|
JCHA ACTIVITY REGISTRATION FORM
Tuesday, Sept 14 Networking Meeting
6:00
p.m.
MRI & Imaging of Georgia |
Johns Creek Office [MAP]
6630 McGinnis Ferry Road,
Suite D
Johns Creek, GA
30097
Hosted and Sponsored by
Attendee Name
(one name per
registration)
Practice/Company Name
E-mail (req.)
JCHA Member
(or am coming in place of a JCHA Member) - NO FEE
Non-Member
| Provider
- $10 FEE
(You must be a direct
provider of healthcare to patients to qualify for this attendee
category. Submit this registration
form and follow instructions on next page to pay the registration fee.)
JCHA
Annual Sponsor - NO FEE
Non-Sponsor
| Industry/Non-Provider
- $50 FEE (Submit this registration
form and follow instructions on next page to pay the registration fee) |
