NJ MGMA - 2010 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

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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 conference room rate at Trump Taj Mahal Hotel & Casino of $95 per night, please call 1-800-825-8888 and ask for reservations. Be sure to mention the conference code ANJPMC. Reservations must be made by 3/31/2010. You can also make reservations online @ www.trumpmeetings.com All rooms are in the new Chairman Tower. Friday night stay is available for $150.00 with advance registration by 3/24/10.

Registration Fees

Member rate¹	$449
Non-Member Rate	$649
Student/Residency Rate	$329
Guest Rate²	$329

^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 3/15/10. A 50% refund will be given to any approved requests received between 3/15/10 – 4/1/10. Cancellation requests for refunds will NOT be accepted after April 1, 2010. Questions: Call 609-585-6871 or Email njmgma@hq4u.com No-shows are non-refundable.

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