About Bob Hoffman, DC Keep your pictures organized, so that yu can Dr. findBob whatHoffman you need. is Let the President Publisher arrange extra picof theyour Masters Circle, a unique tures off to practice the side asbuilding you insertand personal them. growth organization that has rev- olutionized the traditional model of coaching for chiropractors and other wellness providers. Dr. Hoffman was the 12th president of the International Chiropractors Association and served as the chairman of the board of the New York Chiropractic Council. He is a bestselling author, sought after coach and international speaker. Dr. Hoffman has successfully guided thousands of doctors and their teams to professional excellence and personal mastery. 2015 ICAI SPRING SEMINAR REGISTRATION (Registration and order must be received by April 1, 2015 to receive a ICD-10 Coding Manual at seminar) Last Name:________________________ Office Address:_______________________________________________________________ City:_________________________________State:_____________________ Zip:_________ Phone: (______) ________________________Fax: (_____) ___________________________ Chiropractic College:___________________________________ This 4-hour workshop with 2bonus hours is a hands-on, interactive workshop designed to help doctors and their teams understand ICD-10 coding requirements. Those responsible for ICD-10 coding want to participate in this workshop. Topics include ICD-10 format, structure, guidelines, and terms. It also includes the difference between ICD-9 and ICD-10. The trainer uses example cases to teach coding and documentation requirements in a true workshop format where participants practice coding and interact with one another. The ChiroCode ICD-10 Coding for Chiropractors, 2nd edition is required to participate. Yr. Graduated:________ Email:______________________________ Name to appear on badge: __________________ 12 Hours C.E. 8 Hours C.E.  $575 2015 Spring Seminar Fee ICAI Member Seminar Fee  $450  $450 (Includes ICD-10 Coding Manual for Sunday Lecture) Guest w/ D.C. ACA ICD-10 Workshop with Nick Payne, DC First Name:_____________________ M.I.:_____ (ChiroCode Book Not Included) ICD-10 ChiroCode Book  $100  $119  $350  $100 4 Hours C.E. (Risk Management)  $375  $300 (Includes ICD-10 Coding Manual by ChiroCode)  $100 I am not yet an ICAI member, but please secure a copy of “ICD10 Coding for Chiropractors” for the Sunday morning presentation. (No refunds / pre-sale only) PAYMENT INFORMATION Enclosed is my check for $__________ payable to ICAI for items marked above. I authorize ICAI to charge my credit card for $_________ for item(s) marked above. CC#________-________-_______-_______ Expiration Date: ____/____ CSC / CSV Code ______ Name As on Card:_________________________ X Signature:_______________________________ Billing Address, this card:  Office  Home  Other IMPORTANT NOTICE! ChiroCode ICD-10 Coding for Chiropractic 2nd Edition is required to follow and benefit from Sunday’s presentation. In order to receive your book, all attendees wishing to reserve a copy must submit their registration and book order by April 1, 2015. Or, you may order a copy directly from www.chirocode.com Seminar Dates May 2nd & 3rd, 2015 Mail or Fax Completed Form to: ICAI 1514 E. Bristol Street, Elkhart, IN 46514 Or Fax to (574) 266-5580 For more information call Carol: (765) 569-3722 * Please note: Payment for the purchase of additional CPT-10 Coding for Chiropractors must accompany request.