NJMGMA - 2009 PRACTICE MANAGEMENT CONFERENCE ATTENDEE REGISTRATION FORM

Contact Information

1 AAA Drive
Suite 102
Trenton, New Jersey 08691

Tel: (609) 585-6871
Fax: (609) 581-8244

SiteMap

Practice Management Conference Attendee Registration Form

Please fill out and submit the form below, only if you are paying by credit card. An email address is necessary for confirmation.

Salutation:
*^First Name:**
MI:
*^Last Name:**
Title:
*^Company Name:**
*^Business Mailing Address:**
*^Business City:**
*^Business State:**
*^Business Zip:**
*^Work Phone:**
Work Fax:
*^Email:**
Home Mailing Address:
Home City:
Home State:
Home Zip:
Home Phone:
*^Preferred Mailing Address:**
Guest First Name:
Guest Last Name:
Guest Address:
Guest City:
Guest State:
Guest Zip Code:
Guest Phone:
*^Membership Type:**
Special Dietary Needs:

To receive the discounted room rate at BALLYS ATLANTIC CITY OF $85 per night, reservations must be made through the Reservations Department by calling 1-800-345-7253 between the hours of 9:00am and 5:00pm, Monday through Friday. Each individual must identify themselves with New Jersey Medical Group Management Association in order to receive the discounted rate. Reservations must be made by 2/25/09.

Registration Fees

Member rate¹	$399
Non-Member Rate	$599
Student/Residency Rate	$299
Guest Rate²	$299

^1**New member & conference registration at the same time will receive the discounted rate of $374.00 for both. To become a member please select this link http://www.njmgma.com/ccapplication.asp and process your membership prior to registering for the conference ²If you are a member of NJMGMA, MGMA, or a State MGMA you eligible for the member rate. All others must pay the non-member rate. ²The Guest Rate allows access to the cocktail reception, breakfast(s), luncheons and exhibit hall only.


CANCELLATION POLICY

Cancellations MUST be received in writing to qualify for a refund. Fax your request to 609-581-8244 or email to njmgma@hq4u.com in order to qualify. A $50 administrative fee will be deducted for all approved cancellation requests if received prior to 2/25/09. A 50% refund will be given to any approved request received between 2/26/09 - 3/6/09. Cancellation requests will NOT be accepted after March 6, 2009 and no refunds will be given. No-shows are non-refundable.

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