On-Line Registration Form

The Home Care Association of Colorado presents 

"ICD-9 Coding Compliance For
Home Care"

Thursday, February 20, 2003
8:30 am to 4:00 p.m., Mountain Standard Time

The Arvada Center for the Arts and Humanities
6901 Wadsworth Boulevard, Arvada, CO

Please complete all information below, then click the Send button at the bottom of the form to transmit your registration electronically to the HCAC office.

Be sure to review the Cancellation Policy before sending your registration.

On-line Registration Form

Agency/Company 
Agency Contact 
Address 
City, State, Zip

Phone
Fax 
Email 

Select one option below:
HCAC Provider Member     
HCAC Allied Member
Nonmember Provider
Region VIII
Other State Home Care Association Member 

Name of 1st Registrant 

Name of 2nd Registrant

Name of 3rd Registrant

Name of 4th Registrant

Registration Category
Please select your categories below: 
(Press the Control button on your keyboard and click mouse to select more than one option)

Total Amount Due
 $

Payment Options
 Please select one option below:
MasterCard*       VISA *
Please include credit card information below.
Invoice to company (include mailing address above)

Cardholder name
Card number
Expiration

*A credit card receipt will be mailed to the mailing address above.

Comments?

Please click below to submit your registration to the HCAC office. 
A confirmation page will appear to acknowledge that your
registration has been sent electronically.

If you do not receive a confirmation page, 
 please contact HCAC staff as soon as possible at hcac@assnoffice.com.


Cancellations & Refunds
All cancellations must be made in writing to the HCAC office, 7853 East Arapahoe Court #2100, Centennial, CO 80112-1361; fax (303) 694-4869; hcac@assnoffice.com.

Written requests for refunds received on or before Thursday, February 6th will receive a 50% refund; fees are nonrefundable after this date.

Questions?
Please contact the HCAC Office: hcac@assnoffice.com
Phone (303) 694-4728, ext. 53                 Fax (303) 694-4869
Return to ICD-9 Coding Seminar page  /   Return to HCAC home page

Home Care Association of Colorado
7853 East Arapahoe Court, Suite #2100, Centennial, Colorado 80112-1361

© Home Care Association of Colorado, 2003. All rights reserved.