Texas Association for Healthcare Documentation Integrity
Annual Meeting, Leadership Conference
February 24 & 25, 2012
Hilton Garden Inn DFW South, Irving, Texas
Send this form with your check payable to TAHDI; mail to Glenda Ripley, CMT, at the address below.
Name ________________________________________________________________ AHDI # ___________
Type or print your name clearly as you would like it to appear on name badge. Include credentials, if applicable.
Address _____________________________________ City/State _____________________ Zip _________
Phone (_____)_______________ Email _______________________________________________________
Component Chapter Affiliation _____________________________________________________________
Students: Name of School _________________________________________________________________
To qualify for the student rate, a letter from your instructor confirming student status must be attached.
Check here if you require special services. Please attach written description of needs.
Check here if you do not want your name on the list of registrants made available to sponsors/exhibitors.
|
Registration (mark appropriate boxes) |
Current AHDI Member |
Non-AHDI Member |
Student |
|
Total Meeting Package
Includes all educational sessions, Friday welcome reception dinner, Saturday continental breakfast, Saturday lunch buffet, and exhibits |
___$140 Regular
___$160 Late/At Door |
___$160 Regular
___$180 Late/At Door |
___$105 Regular
___$125 Late/At Door |
|
Friday only
Educational sessions, does not include lunch.
4 CECs anticipated |
___$70 Regular
___$80 Late/At Door |
___$80 Regular
___$90 Late/At Door |
___$53 Regular
___$63 Late/At Door |
|
Saturday only
Includes educational sessions, continental breakfast, lunch buffet, and exhibits
5-6 CECs anticipated |
___$100 Regular
___$120 Late/At Door |
___$120 Regular
___$140 Late/At Door |
___$80 Regular
___$100 Late/At Door |
|
Welcome Reception only
(included in purchase of Total Meeting Package) |
$30 Regular/Late/At Door |
$30 Regular/Late/At Door |
$30 Regular/Late/At Door |
Guest ticket: $30 Friday Welcome Reception $30 Saturday Lunch Name of Guest _____________________________
Regular registration must be postmarked by February 14, 2012 Total Amount Enclosed: $_________
Late/At Door registration fees apply after February 14, 2012
Note: AHDI Educational Members may send only one attendee at the member rate. Students: Proof of current enrollment required.
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Detach and keep this portion for your records
For information, please contact:
Pat McMahon, TAHDI 2012 Past President
281-857-2866 or patpmcmahon@yahoo.com
Visit the TAHDI website for updates:
www.texasahdi.org
|
Make check payable to TAHDI and mail to:
Glenda Ripley, CMT, TAHDI Treasurer
605 Winterfield Dr., #2207
Hutto, TX 78634
512-577-1100
glendaripley@gmail.com
|
Refund Policy: Written refund request must be submitted prior to February 15, 2012, to qualify for 50% refund.
After that date, no refunds will be given.
Note: Contributions or gifts to TAHDI are not tax deductible as charitable contributions for federal income tax
