Fill out this form, print it out, and fax to McVey Associates at 415-892-1271.

Registration Form for the Reimbursement, Coding & Compliance Seminar

for Cardiology

Sponsored by the West Virginia chapter of The American College of Cardiology

Session:

How many people will be attending?

The fee includes workbook, all materials and refreshments. Your registration will be confirmed by return fax.

The West Virginia chapter of the ACC member fees: $245 first person, $220 each additional person

Non-member fees: $270 first person, $245 each additional person

Name:

Name of Doctor/Group/Clinic:

Street Address:

City, State, Zip:

Office Phone Number: Fax Phone Number:

You can pay by credit card.

Credit Card: AMEX Mastercard Visa Discover Card

Expiration Date:

Signature:

Or, make check payable and mail, with registration form, to:

McVey Associates, Inc.
150 Ford Way, Suite 100
Novato, CA 94945