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Webinar Registration Form
“The Top 10 Reasons Your Compliance Program Fails to Reduce the Risk of Whistleblower Claims and FCA Enforcement” Webinar
Tuesday, September 15, 2009 ♦ 1:00-2:30 pm Eastern
(12:00-1:30 pm Central; 11:00 am-12:30 pm Mountain; 10:00-11:30 am Pacific; 9:00-10:30 am Alaska; 7:00-8:30 am Hawaii)
Co-sponsored by the Business Law and Governance (BL&G), Fraud and Abuse (Fraud), Hospitals and Health Systems (HHS), In-House Counsel (In-House), and Teaching Hospitals and Academic Medical Centers (TH/AMC) Practice Groups
To register: Remit credit card information and completed registration by web to www.healthlawyers.org/teleconferences/
Name: Earliest Bar Date: (for new members only) Title: City: Business Phone: (_____) E-Mail (please write in clearly): AHLA Member ID: Organization: Address: (no P.O. Boxes Please) State: Fax: (_____) Zip:
by phone to Member Service Center at (202) 833-1100 by fax to (202) 775-2482
To avoid duplicate charges, please do not mail this form if you have already faxed it to us or given us your order by phone or through our website.
(Full-price registrants receive email confirmation with call-in information and link to download materials) Registrations must be received by 5:00 pm on Monday, September 14, 2009. Teleconference Registration BL&G, Fraud, HHS, In-House, or TH/AMC Practice Group Member ........................................................................... $145 Government Employee, Academician, or Solo Practitioner Member ................................................................................. $95 Other Health Lawyers Member ........................................................................................................................................... $190 Non-Member .......................................................................................................................................................................... $290 Member Listener*.................................................................................................................................................................... $50 Non-Member Listener* ........................................................................................................................................................... $60
* Note about Listener Registration Options: You may only use Listener options if an additional AHLA member from your organization is registering on the same day at the normal fee. Listeners must use the same phone line as the full price registrant. When using the listener option, please provide the name of the member in your group who paid the full AHLA Member Rate: _________________________________________
Additional Resources: Teleconference CD plus Materials (additional shipping charges may apply for bulk orders; no returns permitted for CD products) AHLA members $145 Non-members $190 CD plus Materials (Item-S091509-CD)
____copies
$
DC residents add 5.75% sales tax $ Shipping charges, add $8 for the first item and $3 for each additional item $ Sub-Total for Additional Resources $
Please allow 10-14 days following the teleconference for shipment.
TOTAL Enclosed: $__
_____
Payment Information: Check VISA MasterCard American Express If paying by check, please fax this form to (202) 775-2482 and then mail the form and check to American Health Lawyers Association, PO Box 79340, Baltimore, MD 21279-0340. This will ensure you receive the call in information in time of the teleconference. Card Number: _____________________________________________________________Exp. Date: Name of Cardholder: _________________________________Signature of Cardholder: ZIP Code of Cardholder’s Billing Address:____________ - __________ Should your total payment be miscalculated, Health Lawyers will charge you for the correct amount. Please note that once your registration is processed, we cannot issue a refund or cancel your registration. 501(C)(3) FED ID No. 23-7333380 WBT