South Texas Chapter Online Event Registration Form

	Healthcare Landscape 2011 South Texas Annual Joint Healthcare Conference Sponsored by the local affiliates of the HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES GREATER SAN ANTONIO HEALTHCARE FOUNDATION Friday, January 28, 2011 Oak Hills Country Club 5403 Fredericksburg Road San Antonio, TX 78229

All required fields are designated with an asterick (*).
ACHE HFMA N/A - Non Member * (Select all that apply)

First Name:	* Middle Initial:
Last Name:	* (Please list credentials)
Preferred Name for Badge:
Job Title:
Healthcare Organization:	*
Address:
City:	*	State: *	Zipcode: *
Telephone:	*
Cell Phone:
E-mail :	*
If payment is by other than registrant, list name of cardholder:
Because of popular demand~ there will be NO on-site registrations!!!
	$175 Member Price $225 Non-Member Price $115 Student Price Landscape Committee Member
Late Fee: Additional $50 fee applies January 24, 2011 @ 5:00 PM Registration fee includes meals, refreshments & reception**
Cancellations must be made before January 26. To receive an 80% refund, your cancellation must be received by January 26. Advance notice of substitute attendees will be greatly appreciated. (NO REFUNDS FOR CANCELLATIONS AFTER 5:00 pm January 26, 2010)

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