Registration for 2008 PPS Refinement

HOW TO ENROLL - Please fill out this registration form. If you have any questions please call 708-895-0381.

COURSE FEE - includes lunch, coffee breaks, class materials and instructor fees.    
Course Fee:  $399 Regular                                       Early Bird Special: $349

CONFIRMATION - Participants will receive a written confirmation prior to the seminar.  

Name 2  : 

Name 3  : 

Name 4  : 

Name 5  : 

Agency : 

Address:                
 

City:         Zip:                State: 

Phone:                   Fax:

Please Select One Check American Express Visa Master Card                Check #    
 

IF PAYING BY CHECK PLEASE MAIL TO:
MEDICARE TRAINING & CONSULTING
1905 BERNICE ROAD Ste. 7
LANSING IL, 60438

Name on the Card:                 

Card #:                                 

Expiration date:                                 

Leave blank if same as agency address.

Credit Card Billing Address:
                                              

City:           Zip:                State:    

Date Attending:     Please Select One San Antonio, TX - Aug. 21-22, 2008 Oakbrook, IL (Chicago Area) Sept. 5-6, 2008

Cancellation Policy 
If Medicare Training & Consulting must cancel a seminar due to low registration a refund will be issued. If a participant cancels 15 or more calendar days prior to the meeting date, a refund will be issued. After 15 days you will receive a credit which may be used to enroll in a future course. We are unable to grant refunds for lodging, air fare, administrative fees, etc.