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35th CSIMS Annual Virtual Conference
Start date : October 22, 2020
End date : October 25, 2020

First Name*:
Last Name*:
Email*:
Salutation*:

Designation*:


 
If other, please specify:
Specialty*:
Company/Organization:
Address 1*:
Address 2:
City*:
State*:
Zip Code*:
Cell Phone (e.g. 5554441212)*:
Alternate Phone (e.g. 5554441212):
 

Please let us know your group type

Group categories include:

Group 1: (MD, DO, DC, DPM, DDS, PhD, PsychD)     

Group 2: (NP, PA)

Group 3: (Attorney, Paralegal, Nurse case manager)        

Group 4: (Insurance Managers & Adjusters, Medical Senior Management & Office Managers)

Group Number*:



If other, please mention:
Are you a QME?*:
 
 
 
  *EVENT REGISTRATION OPTION
 
SrNoOptionSelectCost
31453641Member-Only Early Bird Special - (FIRM Deadline 9/30/2020)**: $485 485.00
3145disabled3642Member-only Regular Registration (10/1/2020 – 10/22/2020)**: $585585.00

                                                                                              Total    
 
 
 
 *PAYMENT METHOD
 
Enter Name on Credit card* :
 
 
 PAYMENT TERMS

** MUST BE A MEMBER so please register as a member for a special rate of $210 if you would like to attend the conference. Membership valid till December 31, 2020.

Credit Card - You will be directed to the PayPal site. You DO NOT need to be registered with PayPal to submit your payment.

Check – Make checks payable to: CSIMS

Forward Check Payment to:

CSIMS Corporate Headquarters

3000 W. MacArthur Blvd Suite 600

Santa Ana, CA 92704

 
 CANCELLATION TERMS

For the 35th CSIMS Annual Virtual Conference, on October 22-25, 2020, there are NO cancellations. Once your membership is verified and your Conference fee is collected, all of the slides and recordings will be made available to all registrants at NO additional cost.


Technology Support:

If you have any problem in submitting the form, please contact [email protected].

Membership and Conference Questions:

For any other questions regarding Membership and the 35th CSIMS Annual Conference on October 22-25, 2020, please contact:

CSIMS Assistant Director, Patricia Aranas

C: 949-525-9202 or 559-385-1433

E: [email protected]

 
   
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