Medical Assistants at the heart of health care

October 13, 2018


Registration Now Open

New Hampshire State Society of Medical Assistants Fall Conference 2018

Date: Saturday, October 13, 2018

Registration is from 8:30 am- 9:00 am   Speakers start at 9:05 am promptly!

Location: Monadnock Community Hospital

                 452 Old Street, Peterborough, NH 03458

Cost: $40 per person.

Light breakfast and a lunch is included in the cost.

          STUDENTS** enrolled in a Medical Assistant program - must show student ID to register. The first 10 students to register may attend at no charge.

** 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.

Registration form and payment must be postmarked no later than October 4, 2018 for this event.

Thank you!

 Please print form and fill out COMPLETELY !  Please only ONE form per person.

**If unable to print form off site you may try cutting and pasting into a word document then printing**


Checks and Money orders made payable to NHSMA. 

PayPal only for all Credit/Debit Card Payments - Please copy and paste registration form and email to TREASURER@NHSMA.ORG to complete your registration.

***Credit Card/Debit Card information WILL NOT be taken by mail.  If you have problems with PayPal please e-mail treasurer@NHSMA.org

Paypal is located top left on the home page.

Mail form along with full payment of check or money order:

NHSMA c/o Dawn Broad

5 Reuben's Driftway

Hampton NH 03842


Name: ____________________________________________________________

Address: __________________________________________________________

City: _________________________State: _____________ Zip: ____________

Email address:_______________________________________________________

Telephone #___________________________

Please provide a short notice contact number in case of last minute rescheduling. ____________________________


AAMA Member ID # (must supply for CEU credits)  _________________________

Non-Member CMA (AAMA)'s please enter last 4 digits of SS# _________________

(SS# is for CEU tracking purposes only required for credits)

Non CMA (AAMA)'s may use the attendance certificate to apply for credits from their sponsoring organization.

Please choose payment type:

____Certified Check or Money Order (made payable to NHSMA)    

____Personal Check ($20 service charge on all returned checks) made payable to the NHSMA

____ I have paid by PayPal.  

All attendees will be given a paper certificate of attendance the day of the conference.  This may be submitted for credits if you are a not a member of the AAMA.

__________Check here if you need a receipt prior to the conference for employer reimbursement.

Please note: no confirmations will be sent unless checked above.

Remember Registration forms must be post marked no later than October 4, 2018.

You are NOT registered until this form is received, even if you pay by PayPal.  The information on this form is needed to complete your registration.

Thank you! 

Breakfast and Lunch will be provided. 

Please report any dietary restrictions / allergies here.  Please note we are unable to accommodate dietary

restrictions after October 4, 2018. _______________________________________________________


**All speakers and times are subject to change without notice**

 anticipated CEU's 5 to 6 (including at least 1 Admin!).