Number
Expiration Date
VISA Number
Expiration Date

Please note: You will receive specific location, travel information and additional details with a confirmation of registration.