HealthPort :: 2009 HealthPort Summit User Conference Registration

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2009 HealthPort Summit User Conference Registration

Payment Options:

	Mail a Check Please mail check to: HealthPort Attn: Susan Korak - Summit 2009 925 North Point Parkway Suite 350 Alpharetta GA 30005
	Fax or Mail Credit Card Information Instead of completing the form below, please print and complete this form and then fax to: Susan Korak at 770.810.4168 or mail to: HealthPort Attn: Susan Korak - Summit 2009 925 North Point Parkway Suite 350 Alpharetta GA 30005
	Bill my Account Customer #
	PayPal® You will be provided instructions after submitting this form.

Information About You

First Name
Last Name
Company
Address
City, State, Zip
Phone
Email

Your Class Choices:

Click here to view course descriptions.

Thursday, November 12
9:30 - 10:45
11:00 - 12:15
2:15 - 3:30
3:45 - 5:00

Friday, November 13
8:00 - 9:15
9:30 - 10:45
11:00 - 12:15
2:15 - 3:30

CANCELLATION AND SUBSTITUTION POLICY:
All requests must be in writing and will be confirmed. A full refund will apply to cancellations received by October 16, 2009. No refunds will be granted for cancellations received after October 16, 2009, or for registrants who fail to attend the conference. Registrants who do not attend the conference or cancel after October 16, 2009 are liable for the entire registration fee. Substitutions for paid registrants are permitted at any time by calling 770-670-2128 with the name of substitution beforehand.