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.