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2013 OfficeMate & ExamWRITER Educational Event Registration Form

* Indicates a required field.

Practice Contact Information

Salutation*
First Name*

Last Name*

E-mail*
Practice Name*
Address*
Line 1
Line 2
City
State
Zip
-
Telephone Number*
Fax Number
Total # of Attendees from Practice*
Where did you hear about this event? Please provide specific information in the text box.*

Attendee Registration Information

Event Location and Date*
Washington, DC: July 18–20
San Diego, CA: August 8–10
Portland, OR: September 12–14
Course Registration*
OfficeMate Educational Event

Learn from the experts how to increase revenue and enhance patient care through effective office management.

# of Attendees Names of Attendees

ExamWRITER Educational Event

Learn from the experts how to increase revenue and enhance patient care through effective EHR management

# of Attendees Names of Attendees

Payment Information

Registration Fee
$598/Person/Course
Method of Payment*

Check Payments

If you are paying by check, make the check payable to Eyefinity and write "OM/EW Edu Event 2013," the location of the event, and your office phone number in the memo field. Send your payment to:

Eyefinity
P.O. Box 742608
Los Angeles, CA 90074-2608

Credit Card or Debit Card

If you are paying by credit card or debit card, call our Finance department at 1.800.269.3666, option 3, after you receive your registration confirmation e-mail message.

Comments



For additional Educational Event information, check out our Education Event web page at http://www.officemate.net/ossu_extension.aspx or call us at 1.800.269.3666, ext. 8264.