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

Registration Form for the Reimbursement & Coding Solutions Seminar

for Peripheral Cardiology

Sponsored by the California 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 California chapter of the ACC member fees: $275 first person, $250 each additional person

Non-member fees: $300 first person, $275 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