Fill out this form, print it out, and fax to McVey Associates at 415-892-1271.
Registration Form for the Two-Day Exam Preparation Course for Otolaryngology
Sponsored by the Association of Otolaryngology Administrators

Session:

How many people will be attending?

Fee includes workbook, all materials and refreshments. Registration confirmed by return fax.

The Association of Otolaryngology Administrators member fees: $595 first person, $570 each additional person
Non-member fees: $620 first person, $595 each additional person

Need overnight accommodations? Check here and we will fax you a list of hotels with your confirmation. Sleeping room reservations and cost are your responsibility.

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

Note: You must register for the exam separately through the Professional Association of Healthcare Coding Specialists (PAHCS).