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  • 8/8/2019 MGMA State Leadership Conference 2011 - Denver

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    MEDICAL GROUP MANAGEMENT ASSOCIATION

    Two days in Denver

    can make all the differenceIn your leadership.In your membership.

    MGMA 2011 StateLeaders Conference

    FEb. 11--12, 2011 DENvER

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    Many thanks to our conference sponsorYoure here for answers, and youve come to the right place.

    Who should attend

    The target audience for this conference is officers

    and paid staff for MGMA state affiliates. Officers,

    chairs and paid staff may participate in the sessionthat will be most helpful to them and their state

    associations. MGMA also welcomes members who

    are not currently involved in state leadership but

    are interested in pursuing such service. Presidents

    of state associations who have identified future

    leaders within your association are encouraged to

    attend.

    Why you should attend

    Whether you are a current State MGMA officer,

    chair, staff contact, or aspiring state leader, theMGMA 2011 State Leaders Conference offers

    the education and inspiration you need to be a

    successful leader.

    Learn from your peers Share experiences,

    get practical tools and gain information.

    Whatever issues your organization faces from

    vendor relationship building to leadership

    development youll return from the MGMA 2011

    State Leaders Conference with the knowledge and

    skills to tackle the challenge.

    Network with your peers Get hands-on advice and

    practical solutions that only your colleagues in

    other state MGMAs can provide. Youll have plenty

    of opportunities to catch up with old friends and

    connect with new ones.

    Conference site

    Set against the stunning backdrop of the Rocky

    Mountains, the Renaissance Denver Hotel is

    conveniently located midway between Denver

    International Airport and downtown Denver.

    Centered in the Stapleton redevelopment area, the

    largest urban redevelopment project in the world,

    the hotel is near many attractions. The crown

    jewels of the Stapleton area are the new Shops atNorthfield and Dicks Sporting Goods Park, home

    of the Colorado Rapids Major League soccer team.

    Join us in the Mile High City!

    General Information

    Lanyard sponsor

    Let us make you aware of anarray of products and servicesto meet your needs.

    Spend your networking breaks at

    the exhibitor tables, where youll

    find solutions and build important

    relationships.

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    Schedule at a Glance

    Thursday, Fe. 10

    Noon-3:00 pm Conference registration open

    3:00 pm Shuttles depart hotel

    4:00-6:00 pm Welcoming Reception atMGMA Headquarters

    6:00 pm Shuttles depart MGMAHeadquarters

    Friday, Fe. 11

    6:00-8:00 am Breakfast in hotel restaurant(included in room rate)

    7:00 am-5:00 pm Conference registration open

    7:30-8:55 am MGMA Joint Council ofSection Officers Meeting(invite only)

    7:30-8:55 am State Staff Meeting

    9:00 am-noon Individual Section Councilof State Leaders (COSL)

    Meetings

    Noon-1:00 pm Keynote sessionMGMA/ACMPE Update

    1:00-2:00 pm Concurrent sessions100 series

    2:00-2:30 pm Networking break

    2:30-3:00 pm Speaker Showcase sessionImpact of Individuals on

    Lobbying Efforts

    3:00-3:30 pm Speaker Showcase sessionAre You Surviving orThriving?

    3:30-4:00 pm Networking break

    4:00-5:00 pm Concurrent sessions200 Series

    Saturday, Fe. 12

    6:00-8:00 am Breakfast in hotel restaurant

    (included in room rate)

    7:00 am-3:45 pm Conference registration open

    8:00-9:15 am General sessionWashington Update

    9:15-9:45 am Networking break

    9:45-10:45 am Concurrent sessions300 Series

    10:45-11:15 am Networking break

    11:15 am-12:30 pm Concurrent session400 Series

    12:30-1:30 pm Networking luncheon

    1:30-2:00 pm Speaker Showcase session$tart a new discussion

    2:00-2:30 pm Speaker Showcase sessionStrengths-Based Leadership:Leveraging Talent for

    Organizational Outcomes

    2:30-3:15 pm Networking break

    3:15-4:15 pm Hot Topic Round Tables

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    9:00 am-noon

    Individual MGMA Section Council of StateLeaders (COSL) meetingEach section meets individually with its state

    leaders and staff. All participants (state and

    national) attend their respective section meeting.

    Noon-1:00 pm

    Keynote session: MGMA/ACMPE Update(lunch will be served)

    Organizational Governance

    William F. Jessee, MD, FACMPE, president and chief executiveofficer, Medical Group Management Association, Englewood,Colo.; Shena Scott, MBA, FACMPE, executive director, Brevard

    Anesthesia Services PA and chair, MGMA Board of Directors;

    and Alan D. Winkler, MHSA, FACMPE, vice president of clinicoperations, St. Vincent Health System, Little Rock, Ark. and chair,

    ACMPE Board of Directors

    Get an update on association business trends from

    the MGMA president and the newly elected board

    chairs. During this presentation, you will discover

    the trends, challenges and opportunities affecting

    Associations in the coming year.

    Conference Schedule

    Thursday, Fe. 10

    4:00-6:00 pm

    Welcoming Reception at MGMAHeadquarters

    Join your colleagues at the MGMA Headquarters

    for drinks and hors doeuvres.

    Friday, Fe. 11

    6:00-8:00 am

    Breakfast in hotel restaurant(included in room rate)

    7:00 am-5:00 pm

    Conference registration open

    7:30-8:55 am

    Joint Council of Section Officers Meeting(invite only)

    MGMA national section officers will meet and

    discuss topics of concern and interest.

    7:30-8:55 am

    MGMA State Staff MeetingThis session is always valued whether you are

    a new or seasoned state staff contact. Join your

    fellow state staffers to discuss issues unique to your

    role.

    Nancy Enos, FACMPE, CPC-I, CEMC, consultant, Nancy Enos

    Medical Consulting, Warwick, R.I., MGMA Eastern SectionChair

    Rosemarie Kuntz, MBA, FACMPE, clinical departmentmanager, Mid Dakota Clinic, PC, Bismarck, ND, MGMA

    Midwest Section Chair

    Jean Hansen, MBA, FACMPE, chief executive officer,Gastroenterology Consultants, Independence, MO, MGMA

    Southern Section Chair

    Judy Montgomery, CPA, MBA, FACMPE, practice

    administrator, Cardiovascular Surgery of Southern Nevada,Las Vegas, NV, MGMA Western Section Chair

    Mindy Zaui, executive director, Illinois MGMA, OhioMGMA and South Florida MGMA, Woodstock, Ga.

    Nancy A. Martin, MBA, CMPE, administrator, CantonAultman Emergency Physicians, Canton, Ohio, MGMA

    Midwest Section Board Representative

    Many thanks to the planning committee for the MGMA 2011 State Leaders Conference:

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    1:00-2:00 pm

    Concurrent sessions 100 series

    101. Membership Recruitment and Retention

    Business Operations

    Dana Guilfoyle, vice president, Communications and Marketing,Medical Group Management Association, Englewood, Colo.,Mindy Zaubi, executive director, Illinois MGMA, Ohio MGMA andSouth Florida MGMA, Woodstock, Ga., and Melissa O. Wilson,executive director, Tennessee MGMA and Kentucky MGMA,Brentwood, Tenn.

    Everyone knows it is more expensive to attract

    a new customer than to keep an existing one.

    As association professionals, our lifeline is our

    membership base. The explosion of digital media

    and business intelligence software provides the

    opportunity to deliver relevant communications atprime touch points in the membership cycle.

    This session will provide you with the knowledge to:

    Discuss best practices for retention marketing

    Discover how the national MGMA has revamped

    its marketing efforts via digital marketing

    Examine different methods and testing processes,

    and leave armed with tips and tricks to

    implement at your association

    102. Key Insights from a Legislative AideRisk Management

    Speaker TBD

    Legislative aides provide support and access to

    elected officials. Learn first-hand from a legislative

    aide how to get time with your legislator, the best

    way to present to your legislators and how to be

    successful in your grassroots efforts.

    This session will provide you with the knowledge to:

    Describe how legislative aides can benefit in

    grassroots efforts

    Discuss the best ways to contact your legislators

    103. All Chiefs, No Indians: LeadingVolunteer LeadersGeneral Competencies: Leadership Development

    Deb Wiggs, FACMPE, chief executive officer, Trinity Management

    Solutions, Bellingham, Wash.

    Maintaining effective leadership in a professional

    organization of leaders can either hone or dull

    your own leadership skills. What are some of

    the critical requirements needed to support your

    leadership efforts and provide your association

    with both consistent and persistent leadership?

    This session will give you some ideas and

    components that provide a framework for effective

    management and leadership in a volunteer

    organization, such as planning and accountability.

    This session will provide you with the knowledge to:

    Describe how to use a strategic plan for structure

    Discover the communication and character traits

    of leaders

    Identify how to handle difficult situations

    104. State ACMPE Forum RepresentativesRound TableStrengthen your relationship with your MGMA

    state association, promote ACMPE effectively and

    serve your state members by coming prepared to

    share ideas with other Forum Representatives.

    This session will provide you with the knowledge to:

    List three ways to promote ACMPE and serve

    your state members

    2:00-2:30 pm

    Networking break

    Conference Schedule

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    2:30-3:00 pm

    Speaker Showcase session: Impactof Individuals on Lobbying Efforts

    Risk ManagementJoel Blackwell, speaker and author, Washington, D.C.

    Communication with elected officials is the key

    to lobbying efforts. During this session, you will

    learn how individuals can impact public policy by

    communicating with elected officials, which kinds

    of communications work best, why relationships

    matter and how to deal with the competition for

    attention caused by the deluge of information

    pouring into their offices.

    This session will provide you with the knowledge to: Describe which kind of communication works

    best in lobbying efforts

    3:00-3:30 pm

    Speaker Showcase session: Are YouSurviving or Thriving?Financial Management

    James A. Stroud, CPA, member, Warren, Averett, Kimbrough andMarino LLC, Birmingham, Ala.

    There are forces in our culture that press on us to

    the point of reducing us to a survival mentality.

    This session will bring the problem into focus and

    illustrate that the solution to living a positive,

    impactful and enthusiastic life lies within each of

    us.

    3:30-4:00 pm

    Networking break

    4:00-5:00 pm

    Concurrent sessions 200 Series

    201. Association Finances Inquiring MindsWant to KnowFinancial Management

    James A. Stroud, CPA, member, Warren, Averett, Kimbrough andMarino LLC, Birmingham, Ala.

    Accounting processes for an association must

    satisfy governmental reporting requirements, but

    the same processes must exceed the expectations

    of your officers, board and members. And all mustbe accomplished without an improper use of funds

    happening on your watch. This session will enable

    you to identify the external and internal interested

    parties, and understand the distinction between

    financial data and useful association management

    financial information.

    This session will provide you with the knowledge to:

    Recognize how time invested in the chart of

    accounts will provide better information for

    association management

    Learn how to connect financial reporting formats

    with association goals

    Describe how to lessen the likelihood that

    a fraud or impropriety occurs under your

    leadership

    Conference Schedule

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    202. Your Associations Role in GrassrootsEffortsRisk Management

    Joel Blackwell, speaker and author, Washington, D.C.

    Your organization can have a large impact on

    public policy. During this session, the speaker will

    review best models and practices for maximizing

    the impact of your organization on public policy.

    To have the most impact, your association will

    need to create a key contact network that will

    recruit, motivate, educate and activate your

    members to communicate with elected office

    holders.

    This session will provide you with the knowledge to:

    Describe the importance of reward and

    recognition, the role of leadership of board

    and officers, and why members are reluctant to

    engage in political communication and how to

    overcome that reluctance

    203. Deepening Your Volunteer PoolLeadership Development

    Betsy Holt, MSS, director of member engagement, Medical GroupManagement Association, Englewood, Colo.; Bonnie Grevengoed,practice administrator, The Fertility Center, Grand Rapids,Mich.; and Karen Larossi, CMPE, manager, Hand-Elbow-Shoulder

    Surgical Specialists of Alaska, Anchorage

    Are you tired of recycling the same set of

    volunteers year after year? Sure, they do a good

    job, but getting some new blood and new ideas

    would be good, too. How do you expand your

    volunteer pool? In this interactive session, well

    take a look at some key findings from volunteer

    research that can help us understand how to make

    it easier for your members to volunteer. Well

    share some best practices and success stories from

    MGMAs national and state offices.

    This session will provide you with the knowledge to:

    List three key ideas that will help you grow your

    volunteer pool

    Describe three barriers that prevent potential

    volunteers from stepping up

    204. State Staff Round Table*Information Management

    Mindy Zaubi, executive director, Illinois MGMA, Ohio MGMA andSouth Florida MGMA, Woodstock, Ga.

    During this interactive discussion, state staff will

    discuss some of the common issues facing MGMA

    state associations as well as share ideas and best

    practices.

    This session will provide you with the knowledge to:

    Identify new opportunities for implementation

    for your state association

    *State staff only.

    205. Overview of ACMPE Certification:Taking the Trip from Nominee to CertifiedMember to Fellow*Beth A. Balen, FACMPE, Western Section Forum Coordinator,

    ACMPE, and Maria F. Petro, FACMPE, Eastern Section ForumCoordinator, ACMPE

    Participating in the American College of Medical

    Practice Executives (ACMPE), MGMAs standard-

    setting and certification body, is the best way to

    demonstrate your leadership and competence

    in medical practice management. ACMPE offers

    nationally recognized board certification andFellowship programs. Gain an understanding of

    the process and requirements necessary to attain

    ACMPE board certification and Fellowship, as well

    as the resources and programs to get you there.

    Identify ways that ACMPE certification can further

    your professional development and personal

    growth.

    This session will provide you with the knowledge to:

    Identify ways that ACMPE board certification

    and Fellowship can further your professional

    development and personal growth

    *ACMPE Forum representatives received waived

    registration fees for the conference, and a $250 travel

    stipend to encourage attendance.

    Conference Schedule

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    Saturday, Fe. 12

    6:00-8:00 am

    Breakfast in hotel restaurant(included in room rate)

    7:00-4:15 pm

    Conference registration open

    8:00-9:15 am

    General session: WashingtonUpdateRisk Management

    Allison Brown, government affairs representative of MedicalGroup Management Association, Washington, D.C.

    Medical practices often receive late and

    contradictory information on the actions of

    Capitol Hill and the administration affecting

    health care and daily administrative burdens.

    Provided in this update will be timely information

    on the regulatory and legislative issues under

    consideration by the administration and the

    Congress. Highlights contain MGMAs advocacy

    objectives for 2011 and the important grassroots

    role that members must play in achievingadvocacy success.

    This session will provide you with the knowledge to:

    Discuss proposed regulatory and legislative

    changes affecting medical groups

    Identify recent changes in Medicare

    reimbursement and program policies

    Recognize the challenges practices will face

    implementing and complying with new

    regulations

    List ways you can effectively participate inadvocacy efforts

    9:15-9:45 am

    Networking break

    9:45-10:45 am

    Concurrent sessions 300 Series

    301. Lobbying 101

    Risk Management

    Anders Gilberg, MGA, vice president of public and privateeconomic affairs; Allison Brown, government affairsrepresentative, both of the Medical Group Management

    Association, Washington, D.C.

    In this session, you will learn strategies for

    effective lobbying. Identify the critical resources

    and plan how to manage the most effective

    lobbying effort.

    This session will provide you with the knowledge to:

    Discover ways to maximize advocacy andminimize the cost

    Explain the common motivators and strategies

    for getting legislators to support your issues

    302. Strategic Planning from the Ground UpOrganizational Governance

    Kenneth T. Hertz, FACMPE, principal consultant, Medical GroupManagement Association, Englewood, Colo.

    The saying goes, If you dont know where youre

    going, theres a good chance you wont get there.

    In order for organizations to achieve their goals,they must have a mission, vision and values

    supported by a thoughtful and sound strategic

    plan. Working from the group up, this session

    will cover the foundational aspects of strategic

    planning vision, mission and values then

    address the process and approach for developing

    the strategic plan.

    At this session, participants will:

    Discuss the importance of mission, vision and

    values, and how to ensure their relevance today

    Discover how to identify and include key

    stakeholders in the strategic planning process

    Explain how to orchestrate the process for

    development of a strategic plan

    Recognize how to develop a strategic plan for

    their organization

    Conference Schedule

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    303. Getting Leaders from YourVolunteer PoolOrganizational Governance

    Nancy M. Enos, FACMPE, CPC-I, CEMC consultant, Nancy Enos

    Medical Consulting, Warwick, R.I.

    Succession planning is an important responsibility

    of state officers. State leaders often struggle with

    the selection of the best candidates for future

    board positions. This session will discuss ways to

    identify the best possible candidates for leadership

    in your volunteer pool. Leaders must recognize

    and avoid pitfalls of volunteers who say yes

    when invited to fill a roll, only to disappear or fall

    short of meeting the responsibilities of the role.

    This session will provide you with the knowledge to:

    Discuss strategies to give current and future

    state leaders a plan to identify, enlist, evaluate

    and mentor the right people to ensure positive

    leadership in the future of the state association

    304. State Staff session*Business Operations

    Mindy Zaubi, executive director, Illinois MGMA, Ohio MGMA andSouth Florida MGMA, Woodstock, Ga.

    During this interactive roundtable discussion, state

    volunteers will share best practices for leadingtheir association into the future and on providing

    services to their membership.

    This session will provide you with the knowledge to:

    Identify new opportunities for implementation

    for your state association

    *State staff only

    10:45-11:15 am

    Networking break

    11:15 am-12:30 pm

    Concurrent session 400 Series

    401. Effective Lobbying at the State LevelRisk Management

    Lawrence Epstein, MPA, CMPE, chief executive officer, PulmonaryAllergy Associates, PA, Highstown, NJ, Diane Bristol, administrator,Midland Ob-Gyn Associates, PC , Midland, Mich., StewartClark,PhD, practice administrator, Cardiology Center, LLC,Marrero, La., and Janet McIntyre, MBA, FACMPE, consultant, J E MHealthcare Consultants, Denver

    Your state association can have a big legislative

    impact at the local level. There are many ways torally the troops, and make significant headway,

    during this session, you will hear several options.

    The panelists will also discuss the governance

    structure at their state association that supports

    advocacy efforts.

    This session will provide you with the knowledge to:

    Describe various activities that the state

    association can implement to advance legislative

    issues

    Discuss different types of governance structuresthat support advocacy at the local

    Conference Schedule

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    402. From Plan to Action: Youve Got YourPlan, Now What?Organizational Governance

    Kenneth T. Hertz, FACMPE, principal consultant, MGMA,

    Englewood, Colo.

    The payoff for strategic planning is the

    achievement of strategic goals and objectives.

    Many organizations complete the planning

    process successfully but fail to achieve the

    desired results. This session presents tools and

    techniques that leaders can use to ensure success

    in the deployment of their strategic plan. The

    presentation will be didactic in nature, with

    specific examples provided that demonstrate both

    success and failure.

    This session will provide you with the knowledge to:

    Discuss how to apply the tools and techniques

    presented to ensure success in their organizations

    Recognize the importance of SMART goals,

    individual accountability and the importance of

    hardwiring processes to ensure success

    Review the importance of evaluation in strategic

    planning along with the concept of a looped

    process

    403. Managing VolunteersLeadership Development

    Betsy Holt, MSS, director of member engagement, Medical GroupManagement Association, Englewood, Colo.

    Volunteers can extend the human capital of your

    organization. Furthermore, volunteers who have a

    good experience will be more satisfied and possess

    greater loyalty to your group. How can you create

    a system to manage volunteers that effectively

    uses their skills and time, while ensuring a

    good time had by all? In this session, we will

    discuss key elements of different approaches to

    volunteer management and describe the volunteer

    management program being built at MGMA

    national.

    This session will provide you with the knowledge to:

    Describe important attributes of a volunteer

    management program

    Conference Schedule

    404. How to use your ACMPE State ForumRepresentative to Enhance your MembersExperienceVenus K. Biskis, FACMPE, Midwest Section Forum Coordinator,

    ACMPE, and Susan Childs, FACMPE, ACMPE Forum Representative,North Carolina

    What is the benefit of promoting professional

    certification to your state members? Participation

    in the American College of Medical Practice

    Executives (ACMPE), MGMAs standard-setting and

    certification body, is the best way to demonstrate

    leadership and competence in medical practice

    management. This session is designed for state

    leaders to learn how to best utilize your ACMPE

    state forum representatives to provide your state

    members the opportunity to pursue certificationand Fellowship in ACMPE. Following this session,

    you will be able to use ideas from other state

    associations to encourage your members to pursue

    the benefits of ACMPE board certification and

    Fellowship. Current state Forum representatives

    are also encouraged to attend to share successful

    activities.

    This session will provide you with the knowledge to:

    Incorporate ideas from other state associations to

    encourage your members to pursue the benefits

    of ACMPE board certification and Fellowship

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    HotelRenaissance Denver Hotel3801 Quebec Street, Denver, CO 80201Phone: 1.888.238.6762

    Special conference room rate:$109.00/night plus 14.85% tax per night

    A block of rooms is reserved especially for you

    at The Renaissance Denver Hotel at the reduced

    rate. Call the hotel directly for sleeping-room

    reservations and ask for the MGMA 2011 State

    Leaders Conference block and rate. Discounted

    rooms are available until Monday, Jan. 24, 2011

    or until they sell out. After this date, reservations

    at the conference rate will be accepted on a space-

    available basis only.

    A first nights deposit, by check, cash or creditcard, including tax, must accompany all

    reservation requests

    Hotel transportationComplimentary transportation is available to and

    from Denver International Airport. Pick up at the

    airport is on baggage claim Level 5 on the west

    side of the terminal, between doors 506 and 508,

    or on the east side, between doors 509 and 511.

    Shuttles run every 30 minutes. Be sure to schedule

    your shuttle time back to the airport at the hotel

    in advance, not that morning, as space is limited.

    Reimbursement for State LeadersConferenceMGMA will waive the registration fee to the

    State Leaders Conference for one (1) state board

    member, one (1) state staff (non-transferable)

    and for one (1) ACMPE Forum representative

    (non-transferable) to attend the conference. In

    addition, MGMA will also provide each state a

    reimbursement of up to $250 for a state board

    member and the ACMPE Forum representative.

    In addition, MGMA will provide each state a

    reimbursement of up to $250 for a state board

    member and ACMPE will provide each state a

    reimbursement of up to $250 for a State Forum

    Representative.

    Cancellation policyAll registration cancellations must be received

    in writing to the MGMA Service Center, 104

    Inverness Terrace East, Englewood, CO 80112, or

    faxed to 303.784.6110 no later than Monday, Feb.

    7, 2011, and are subject to a $100 processing fee.

    No credit or partial or full refund will be made for

    failure to attend after this date. Cancellations by

    telephone will not be accepted.

    If for any reason, MGMA must cancel one of

    its programs or turn you away due to limited

    attendance, your registration fee will be refunded

    in full. However, you are responsible for your own

    airline and hotel reservations. MGMA cannot be

    held accountable for any cancellation charges

    caused by program cancellation or attendance

    limitations.

    Please call the MGMA Service Center toll-free

    at 877.275.6462, ext. 1888, if you need to send

    someone in your place. If the new attendee

    has a different MGMA membership status, the

    registration fee will be adjusted accordingly. For

    more information on administrative policies such

    as a complaint or refund, please call the MGMA

    Meeting and Conferences Department toll-free at

    877.ASK.MGMA (275.6462), ext. 1875.

    DressBusiness casual attire is appropriate for all

    conference functions, including the receptions.

    Weather in February can be mild and hotel

    meeting rooms cool. Dressing in layers is best for

    maximum comfort.

    Note to those with special needsWe wish to take steps to ensure that no individual

    with a disability is excluded, denied services,

    segregated or otherwise treated differently than

    other individuals because of the absence of

    auxiliary aids or services. If you need any auxiliary

    aids or services identified in the Americans with

    Disabilities Act, call the MGMA Meetings and

    Conferences Department toll-free at 877.ASK.

    MGMA (275.6462), ext. 1875, before your arrival.

    ACMPE credit

    The American College of Medical Practice

    Executives (ACMPE) is MGMAs standard-

    setting and certification body and promotes the

    professional growth of leaders. By developing

    the Body of Knowledge for Medical Practice

    Management, ACMPE provides a central

    framework for MGMA resources. This program is

    approved to receive a maximum of 9 credit hours

    as assigned by the ACMPE.

    Registration General Information

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    Please make copies of this form if more than one person registers. Check here if this is a new address

    National MGMA number: _______________________________________ Check here if you only belong to yourlocal/state association

    First name: ______________________________________________ Last name: __________________________________

    Title: ____________________________________ Preferred name on badge: ___________________________________

    Organization: ____________________________ Address: ___________________________________________________

    City: __________________________ State: ____________________ ZIP: ______________________________________

    Phone: ________________________ Fax: _____________________ E-mail: ___________________________________

    A special note to the disabled: Please call MGMAs Meetings and Conferences Department toll-free 877.275.6462,

    ext. 1875, approximately three weeks prior to your arrival if you have a special need and require accommodation to

    participate in this activity.

    REGISTRATION FEES TotalDue

    MGMA State Officer $ 199

    MGMA State Staff $199

    ACMPE State Forum Representative $199

    ACMPE Section Forum Coordinator $199

    *If your registration is waived, please note waived on the registration form. TOTAL DUE FORFor details regarding reimbursement please visit mgma.com/slc11. REGISTRATION: $

    Method of payment (payment must accompany registration):

    Check enclosed Charge my credit card VISA MasterCard American Express

    Card no.: ________________________________________________________ Expiration date:

    Cardholders name: ___________________________________________________________________________________________

    Cardholders signature: ________________________________________ Date: ________________________________________

    Mail the program registration form(s) with your check, made payale to MGMA, to the following lockox address:Medical Group Management Association

    P.O. box 17603Denver, CO 80217-0603

    Register by phone toll-free 877.275.6462, ext. 1888or fax303.643.4439.

    MGMA 2011 State Leaders Conference (LDCNF11)Fe. 11-12, 2011

    Program Registration Form

    I will attend the welcoming reception on Thursday, Feb. 10.