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For Medical Office Professionals
17-19, 2012
This conference is for everyone responsible for the productivity,
profitability, and compliance of the practice. A variety of topics,
presenters, one-stop CEU collection, and networking opportunities
are all in one place making this conference the best experience
and value for your training dollar.
    Letter from                                                A Continuing Education Experience
    Conference Chair
    I am excited to Chair this year’s Las Vegas Conference
                                                               Created Especially for You!
    for Medical Office Professionals. This year we really
    want to inspire you to make a measurable impact on
    the profitability and productivity of your practice.       PMI’s 8th Annual Las Vegas Conference is the place for medical office professionals to
    Whether your area of concentration is compliance,          learn new skills, address challenges with experts, network with peers, and bring back
    coding, reimbursement or general management of the         solutions to improve practice performance, profitability and compliance.
    practice, you will have a tremendous opportunity to
    benefit from all the training, networking, resources
                                                               The Conference is organized into two learning tracks (coding/reimbursement and office
    and experts gathered all in one fabulous place!
                                                               management/compliance). Attendees can choose from over the course of three days focused
                                                               on medical practice coding, reimbursement, office management, and compliance, presented by
    The Preconference on October 17 will give participants
                                                               six experts. Attendees are comprised primarily of outpatient coding and billing professionals
    “up close” access to practice management experts to
                                                               and medical office managers from across the U.S. A conference manual and tote bag, access to
    address their office’s challenges. More information is
                                                               all general and breakout sessions, breakfast and lunch plus up to 18 continuing education units
    provided in the next column.
                                                               are included. Exhibitors will be on hand to share product information and door prizes with
    Our Keynote Speaker and Master of Ceremonies,
    Aric Bostick, will get you fired up and ready to learn
    with a big dose of enthusiasm and energy. His
    message is inspirational and impactful and we can't
                                                                              }     Keynote presenter and Master of Ceremonies, Aric Bostick,
                                                                                    will share an impactful message guaranteed to ignite your
    wait for you to meet him!
                                                                                    focus and sense of purpose.

    You'll also get to see some of your favorite PMI faculty   Highlights:
    members and guest speakers present 16 sessions
    packed with tips, tools, and techniques aimed at           • Pre-Conference full-day session provides up-close access to practice management
    making you more productive and valuable to your              experts in a series of roundtable group discussions.
    practice. Your conference manual will include all          • Two full days, 16 sessions covering the business side of running a medical practice
    sessions so even if you miss a session, you'll still       • PMI-certified Professionals earn all annual CEUs for certification renewal in one place
    receive a copy of all the presentation slideshows.
    We want to load you with as many resources as              • AAPC CEU approval granted for conference attendance (see last page for details).
    possible to help you become more successful in your
                                                               • Powerful and motivating kick-off with Master of Ceremonies, Aric Bostick
    profession and ultimately help you lead your practice
    to better performance and heightened profitability.        • Opportunities to network with attendees

    We have some fun social events planned giving you
    several opportunities to mingle with fellow conference
    participants, PMI faculty and staff in a relaxed           Pre-Conference                           October 17, 9 a.m. to 4 p.m.
    environment. There will be a pre-registration
    gathering at the hotel on Wednesday evening. Then,         Pre-Conference participants will gain direct access to a team of tenured professionals with a
    on Thursday evening our exhibitors will be hosting a       proven history tackling and solving the very issues that are challenging the viability of many
    fun social event to be revealed at a later date.           practices today. This session is designed for office managers, reimbursement staff, and future
                                                               practice leaders. The day will commence with introductions and a brief presentation to frame
    Hundreds of repeat attendees have made this                the day. From there, the class will form smaller groups around the five experts in a more
    conference their annual training event. If you've never    intimate, conversational forum. After a timed question and answer period, groups will rotate
    attended before, I want you to be a part of this year’s    from table to table throughout the day so that everyone will get to spend time with each
    conference. Whether you plan to travel solo or attend      expert to address a specific area of focus.
    with colleagues, we want you to come and experience
    PMI at its very best. It really is the must-attend         This is a unique opportunity for participants to rub elbows with experts from a variety of
    learning event of the year. I am looking forward to        disciplines and capitalize on their years of experience. They will get answers to their most
    seeing you there!                                          pressing areas of concern relating to practice performance, reimbursement and compliance.
                                                               In a dynamic wrap-up session, the presenters will review some of the most critical challenges
    Sincerely,                                                 with the goal of arming participants for success when they return to the practice.

    Linda D’Spain                                              Our experts
                                                                                   • Robert Liles: Compliance – Fraud and Abuse
                                                                                   • D. K. Everitt: Compliance – HIPAA / OSHA
    Linda D’Spain, CMPE, CMCO, CMC, CMIS, CMOM                                     • Audrey Coaxum – Practice Profitability
    2012 PMI Las Vegas Conference Chair                                            • Linda D'Spain – Personnel Management Issues – Generation Gap
                                                                                   • Maxine Collins – Coding and Billing
Meet the Faculty

       Aric Bostick
       Master of Ceremonies and Keynote Speaker
       Aric is one of the nation’s top motivational speakers and success trainers with the keen ability to inspire people from all walks of
       life to believe in themselves, set goals and follow their dreams. Aric really fires up his audience and his words will resonate with
       us all. Taken to heart, his message has a profound impact on our ability to do our best job at work and dig deep to make a
       difference in how we act and perform. His stories may make you laugh or they may make you cry, but they will always make
       you think.

       Linda D'Spain, CMPE, CMCO, CMC, CMIS, CMOM
       Conference Chair
       Linda is an enthusiastic and knowledgeable professional with an extensive background in the medical field. During her 25 years
       in medical practice management, she has managed multiple specialties. She has served as an administrator for a medical group
       practice where she was responsible for leading, managing, and growing the practice. Linda develops, writes and presents
       curriculum for PMI seminars and certification classes. She has earned the designation of a Board Certified Medical Practice
       Executive through the American College of Medical Practice Executives and is currently working toward her fellowship in Health
       Care Administration.

       Audrey Coaxum, CHI, CMC, CMIS, CMOM
       Audrey is a hands-on specialist with almost two decades of well-rounded experience in the health care industry. She has overseen
       the development and implementation of policy and procedures relating to practice management, risk management and
        compliance based on federal, state, NCQA, HIPAA and OSHA standards. She has served on Quality Assurance, Management,
       Network Development, Utilization Review, Health Disparities and Compliance Boards. She is a Certified Health Care Instructor,
       who has trained many health care personnel, including physicians, on medical documentation and compliance issues relating to
       the coding, billing and reimbursement for services.

       Maxine Inman Collins, MBA, CPA, CMC, CMIS, CMOM
       Maxine has more than 20 years of experience in medical practice management, adult education and general business. She has
       taught courses at various levels, including teaching business communications and accounting at Midwestern State University in
       Texas. Maxine has extensive experience teaching administrative and clinical personnel essential medical office skills such as
       medical terminology, CPT and ICD-9 coding, reimbursement, OSHA, and HIPAA compliance. She is adept at personnel
       management, government rules and regulations, accounting and budgeting.

       D.K. Everitt, BBA, CMCO
       D.K. is a Healthcare Compliance Officer, whose work includes assessing hundreds of medical facilities, implementing Corporate
       Integrity Agreements and OSHA compliance training. He has authored several compliance books and serves as president of
       The Compliance Division, L.L.C. He has spent the last 25 years developing and managing corporate compliance programs and
       shares his talents as an Adjunct Lecturer and Preceptor for Trinity University’s Health Care Administration Graduate Studies
       Department. He has shared his knowledge with participants at several of PMI’s conferences. D.K. also serves on PMI’s Board of
       Experts as a Contributing Editor.

       Robert W. Liles, JD, MBA, MS
       Robert is lead legal counsel on matters of compliance for PMI, and is the lead developer for PMI’s new Compliance credential
       (CMCO). He was the first National Health Care Fraud Coordinator and subsequently worked as Deputy Director of the U.S.
       Department of Justice, Executive Office for United States Attorneys. As Managing Member in the Washington D.C. based office
       of Liles Parker, PLLC, Robert heads one of the nation’s leading law firms focused on health care fraud defense and regulatory
       matters representing providers in civil, criminal, and administrative proceedings.

    Inside the Sessions
                         GENERAL SESSIONS

                                                                                    Anatomy & Physiology - The Clinical Knowledge
                                                                                    You Need Today to Code Tomorrow
                                                                                    ICD-10-CM codes will require more detailed documentation in order to show
                                                                                    medical necessity for services rendered by providers. Many of us use these
          Improving the business of medicine through education                      terms every day but don’t know what they mean. Improve your knowledge
                                                                                    so you don’t get left behind. Avoid denials and errors in claim filing. Get up
                                                                                    to speed now with the clinical language of coding. Review actual sections
    Get Fired Up! From Burnout to Breakthrough                                      of ICD-10-CM codes and learn the clinical meaning of the code titles. Tie
    Feeling a loss of focus or enthusiasm at the office? Master of Ceremonies       anatomy and physiology to documentation and actual ICD-10 codes. We
    and Keynote Speaker, Aric Bostick, will help you refocus your mind and          will hit on a variety of specialties and apply to coding in ICD-10. Maxine Collins
    get excited about what you do. Draw a line in the sand today and
    challenge yourself to make a difference in your workday, your career            Coding & Billing for Mid-Level Providers
    and your life! You’ll answer important questions that will immediately          This session will address compliance concerns regarding mid-level provider
    shift your thinking to bring out the best in YOU every day. Participate in      billing patterns. The doctor has left the building. Now what? Can we still bill
    exercises that you can take back to the practice and share with your team.      Incident-to? Understand why the OIG is looking at Incident-to services this
    Build work relationships, creating an atmosphere that matters to you,           year and get clarification on the guidelines and billing requirements. The rules
    your coworkers and your patients. Those that embrace these principles           and guidelines for Medicare and other third-party carriers can get confusing
    and carry this energy into their office will create more synergy among          when billing for non-physicians practitioners. This session will help you better
    coworkers, reduce stress, uplift patients, and add to overall job               understand the rules and avoid possible fraudulent billing for your mid-level
    satisfaction. Get Fired Up! includes a self-reflection guide to reinforce       practitioners. Linda D’Spain
    your experience. Aric Bostick

    Audits and Outcomes: Practice Compliance Issues Uncovered
    What is your role in ensuring that claims are billed out correctly? Do you
    verify that the medical record documentation substantiates the codes on
    every claim? Is your state on the 2012 OIG list for scrutiny due to a higher
    error rate? How do you communicate with your providers effectively
    and gain assurance that your practice will withstand a RAC audit?
    This panel session will address one of health care’s chief concerns – billing   Managing A Records Retention/Destruction Program
    compliance and correct coding. We will take a look at the most common er-       Failure to have a functional plan for the retention/destruction of medical
    rors found in actual audit results and provide insights to help you             records exposes your practice to multiple risks, including compliance
    analyze your charts for potential errors. Get clarity on how to respond         violations and fines. An effective plan for records takes into consideration
    to audit findings and what to expect from outcomes. Find out exactly            the possibility of litigation, investigations and audits. This session explores
    what you are responsible for and get prepared to step up to the task.           statutes and regulations governing document retention and destruction
    Panel of Experts                                                                and provide guidance to help you identify the types of records, forms and
                                                                                    documents you should maintain access to, archive, or destroy. Challenges
    So You Think You Know HIPAA?                                                    related to electronic records retention and disaster recovery will also be
    HIPAA enforcement is on the rise and penalties are increasing at an             discussed. Make sure you have the correct system in place with clear
    alarming rate. Prepare now with this discussion of real life HIPAA audit        procedures for proper records maintenance. Audrey Coaxum
    outcomes. We will provide you with practical compliance measures to
    help you prepare for a future audit and avoid being targeted in the first       Translating Efficiencies to Profit
    place. D.K. Everitt and Linda D’Spain                                           Your office can experience a breakthrough in profitability when you put
                                                                                    some of what you learn in this session to work. But what does it mean?
    Faculty Wrap-Up Session                                                         The efficiencies of providing your services determine if the practice is
    During this final session of the conference, our Faculty will gather together   working at peak profitability. The overhead ratio represents both the sum
    on stage to address questions and highlight important information               of all costs associated with the practice operations and the financial results
    provided during the conference. Join in this open forum with our panel of       of the expenditures. This valuable resource will stimulate thoughts on where
    experts to ask a question or to share something of value that you received      dollars could be saved or spent in the right places and increase profitability
    from this continuing education experience. What did you learn that was          in your practice. Review top practice expense areas and identify opportunities
    new to you? What will you do differently when you return to the practice?       to reduce costs, avoid hidden costs and evaluate the value of EHR
    Don’t miss this unique opportunity to review critical components and            systems. Linda D’Spain
    integrate the tools, tips and techniques that you have gained before you
    return to the office to settle office debates and solve remaining problems
    that affect your practice’s productivity and reimbursement. Faculty Panel


The Keys to Successful Diagnostic Coding                                           Documentation Analysis
Failure to code to the highest degree of specificity impacts third-party payer     Develop skills to perform a gap analysis on provider documentation. Take
outcome, utilization statistics and practice reimbursement. ICD-9-CM               a look at various aspects of your provider’s documentation to prepare for
revisions are becoming more specific, requiring detailed documentation in          potential outside audits. Prepare for enhanced documentation needs with
preparation for ICD-10. With these incremental changes to diagnostic coding        the conversion to ICD-10. Determine whether provider documentation is
already underway, coders must keep up or get left behind. Sharpen your             sufficient for capturing data for evaluating, monitoring and improving quality
diagnostic coding skills to curb error rates and decrease your reliance on         of care. Learn about data quality outcome opportunities that help to address
EMRs now. Protect your practice from RAC audits and put an end to denials          health care administrative needs. Audrey Coaxum
that decrease your reimbursement. Maxine Collins
                                                                                   Winning the Appeals Game
Coding and Billing in 2012 and Beyond                                              In this session we will take an in-depth look at the appeals process, diving
This session will provide up-to-date information on coding changes, new            into some of the more difficult appeals including bundling, downcoding, lack
and deleted edits, and guideline revisions that impact your practice’s             of recognition of modifiers 25, 59 and 57. Learn reasons for denials and how
reimbursement. Recent news and updates issued by Medicare and the                  RACs and other government and commercial payer audits are increasingly on
major private carriers will be summarized and explained. A special emphasis        the lookout for errors and overpayments to take back. Make sure you aren’t
will be on E&M coding, an area under scrutiny this past year by the OIG.           letting reimbursement fall by the wayside. Whether the issue is inadequate
Can you accurately distinguish between new & established patients in a             payment, denial or rejection, it is imperative to appeal claims in a timely
group practice? Do you understand the importance of taxonomy codes                 manner with as much supporting documentation as possible. Walk away with
that are tied to the provider’s NPI number that indicates specialties and          the knowledge you need to appeal insurance claims efficiently and effectively,
subspecialties? This session will cover critical coding and billing issues          resulting in accurate reimbursement and enhancement of the overall
impacting medical practices today and prepare you for accurate claim filing        reimbursement cycle. Audrey Coaxum
in the future. Maxine Collins


Walking the HR Tight Rope                                                          Incorporating & Managing Technology in the Practice
Most of us don’t have an extensive background in HR law, yet we hire and           Should your physician communicate with patients via email or social
manage employees on a daily basis. Cultural shifts in the medical practice         networking? Is telemedicine an option for your providers? This session will
reflect a positive trend but with it new compliance challenges regarding           address the impact of using mobile health technology tools in your practice.
potential lawsuits and claims. A series of missteps can hang a huge liability      Learn about security considerations that must be addressed when using
on your practice. This session will address human resource risk areas and          various forms of e-health (EHRs, patient portals, smart phones, etc.) in your
teach you how to implement policies and procedures to help manage risk in          practice. Develop a plan for addressing the impact of social networking
the medical office. Learn what steps are required for compliance with current      (e-mail, Twitter, Facebook, etc.), web site use, online ratings and blogs in
HR Laws and identify the gaps in your present policies. We will discuss proper     the office. Audrey Coaxum
protocols regarding social media and the valuable role of job descriptions
and the employee handbook. We will also address Exempt/Non-Exempt                  What Is Integrated Care and How Will It Affect Your Practice?
employees, pay requirements, overtime compensation and at-will                     Integrated Care is the future of reimbursement. This session will prepare you
employment. - Linda D’Spain                                                        to evaluate your opportunities for successful operations in 2012 and beyond.
                                                                                   We will review your options including current voluntary programs like the
Don’t be a Statistic: 90-Minutes with Fraud & Abuse                                Medicare Shared Saving Program and related Medicare programs as well as
Attorney on Protecting Your Practice                                               physician led Accountable Care Organizations. Maxine Collins
Participation in Medicare is a privilege – not a right. As a number of cases
have recently reflected, CMS will not hesitate to terminate your participation
in the program. Hear the steps you can take immediately to reduce your level             Comments from 2011 Las Vegas Conference
of risk. Join healthcare attorney and former Deputy Director of the US Dept.
of Justice, Robert Liles, as he explores actual case studies and shares insights         “This conference was the best thing I could have done regarding
on protecting your practice from health care violations and penalties for                getting educated for my job.” – Kim Pechnik, CMC
fraud and abuse. Don’t assume an audit won’t happen. Get prepared with
the knowledge you need now. It’s much less expensive to go through the                   “This was a very good conference with great topics and speakers.”
compliance process than to hire an attorney. Bring your questions and get                                                         – Nancy White, CMC
answers from this nationally-renowned fraud and abuse expert. Robert Liles

      Conference Schedule

                                Pre-Conference Sessions |                           Wednesday, October 17, 2012
       8:30 a.m. to 9:00 a.m.    Registration/Breakfast
      9:00 a.m. to 12:00 p.m.    Morning Introductions and Roundtables
      12:00 p.m. to 1:00 p.m.    Lunch
       1:00 p.m. to 4:00 p.m.    Afternoon Roundtables and Wrap-up
       5:00 p.m. to 8:00 p.m.    Pre-registration “Meet and Greet” Networking Event

                                Conference Day 1 | Thursday, October 18, 2012
       7:00 a.m. to 8:00 a.m.    Registration and Continental Breakfast
       8:00 a.m. to 9:20 a.m.    Get Fired Up! From Burnout to Breakthrough, Aric Bostick
       9:20 a.m. to 9:25 a.m.    Welcome from the Conference Chair, Linda D’Spain
       9:25 a.m. to 9:45 a.m.    Exhibitor Meet & Greet and Refreshment Break
                                                                                    Coding                                                Management
      9:45 a.m. to 11:15 p.m.    Coding & Billing in 2012 and Beyond, Maxine Collins           Don’t Be a Statistic: 90 Minutes with Fraud &
                                                                                               Abuse Attorney, Robert Liles
     11:25 p.m. to 12:25p.m.                                                                   Integrated Care and How It Will Affect Your Practice,
                                 Documentation Analysis, Audrey Coaxum
                                                                                               Maxine Collins
      12:30 p.m. to 1:30 p.m.    Lunch
       1:30 p.m. to 2:30 p.m.                                                                  Managing a Records Retention/
                                 Coding & Billing for Mid-Level Providers, Linda D’Spain
                                                                                               Destruction Program, Audrey Coaxum
       2:30 p.m. to 2:45 p.m.    Refreshment Break
       2:45 p.m. to 4:15 p.m.    Audits & Outcomes: Practice Compliance Issues Uncovered, Panel of Experts
       5:00 p.m. to 8:00 p.m.    Networking Event (to be announced)

                                Conference Day 2 | Friday, October 19, 2012
       7:30 a.m. to 8:00 a.m.    Registration and Continental Breakfast
       8:00 a.m. to 8:10 a.m.    Announcements from the Conference Chair, Linda D’Spain
       8:10 a.m. to 9:10 a.m.    So You Think You Know HIPAA? D.K. Everitt and Linda D’Spain
       9:10 a.m. to 9:30 a.m.    Exhibitor Visits and Refreshment Break
                                                                                    Coding                                                Management
      9:30 a.m. to 11:00 p.m.    Anatomy & Physiology - The Clinical Knowledge You
                                                                                               Translating Efficiencies Into Profit, Linda D’Spain
                                 Need Today to Code Tomorrow, Maxine Collins
     11:10 p.m. to 12:10 p.m.    Winning the Appeals Game: Tackling Claim
                                                                                               Walking the HR Tight Rope, Linda D’Spain
                                 Rejections, Audrey Coaxum
      12:20 p.m. to 1:30 p.m.    Lunch
       1:30 p.m. to 2:30 p.m.    The Keys to Successful Diagnostic Coding, Maxine Collins      Incorporating & Managing Technology in the
                                                                                               Medical Practice, Audrey Coaxum
       2:30 p.m. to 2:45 p.m.    Refreshment Break
       2:45 p.m. to 4:15 p.m.    Faculty Wrap-up Panel

    * Schedule and Sessions are subject to change. Visit www.pmiMD.com for programming updates.

                                  NETWORKING EVENTS
                                 Wednesday Evening Pre-Registration
                                 Meet & Greet: 5-8 p.m.
                                 Join PMI for a casual pre-registration meet and greet hosted by PMI and conference
                                 exhibitors. Stop by the conference meeting area to pre-register, pick up your conference
                                 materials, and meet the presenters and fellow attendees in a casual environment.

                                 Thursday Evening Networking Social: 5-8 p.m.
                                 Thursday evening, be our guest at the Networking Social. Sip a cocktail and grab                                          Accommodations
                                 a snack before you head out for the evening. More details to come!
                                                                                                                                                           Pre-Conference and Conference sessions
                                  Add-a-Companion Meal Pass                                                                                                will be held at the Rio All-Suite Hotel
                                  All conference meals are included in registration fees. This year, by popular demand, we have added                      & Casino, where we have secured a
                                  a new option for anyone who wants to have lunch with a travel companion who is not a registered                          discounted conference group rate.
                                  attendee. Meal Pass includes breakfast and lunch each day and admission into both evening
                                  receptions. The fee is $100 per day. You can check the “Meal Pass” box on your registration form or
                                  contact us to add a Meal Pass up to one week prior to the conference.                                                    Guest rooms are $89/night
                                                                                                                                                           (single/double occupancy).

CEUs                  PMI Pre-Conference Session – October 17                                                                                              Rate good through September 25 only,
                      Pre-Conference is approved for 6 CEUs from PMI.*                                                                                     subject to availability. Early reservations
                      Pre-Conference session on October 17 has the prior approval of AAPC for 6 continuing education                                       are highly recommended.
                      hours. The expiration date is 7/31/2013.**

                      PMI National Conference Sessions – October 18-19                                                                                                Reserve Now
                      2012 PMI National Conference for Medical Office Professionals is approved for up to 12 CEUs for
   CEU APPROVED*      PMI Certified Professionals.* CEUs are awarded based on attendance at each session.                                                             866-705-3695
                      2012 PMI National Conference for Medical Office Professionals has the prior approval of AAPC for
                      12 continuing education hours (6 CE hours per day, October 18 and 19). The expiration date is
                      7/31/2013.**                                                                                                                         Hotel rate does not include applicable state and local
                                                                                                                                                           taxes. A credit card or cash deposit may be required
                      *CEUs may be applied to annual recertification requirements for Certified Medical Coder (CMC),                                        to reserve a room and during check-in. Details on
                      Certified Medical Insurance Specialist (CMIS), Certified Medical Office Manager (CMOM), and                                          room type, availability, check in/out times, parking
                      Certified Medical Compliance Officer (CMCO).                                                                                         fees, restrictions, shuttle service, cancellation policies,
                                                                                                                                                           etc. should be obtained at the time of reservation.
                      **Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

  Participant Information                                                                                     Registration Fee and Discounts
 Physician/ Practice Name                                                                                     Pre-Conference & Conference                            Conference Only
 Practice Address                                                                                             October 17-19    $1,590*                               October 18-19                    $1,095*
 City                                                    State                       Zip
                                                                                                                                      *$100 off through August 31
 Phone (       )                                         Fax (         )                                        Early Bird Discount applies to Pre-Conference and/or Conference Registration.
                                                                                                                                     See below for additional discounts.
                                                                                                              *Certification Discount
                                                                                                              Conference registrants with an active certification with PMI will receive an additional
 If attending the Pre-Conference on October 17 (see page 1 for details), Check “all 3 days” below.            10% off their registration fee (10% off is calculated off of the conference fee less Early
                                                                                                              Bird Discount as applicable).
                                                              Attending      Attending     Registration
                                                              all 3 days      2 days                          *Multiple Registration Discounts
 Participant Name                                             Oct. 17-19     Oct. 18-19    Fee see column 2
                                                                                                              Registrants from the same practice apply as follows: Second - fourth registrant all
                                                                  o            o                              receive 10% off. Five or more registering together all receive 15% off registration fees.
                                                                  o            o                              Cancellation Policy
                                       ($100 per day, see networking                                          If you must cancel your conference registration, you will receive a full credit for your paid
 o Add-a-Companion Meal Pass             section above for details)                                           conference registration balance, good toward future PMI training or products for up to one year.
                                                                                                              To receive a refund, minus a $100 processing fee, you must cancel by September 17, 2012.
 List additional participants on a separate form.                          Total                              No refunds will be issued for cancellations received after September 17, however, a credit will be
                                                                           Fee Enclosed                       applied to your account, good for one year from date of issue. Credit for registration fee does
                                                                                                              not include travel and/or lodging expenses.
 Method of payment:
 o VISA                          o American Express                                                           Registration Methods
 o MasterCard                    o Check or Money Order
                                                                                                                         Visit www.pmiMD.com                                 Fax: (210) 691-8972
                                 (Payable to Practice Management Institute)                                                                                                  Complete order form and fax
                                                                                                                         for secure online
 If paying by credit card, please complete the following:                                                                ordering 24/7.                                      to Shelby Roberts.
 Card No.                                                                            Exp. Date                           Call: (800) 259-5562                                Mail with Payment to:
 Cardholder Name                                                                                                         or (210) 691-8900                                   Practice Management Institute®
                                                                                                                         Registration lines are open                         9501 Console Drive, Suite 100
                                                                                                                         from 8 a.m. - 5 p.m.                                San Antonio, TX 78229
 Cardholder Signature
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                                                                                                                                                                             Practice Management Institute)              7

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