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The
international society for
RESEARCH IN
HEALTHCARE
FINANCIAL
MANAGEMENT
INTERNATIONAL
SYMPOSIUM
&
WORKSHOP 2006
August 3-5, 2006
Hyatt Regency Baltimore on the Inner Harbor
Baltimore, Maryland USA
Registration Form
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First Name
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Middle Name
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Last Name
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Title
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Employer Organization
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Business Street Address
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City
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State / Province
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Zip / Postal Code
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Country
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Telephone Country Code
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Telephone City Code
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Voice Telephone Number
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Fax Number City Code
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Fax Number
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E-mail Address
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REGISTRATION-Registration fee includes: Name Badge (
required
for admittance to all events
), one copy each of the hard-copy and
electronic Conference Proceedings, List of Registrants, Wednesday evening
Early Bird Reception, Thursday evening Welcome Reception, Thursday, Friday
and Saturday continental breakfasts, one ticket to each of the Thursday
and Friday luncheons, and one ticket to the Friday evening banquet. Registrations
must be
received
at the Society headquarters on or before April
29, 2006 to qualify for early registration rates.
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Method of Payment
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(Payment in US funds must accompany this application. The
Early Registration Deadline is April 29, 2006
. Cancellations must
be received in writing in order to be processed.
No refunds will be
available for cancellation requests received after July 9, 2006, or for
no-shows
.)
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Check, draft or money order enclosed (
make payable to:
is
RHFM
)
(US Federal Tax-exempt ID # 52-2142374)
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Card Number:
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Security Code (3 or 4 digit code at the back of the card, after the credit card number)
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Expiration Date
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Cardholder Name (as shown on card)
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