Name:
Company:
Job Title:
Address:
City:
State: Zip:
Daytime telephone:
Email:
License/Reg. Number (If applying
for LTC CEU's)

Please Indicate your professional group
HFMA (MN) HFMA (ND) MGMA (MN)
MGMA (ND) ACHE (MN) ACHE (ND)

FULL REGISTRATION: Both Days (includes all meals) =
$225 for full registration if postmarked after March 28, 2008.
$205 for full registration if postmarked before March 28, 2008.
(Group Discount: First and second registrants from the same organization @ regular rate.
Third, fourth, etc. registrants from the same organization pay a reduced price of $155 each.)

BANQUET (complete for full registrations)
Yes, I will be attending the banquet.
No, I will not be attending the banquet.
I need extra tickets @ $ 20 each (i.e. for a spouse or guest) How many?
Vegetarian meal(s) needed

PARTIAL REGISTRATION: Half Day = $85
(Does not include banquet ticket. This may be purchased separately.)
Thursday A.M. or
Thursday P.M. or
Friday A.M.
Banquet Ticket(s) @ $ 20 each (for partial registration)
Lunch Ticket on Thursday @ $ 10 each (for partial registration)
Vegetarian meal(s) needed

Special Needs

It is the policy of Concordia College to provide equal opportunity for all qualified persons in its educational programs and activities.
The college is in full compliance with the laws of the United States and all applicable regulations.
The college does not discriminate on the basis of race, creed, color, national origin, age, sex or physical handicap in the educational programs that it operates.

CHECKS may be made payable to: Concordia College.
A single check for multiple registrations is acceptable.

Mail check to:
 Concordia College/HFMA Healthcare Institute
Attn:  Jessi Mithun
901 8th St. S.
Moorhead, MN 56562
 

Thank you for your registration. You will receive a confirmation from Jessi Mithun.