REGISTRATION INFORMATION the Metropolitan Philadelphia Chapter

REGISTRATION INFORMATION
38th Annual Institute of the NJ Chapter of HFMA in cooperation with
the Metropolitan Philadelphia Chapter
The Borgata Hotel, Casino & Spa - Wednesday October 8, 2014 through Friday October 10, 2014
Registration and payment is available online through the HFMA NJ Chapter website at www.njhfmainstitute.org. The
form may also be faxed, with credit card information, to (609) 348-4433. OR, if paying by check, please fill out the form
and mail to the address noted below.
Host Site & Hotel:
Badge and Mailing Information:
_______________________________________________________________
BORGATA HOTEL, CASINO and
FULL NAME
SPA, One Borgata Way, Atlantic
_______________________________________________________________
City, NJ 08401
FIRST NAME FOR NAME BADGE
www.theborgata.com
_______________________________________________________________
COMPANY/ORGANIZATION
To reserve a room at The Borgata,
_______________________________________________________________
Hotel, Casino, and Spa, call (866)
TITLE
MY-BORGATA or 1-866-692-6742.
_______________________________________________________________
ADDRESS
Please identify yourself as a NJ
_______________________________________________________________
Healthcare Financial Management
CITY/ STATE/ ZIP
Associate
or
reference
code:
_______________________________________________________________
GBHFJ14 in order to receive the
EMAIL (Required)
BUSINESS PHONE FAX
discounted rate of $139 per night.
_______________________________________________________________
Price does not include taxes. Any
HFMA CHAPTER MEMBER NUMBER
reservations made after September 14,
Registration Type
Provider
Member
NonProvider
NonProvider
Member
NonMember
Regular Registration
$325
$475
$575
Walk-in Registration
$425
$525
$625
Wednesday Only
$200
$325
$425
Thursday Only
$250
$375
$475
Wed. Only- Walk-in
$300
$400
$500
Thurs. Only- Walk-in
$325
$425
$525
Student Registration (Full Time)
$125
$125
$125
2014 are on a space availability basis
at the current rack rates. Cancellations
are subject to Hotel policy, and may
result in one night’s room rate. Please
confirm with Hotel prior to
cancellation.
Check all that apply:
____ Chapter Board Member ____ CHFP ____ FHFMA
Payment Information:
Payment Enclosed (Check Payable to NJ HFMA (Fed ID: #26-0266857) Mail to: NJ HFMA (Fed ID #26-0266857)
c/o D. Lawrence Planners, L.L.C. / 1125 Atlantic Avenue, Suite 634 / Atlantic City, NJ 08401
Charge $___________ to: Circle one:
VISA
MasterCard
American Express
______________________________________________ ____________________ ___________________________
Account Number
Exp Date
3 or 4 digit Security Code
_____________________________________________________________________________________________
Print Cardholder Name
Cardholder Signature
______________________________________________________________________________________________
Credit Card Billing Address
City
State
Zip Code
*Conference Fees are not refundable on or after October 1, 2014
** Note that credit card payments to HFMA – NJ will appear as a purchase from D. Lawrence Planners, LLC on your credit card statement.