2004 Louisiana HIPAA Conference Product Order Form

**please note that the form may take up to 30 seconds to process**

Product Order Form

Each of the eleven highly informative sessions of the 2004 Louisiana HIPAA Conference were professionally recorded, including both the privacy and security tracks, as well as the Crash Course. For more details, go to the agenda.

The entire set is now available to be purchased for only $325. Combined with the 2004 Program and Handout Manual (only $99.00), the Conference becomes an resource that you can refer to often. Perhaps more importantly, it will be an invaluable tool to train other members of your organization.

And members of Preferred Organizations get a 10% discount

I. Please fill out the information below.

Name

Title

Organization

Address

Phone

Fax

Email

II. Select the Product(s) you wish to purchase. (Please submit multiple forms for multiple purchases, or call HPM at 1-800-841-8240)

	Digital Recordings - 2004 Louisiana HIPAA Conference ($325.00)
	2004 Program and Handout Manual ($99.00)
	Note that 8% Louisiana sales tax will be added to all Louisiana purchases. $8.00 shipping and handling will be added to all purchases.
III. You are entitled to a 10% discount if you are a member of any of the Preferred Organization(s) below. Select the one to which you belong. (Only one discount per registration.)

IV. Select Payment Option

Our check is being mailed to HPM, P. O. Box 66776, Baton Rouge,

Louisiana, 70896

Our credit card information is being faxed for security to HPM at

225-765-7223. (click here to print fax form)

Please bill us at the above address.

Healthcare Provider Management, Inc. is ADA Compliant. Click here for more information.