Seminar Registration Procedure

I.  Select the Seminar

     Select the Seminar(s) for which you wish to register. This is done by checking the box under "Register" for each seminar you wish to attend.

II.  Enter Information about person attending:

                             (submit a separate form for each person attending)

Name:         

Title:           

Business:    

Address:     

City:             State: Zip Code:

Telephone:      Fax: 

E-mail:        

III. Select Payment Method

      I am a member of the following sponsoring organization: Louisiana Hospital Association Louisiana Medical Group Management Association Louisiana Healthcare Financial Management Association Louisiana Orthopedic Association Louisiana Society of Anesthesiology Louisiana Society of Thoracic Surgery Heathcare Association of Louisiana

     Name of HIPAA Privacy Workgroups Member Entity (if any):

     (Required to get the WorkGroups Member price.)

     Our check is being mailed to HPM, P. O. Box 66776, Baton Rouge, Louisiana, 70896

     Our credit card information is being faxed for security to HPM at 225-765-7223.

     Please bill us at the above address.

IV.  Enter Additional Information (Optional) 

Notes/Comments:

V.  Submit the Information