REGISTRATION FORM
PROGRAM INFORMATION
COURSE NAME ID# Date Time Fee
Billing for Advanced Practice Providers 26593-0820 08/20/2026 1:00 PM - 4:00 PM $239.00

Sign in begins 15 minutes prior to the program. Instructional materials are included. Refer to your confirmation receipt for further information.

PARTICIPANT INFORMATION
Physician/Practice Name  
Specialty  
Address, City, State & Zip  
Phone Fax
Email  
Certified ID# Promo Code

Participant Name Course ID# Date Fee
       
       
       
       
Discounts (see below)  
Total Amount Enclosed  
Method of Payment
VISA MasterCard American Express Check or Money Order
Payable to Practice Management Institute
If payment by credit card, please complete the following:
Card No.:   Exp. Date: Total Amount:
Cardholder Name:   Cardholder Signature:  

HOW TO REGISTER

Phone: 585-473-7573

Mail: LUCIA CASTILLEJO, MS , MONROE COUNTY MEDICAL SOCIETY , PO BOX 22894 , ROCHESTER 14692

Registration Confirmation: Confirmations will be sent to the email or fax number listed on the registration form on the day your registration is posted in our system. Please check your confirmation for accuracy.

DISCOUNTS

Certified Professional Discount
PMI Certified Professionals with an active certification (CMC, CMIS, CMOM, CMCO) receive 10% off their registration fee. Certification must be active at time of registration and the Certification ID is required.

Group Discount
Organizations registering two or more participants from the same practice can take advantage of the following discount structure: first registrant attends at the regular rate, second through the fourth registrants receive 10% off. Five or more registering together all receive 15% off the published registration fee.

Host Discount
In some cases, host organizations are able to underwrite some of the program fees and extend a discount to their members/community. The discount structure varies by location and will be noted on the registration form, if applicable.

PMI discounts may not be combined. The greatest discount will be applied to individual registrations.

CANCELLATION POLICY

Cancellations must be sent via email to info@pmiMD.com with "Cancellation Request" in the subject line. Correspondence must include the registrant's name, payee's contact information, course ID number or city and date of the program. PMI will issue a credit voucher for the full amount paid that may be used by anyone in the practice for one year after issuance. If cancellation notice is provided at least 7 days prior to the scheduled program, a refund may be requested, minus a 20% processing fee. Questions? Call PMI at 800-259-5562.