AMBA Compliance Online Seminar Registration Form
Please print and send along with your payment to AMBA.
Be sure to include your email address clearly written so we can send your access password and user name via email.
___Online Compliance Seminar $69
Name of Seminar Attendee:
City ST Zip:
Send registration to:
American Medical Billing Association
2465 E. Main
Davis, OK 73030
Credit Card Type: ___Visa ___MC ___Discover
Expiration Date: __________
Name on Card:______________________________(Print)
Or, fax your form with a credit card payment to (580) 369-2703. Be sure to include the expiration date and name on the card when paying by credit card. Visa, MC and Discover accepted.