“Let’s bind together and Explore….. our CEU Sessions Together”
ILLINOIS SOCIETY OF MEDICAL ASSISTANTS
59TH ANNUAL CONFERENCE – REGISTRATION FORM
Comfort Inn & Suites/Hickory Grove Conference Center
April 17-18th, 2015
MEMBER NON-MEMBER STUDENT
_____ Advance – Full Registration (through 4/6/15) $100.00 $125.00 $100.00
_____ Full Registration (late after 4/6/15) $110.00 $135.00 $110.00
_____ Education (CEU Sessions Only) $ 40.00 $ 50.00 $ 40.00
_____ Education & Saturday Lunch Only $ 60.00 $ 70.00 $ 60.00
_____ Friday Lunch Only $ 20.00 $ 20.00 $ 20.00
_____ Saturday Lunch Only $ 20.00 $ 20.00 $ 20.00
Total Paid $______Make checks payable to “Rockford Chapter of Medical Assistants”
I am a member______Student______Officer______Non Member______
Comfort Inn & Suites
1133 N. 7th Street
Rochelle, IL 61068
(815-562-5551)
NAME ______
CHAPTER______
ADDRESS______CITY______STATE______
PHONE ____-______-______CELL____-______-______
Hotel Accommodations: Comfort Inn & Suites, 1133 N. 7th Street, Rochelle, IL 61068 Phone Number (815) 562-5551. A block of rooms is set at the rate of $99.99 per night for king or double. Book your reservation ASAP. Please call before 4/1/15 in order to receive the discounted rate and please mention ISMA for the discount rate. Rooms will be on a first come first serve basis for the special room rate. Cancellation policy: Please ask for the cancellation policy if needed.
Please mail this registration to: Katherine Schoonhoven, CPC, CMA (AAMA), 4871 Tchaikovsky Street, Rock City, IL 61070. If you should have any further questions, please call (815) 238-6938. Special Needs/other questions: If you have special needs (accommodations, meals, etc.) or have any other questions please contact Katherine Schoonhoven at (815) 238-6938 or E-mail at .
For more information you can visit our website: ilsocmedasst.org or our Facebook page: Rockford Chapter of Medical Assistants/ TOPICS TO BE ANNOUNCED AT A LATER TIME