Executive Court Banquet Facility
1199 Mammoth Road
April 5 and 6, 2019
8:00 AM to 5:00 PM Registration 7:30 AM
Meet your rep on Friday night with appetizers and soft drinks
One form per person. Must pre-register to attend. Registrations will not be taken at the door.
Member: yes ______ ID# _________________________(needed for member bonus!!!)
Non-member: ______ Last 4 digits of SS# (for tracking purposes): ________________________
Town: __________________________ State: _________________ Zip: __________
Phone Number you can be reached at on short notice: ___________________________________
Please CIRCLE which days you wish to attend.
Early Bird Registration must be post marked on or before February 22, 2019- Now Extended to March 8, 2019
Friday only: $80 Saturday only: $80 Both Days: $ 150
Registration no later than March 20, 2019
Friday only: $ 110 Saturday only: $ 110 Both Days: $ 185
MEDICAL ASSISTANT STUDENTS**:
Friday only: $ 20 Saturday only: $ 20 Both Days: $ 40
I would like to attend "Meet Our National Rep", Lisa Lee, CMA (AAMA), Immediate Past President, AAMA, on Friday night following the conference. Location to be determined. Lots of appetizers and soft drinks will be provided at no charge. Please come and meet your Board Members and our National Rep in an informal, relaxed and fun get together!
Yes, I will be there! ______ Sorry, I can't make it._______
*!* Please refer to the Spring Conference opening page for information on $10 Member Bonus *!*
** A Medical Assistant Student is defined as a student currently enrolled in a Medical Assistant Program. If you are a student of another discipline, you do not qualify for the discount. If you hold a current CMA (AAMA) or RMA (through the AMT) you are not eligible for the student discount.
Do you have any dietary restrictions? Please explain: ________________________________
Dietary Restrictions cannot be accommodated unless notified by March 20, 2019
i******************************Absolutely NO refunds**********************************
Please copy and paste registration into Word. Fill out form and send with check or invoice number to:
5 Reuben's Driftway
Hampton, NH 03842
_____ I am paying by personal check or certified check. Make checks payable to NHSMA. Please enclose copy of registration with check.
_____ I am paying by PayPal. Invoice #: ____________. Please be sure to send this registration with your invoice number by mail to the above address or by e-mail to Treasure@NHSMA.org Please note your registration IS NOT complete unless this registration form is received by the NHSMA. PayPal does not provide the necessary information to complete your registration.
PayPal can be found on the HOME page in the upper LEFT hand corner and at the top of this page.
*****Please be informed that any returned checks will be subject to a $40.00 Fee *****
Presentation topics can to be found on the AGENDA page. Both topics and times are subject to change without notice. Check back frequently for up-dates.
The menu is posted under the MENU page.
Overnight accommodation information can be found on the OVERNIGHT ACCOMADATION page
We look forward to seeing you there!!!
** Photos will be taken at this event and may be posted to our website or on our Facebook page. No names will be posted without consent. Your registration is considered consent to have your photo posted.