PHIMA | Pennsylvania Health Information Management Association

2009 PHIMA Annual Meeting
The Penn Stater Conference Center Hotel
State College, PA
May 18-20, 2009

"Searching for a Better Tomorrow"

Attendee Registration Form

Thank you for your interest in attending our annual meeting!
The dress code is casual to business casual. Jeans are fine!

If you have registration questions, please email us.

1. Complete the information below.

* Required information

* Membership Status:		Premiere Member (has paid both AHIMA and additional PHIMA $20 dues) Non-Member (has not paid both AHIMA and PHIMA dues) Join Now! Student (has paid PHIMA dues) Join Now! Student - Name of School:
AHIMA ID:
* First Name:
* Last Name:
Credentials:
Title:
Organization:
*Address:
Address cont'd:
* City:
* State:
* Zip Code:
* Phone:
Fax:
* E-mail:
* Opt Out:		As a registered attendee for this PHIMA meeting, we offer the opportunity for your contact information to be shared with other registered attendees or exhibitors to provide you with networking opportunities and special offers/updates. However, it is your choice if you want your information to be included or excluded in such communications by checking on of the following:

2. Registration Type

Registrations include all education sessions and events for the day. Please select your registration type below.

A 10 day notice of cancellation is required for refund.

Non-Members can save on registration fees! Join Now!

Registration Type	Premiere Member	Non-Member	Student
Full Registration - 16 CEs	$200.00	$225.00	$75.00
Includes: President's Reception (Monday) Breakfast (Tuesday) Appreciation Luncheon (Tuesday) Vendor Reception (Tuesday) Business Meeting Breakfast and Installation of Officers (Wednesday) Luncheon (Wednesday)	After 4/25, $225.00	After 4/25, $250.00	After 4/25, $100.00
Registration Type	Premiere Member	Non-Member	Student
One Day Registration - Monday, 5/18 - 3 CEs	$75.00	$100.00	$25.00
Includes: President's Reception (Monday)	After 4/25, $100.00	After 4/25, $125.00	After 4/25, $50.00
Registration Type	Premiere Member	Non-Member	Student
One Day Registration - Tuesday, 5/19 - 7 CEs	$150.00	$175.00	$50.00
Includes: Breakfast (Tuesday) Appreciation Luncheon (Tuesday) Vendor Reception (Tuesday)	After 4/25, $175.00	After 4/25, $200.00	After 4/25, $75.00
Registration Type	Premiere Member	Non-Member	Student
One Day Registration - Wednesday, 5/20 - 6 CEs	$150.00	$175.00	$50.00
Includes: Business Meeting Breakfast and Installation of Officers (Wednesday) Luncheon (Wednesday)	After 4/25, $175.00	After 4/25, $200.00	After 4/25, $75.00
Registration Type	Premiere Member	Non-Member	Student
CCS Preparation Readiness Workshop Only - 6 CEs	$99.00	$125.00	$25.00
	After 4/25, $125.00	After 4/25, $150.00	After 4/25, $50.00
CCS Preparation Readiness Workshop and Annual Meeting Full Registration - 21 CEs	$200.00	$225.00	$75.00
	After 4/25, $225.00	After 4/25, $250.00	After 4/25, $100.00
Registration Type	Premiere Member	Non-Member	Student
Special Workshop (topic TBD) Only - 6 CEs	$99.00	$125.00	$25.00
	After 4/25, $125.00	After 4/25, $150.00	After 4/25, $50.00
Special Workshop (topic TBD) and Annual Meeting Full Registration - 21 CEs	$200.00	$125.00	$75.00
	After 4/25, $225.00	After 4/25, $250.00	After 4/25, $100.00

3. Social Function Attendance

To assist PHIMA with planning for these events, please indicate how many will be attending these events.

All social functions are included with the Full Registration or One Day Registration. Additional tickets may be purchased to these events for non-registered guests who may want to attend.

If you are planning to attend, select "1". If you are not planning to attend, select "0".

	Included with the Full Registration or One Day Registration	Additional Ticket Price
*	President's Reception (Monday)	Member ($30), Non-Member ($30), Student ($20)
*	Breakfast (Tuesday)	Member ($20), Non-Member ($30), Student ($20)
*	Appreciation Luncheon (Tuesday)	Member ($20), Non-Member ($30), Student ($20)
*	Vendor Reception (Tuesday)	Member ($30), Non-Member ($30), Student ($20)
*	Business Meeting Breakfast and Installation of Officers (Wednesday)	Member ($25), Non-Member ($30), Student ($20)
*	Luncheon (Wednesday)	Member ($20), Non-Member ($30), Student ($20)

4. Special Requirements

It is important that you enjoy the meeting. If, due to a food allergy or a disability, you have special needs or requirements, please let us know below.

5. Educational Track Selection

To assist PHIMA with planning for appropriate resources (i.e., room size, chairs, refreshments, etc.)please indicate the breakout sessions you plan to attend.

Monday, May 5th

Agenda

Time

Concurrent Session

1:00 pm – 2:00 pm

3:15 pm – 4:15 pm

4:30 pm – 5:30 pm

Tuesday, May 6th

Agenda

Time

Concurrent Sessions AM

TBD

8:30 am – 9:15 am

9:30 am – 10:15 am

11:30 am – 12:15 pm

Time
Concurrent Sessions PM

2:45 pm – 3:30 pm

3:45 pm – 4:30 pm

4:45 pm – 5:30 pm

Wednesday, May 7th

Agenda

Time

Concurrent Sessions – AM

10:15 am –11:00 am

11:15 am – Noon

1:15 pm – 2:00 pm

2:15 pm – 3:00 pm

6. Acceptance of Terms and Conditions

I have reviewed and acknowledge acceptance of the terms and conditions which includes the cancellation policy, insufficient check funds policy, and exhibitor agreement.

7. Questions or Comments

Do you have a question or comment? Please enter below and we will contact you.

Payment options include: Check or credit card