2010 RHC Update Seminar Registration Form

Please complete the following registration information

 Name

Clinic

Address (1)

Address (2)

City, State, Zip

Telephone

Fax

Email

Please check beside the seminar that you wish to attend and check whether you want to order the Workbook and CD as well as the Seminar. The cost of the seminar is $200 and the cost of the workbook is $100. You do not have to come to the seminar to order the workbook or the cost report workbook.

Location	Date	Seminar	Workbook
Indianapolis	April 23^rd
Columbia, SC	April 30th
St. Louis	May 7th

Please mail this form to Mark R. Lynn, Healthcare Business Specialists,

Suite 214, 502 Shadow Parkway, Chattanooga, TN 37421 or fax it to (800) 268-5055. Checks should be made out to HBS or you may Paypal the payment to la_vita_nouva@hotmail.com. Workbook only orders accepted.