Registration Form
Connecting the Laboratory to the Electronic Medical Record - Issues and Opportunities

Renaissance Philadelphia Airport Hotel
 Philadelphia, Pennsylvania
15-16 September 2000

$395 – If registration/payment is received by 11 August 2000.

$445 – If registration/payment is received by 11 August 2000 but before 11 September 2000.

$495 – If registration/payment is received after 11 September 2000.

$545 – If registration/payment is on site.

The registration fee includes course materials, morning coffee breaks, and lunches. In addition, following the conference you will receive a CD-ROM with the meeting transcript, EMR, dictionary, abstracts, the latest federal government information on the EMR, and commercial information. Space is very limited, so please register early. Registrants will be sent a letter of confirmation and directions to the conference site.

Written cancellation must be received by 31 August 2000 to obtain a partial refund (a $50.00 administration fee will be retained). No refunds will be granted after 31 August 2000.

Registrant Information (please print)

Name-Degree/Certification ____________________________________________________

Title_______________________________________________________________________

Affiliation __________________________________________________________________

Company __________________________________________________________________

Mailing Address _____________________________________________________________

City / State / Zip _____________________________________________________________

Phone/Fax _________________________________________________________________

Please check the appropriate boxes

Registration/payment made by 11 August 2000 (conference fee = $395)

Registration/payment made after 11 August 2000 but before 11 September 2000
(conference fee = $445)

Registration/payment made after 11 September 2000 (conference fee = $495)

I intend to participate in the session discussions by sharing information on:

Topic Session _____________________________________________________________

  Topic Session _____________________________________________________________

Payment Method
Check enclosed (payable to CLMA) □
VISA
MasterCard
Discover
Amex

  Name on card Acct.#

  Signature Exp. Date

Please mail or FAX this form to
Sandra Robinson
CLMA
989 Old Eagle School Road
Suite 185
Wayne, PA 19087
Fax: 610.995.9568

OR Register on-line at www.clma.org  

Continuing Education Credits
This program has been approved for ACCENT and PACE credits. Continuing Medical Educations Credits are pending.

Questions?
Call Sandra Robinson (610-995-2640 ext. 212) at the CLMA Executive Office or sandy.robinson@clma.org.

Accommodations
The Renaissance Philadelphia Airport Hotel has extended a special conference rate of $118 per night plus tax (single or double occupancy) until 15 August 2000. Please be sure to identify yourself as a participant of the NACB conference. Any reservations made after 15 August 2000 will be based on availability and will be charged the regular room rate. For your convenience, all reservations can be made directly with the hotel by calling 610-521-5900. The hotel provides a free shuttle van from the airport. Parking at the hotel is free.