FHIMA | Florida Health Information Management Association

* Required information

* Registration Status:		Student - Name of School:
AHIMA ID:
* First Name:
* Last Name:
Credentials:
Title:
Employer:
* Billing Address:
Address cont'd:
* City:
* State:
* Zip Code:
* Daytime Phone:
Home Phone:
* E-mail:
* Opt Out:		As a registered attendee for the FHIMA meeting, we offer the opportunity for your contact information to be shared with other registered attendees or exhibitors to provide you with networking opportunities and special offers/updates. However it is your choice if you want your information to be included or excluded in such communications by checking on of the following:
FHIMA Affiliations:		FHIMA President FHIMA Delegate Regional President First Time Attendee FHIMA Committee Member Ambassador of Education

Registrations include all education sessions and events for the day.
Please check your registration type below.

Advanced Registration - On or Before June 15th

Advanced Registration Type	FHIMA Member	Non-Member	Student¹
Full Registration (Tuesday-Thursday) Includes all food functions, exhibit hall & President’s Reception	$350.00	$400.00	$90 Includes exhibit hall and food functions $25 Includes exhibit hall but NO food functions
Advanced Registration Type	FHIMA Member	Non-Member	Student¹
One Day Registration - Tuesday Includes food function, exhibit hall on Tuesday and President’s Reception	$150.00	$200.00	$35 Includes exhibit hall and food functions
			$25 Includes exhibit hall but NO food functions
Advanced Registration Type	FHIMA Member	Non-Member	Student¹
One Day Registration - Wednesday Includes food function and exhibit hall on Wednesday	$150.00	$200.00	$35 Includes exhibit hall and food functions
			$25 Includes exhibit hall but NO food functions
Advanced Registration Type	FHIMA Member	Non-Member	Student¹
One Day Registration - Thursday - Coding or Legal Includes food function	$150.00	$200.00	$35 Includes exhibit hall and food functions $25 Includes exhibit hall but NO food functions

Regular Registration - After June 15th

Regular Registration Type	FHIMA Member	Non-Member	Student¹
Full Registration (Tuesday-Thursday) Includes all food functions, exhibit hall & President’s Reception	$385.00	$435.00	$110 Includes exhibit hall and food functions $55 Includes exhibit hall but NO food functions
Regular Registration Type	FHIMA Member	Non-Member	Student¹
One Day Registration - Tuesday Includes food function, exhibit hall on Tuesday and President’s Reception	$185.00	$235.00	$55 Includes exhibit hall and food functions $25 Includes exhibit hall but NO food functions
Regular Registration Type	FHIMA Member	Non-Member	Student¹
One Day Registration - Wednesday Includes food function and exhibit hall on Wednesday	$185.00	$235.00	$55 Includes exhibit hall and food functions $25 Includes exhibit hall but NO food functions
Regular Registration Type	FHIMA Member	Non-Member	Student¹
One Day Registration - Thursday - Coding or Legal Includes food function	$185.00	$235.00	$55 Includes exhibit hall and food functions $25 Includes exhibit hall but NO food functions

¹Must have valid student AHIMA ID# to qualify for student pricing

To assist FHIMA with planning for these events, please indicate how many will be attending these events.

Additional tickets may be purchased to these events for non registered guests who may want to attend. Additional tickets are $50 for the Membership Lunch and $25 for the President’s Reception.

*		Membership Lunch (Tuesday)
*		President's Reception (Tuesday Night) Included with Full or Tuesday day registration fee

It is important that you enjoy the meeting. If, due to a food allergy or a disability, you have special needs or requirements, please let us know below.

To assist FHIMA with planning for appropriate resources (i.e., room size, chairs, refreshments, etc.)please indicate the concurrent sessions you plan to attend.

Tuesday, July 15th - View Agenda

Time

Session

9:10–10:10

10:45–11:45

1:45–2:45

3:15–4:15

4:15–5:15

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Wednesday, July 16th - View Agenda

Time

Session

9:10–10:10

10:45–11:45

1:45–2:45

3:00 –4:00

4:15–5:15

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Thursday, July 17th - View Agenda

Time

Session

8:00-9:00

9:10–10:10

10:45–11:45

1:45–2:45

3:00–4:00

4:15–5:15

I have reviewed and acknowledge acceptance of the terms and conditions which includes the cancellation policy, insufficient check funds policy, and credit card terms.

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Payment options include: Check or credit card

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* Required information

2. Registration Type

3. Special Event Attendance

4. Special Requirements