Documentation for ICD-10 Medicare & Insurance Updates For 2015  Louisville January 24-25, 2015 Pre-registration deadline: January 8, 2015 Marriott Louisville East 1913 Embassy Square Blvd Louisville, KY 40299 502-4911184  Lexington February 21-22, 2015 Pre-registration deadline: February 5, 2015 Griffin Gate Marriott Resort & Spa 1800 Newtown Pike Lexington, KY 40209 859-288-6193 Saturday Sunday Registration 12:00 – 12:30 8:00 – 8:30 Seminar 12:30 – 6:30 8:30 – 2:30 Registration Fee: $150.00 pre-registration • $180.00 late registration • $210.00 at event Cost includes one Doctor and one non-‐DC Staff Member—Registration is not complete payment is received THIS COURSE IS APPROVED FOR 12 CE HOURS, SPONSORED BY THE KENTUCKY CHIROPRACTIC SOCIETY, AND PRESENTED BY DR. CHARLES COPELAND DC Dr. Copeland is a graduate of Life University and has been practicing in Louisville since 1997. He teaches several weekend classes each year focusing on compliance, coding, and documentation, including a national certification compliance class, MCS-P. He teaches the Peer Review Certification Class at Logan University. Dr. Copeland serves on both the Kentucky Peer Review Committee and Worker’s Comp Committee for Chiropractic in Kentucky. Name _____________________________________________ KY License Number ____________ Company ____________________________Staff Attending Yes___ No___ Name__________________ Address _____________________________________________________________________________ City _____________________________________________________________________________ Business Phone ______________________________ Cell Phone __________________________________ E-‐mail Address ______________________________ Fax __________________________________ Payment Type (select one): Credit Card via phone at 502-‐454-‐5000 Check (by mail only) -‐ Make checks payable to Dr. Charles Copeland Please fill out the following form and submit it in one of the following ways: • Call (502) 454-‐5000 to pay with credit card by phone • Mail to: Charles E. Copeland, DC Insurance and Medical Compliance Consulting 1525 Bardstown Road Louisville, KY 40205 Please submit your check payment with this form or pay with credit card by phone at 502-‐454-‐5000. Registration is not complete until payment is received. Questions? E-‐mail [email protected].