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Training Registration | Professional Learning Center | The Coalition

Professional Learning Center

Training Registration

Medicaid Conference

November 20th 9am - 4:30pm, HIP Corporate Headquarters - 55 Water St., corner of Old Slip, NYC. Breakfast and registration begin at 8:00am. Lunch will be served. (Use www.hopstop.com to get local transportation directions.)


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Session

Personal Information

* Required fields.

* First Name:
* Last Name:
* Organization:

If your agency name does not appear in drop down list, select "OTHER" at the bottom of the list and enter the name of your organization in the field that will appear below.

You must write-in your organization name:
Department/Program:
* Title:
Designation:
Ex: RN, MD, PhD, LCMS
* Address:
* City:
* State:
* Zip:
* Phone: Ext
* Email Address:

Method of Payment

Online Credit Card
Mail (check or credit card)
Fax (credit card)

Cancellation Policy

* I agree that my agency will be billed if I do not cancel my registration in writing by November 14, 2008. A service charge of $50.00 will be withheld. Please send all cancellation requests to scott@fscgroupinc.com.