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REGISTRATION / PAYMENffi INF.ORMAlilON

D OPTION 1 D OPTION 2

$150 per person/per webinar See group discount payment schedule below

To register on-line with a credit card, g o to HTTPS://ECOMMERCE.NJHA.COM/EVENT/3025

I WILL ATTEND 2020 Coding Clinic Updates {check all that apply)

Session I

Session II

Session Ill

Session IV

Name

Facility

Title

1 nd Quarter 2020 Coding Clinic Updates

2nd Quarter 2020 Coding Clinic Updates

3th Quarter 2020 Coding Clinic Updates

4th Quarter 2020 Coding Clinic Updates

□ April 15,2020

□ July 15, 2020

□ October 14, 2020

□ December 16, 2020

Telephone

E-mail

PAYMENT: 0 CHECK 0 MASTERCARD □ VISA □ AMEX

Card# Exp Date

Print Name (as it appears on card)

Signature Date Payment$

• If registering 5 or more employees from the same facility, select from the group discount payment schedulebelow; discounted cost is per attendee

• If paying by check, make check payable to NJHA-HBS and mail with your registration form to: NJHA-HBS,P.O. Box 828709, Philadelphia, PA 19182 AND e-mail a copy of your registration form to njhais@njha.com

• No refunds will be issued; individuals unable to attend may assign an alternate

• Program materials will be sent electronically one week prior to the date of the webinar

PAYMENT OPTION 2: Group discount rates

Number of Participants Standard Rate Discount Cost Per Attendee

1-4 $150 0% $150

5-10 $150 20% $120

11 or more $150 30% $105