AHIA Online Registration Form 
 

First Name:

  
  Last Name:  
  Title:  
  Organization:  
  Street Address:  
  Street Address:  
  City:  
  State:  
  Country:  
  Zip Code:  
  Work Phone:  
  Work Fax:  
  Email Address:  
  Badge Name:  
 

Check all that apply:

  
  AHIA Member?  
  First Time Attendee?  
  Please do not allow my name to be used by other organizations
  Please correct mailing information  
    T-Shirt Size:  
 
Registration Fees:  Check all that apply
 
Before 8/30
After 8/30
AHIA Member Rate
$750
$850

Join & Register
(Includes 1 year membership)

 $930  
$1030

Quantity Discount *
Member Discount (2nd registration)

$650

 

$750
Non-member (includes 1 year membership) $830 
$930
OPTIONAL SESSIONS:
      
CIA Exam Review
(Part I, II, III, IV:  $75 per part)

Part I  
Part III 

 Part II
Part IV
 
Before 8/30
After 8/30
Optional Session #1 $75
$95
Optional Session #2 $75
$95
Optional Session #3 $75
$95
SUBTOTAL:
Registration Fees (A)
         
MEAL TICKETS:
(Required for guests only: Paid registrants receive meals for all scheduled meal functions.  Please enter number of tickets required.)
Monday Luncheon @ $30 each  
Monday Welcome Reception @ $35 each  
Tuesday Luncheon @ $30 each  
SUBTOTAL:
Meal/Reception (B)
TOTAL AMOUNT DUE (A+B) =
PAYMENT INFORMATION:
NOTE: Payable in US Funds only.		  
Check (payable to AHIA)      
Credit Card:        
  AmExp        
  MasterCard        
  Visa        
Credit Card #:       
Expiration Date:   
Name on Card:     

SESSION CHOICES:
(Choose one in each applicable time frame)
CIA Exam Review:
Part I
Part II
Part III
Part IV
 
Optional Sessions:

Optional Session #1   Internal Audit’s Role in Information System                                             Implementations

Optional Session #2    Compliance Auditing & Monitoring:
Optional Session #3    Revenue Cycle 101
Optional Session #4    Using Internal Controls Frameworks
Workshops:
(Choose one in each time frame)
Monday, 10/10
    10:20 a.m. - Noon 
    1:20 - 3 p.m.
    3:20 - 5 p.m.
Tuesday, 10/11
  10:20 a.m. - Noon 
  1:20 - 3 p.m.
  3:20 - 5 p.m.
Wednesday, 10/12
   8 - 9:40 a.m.
  10 - 11:40 a.m.
 
Reception:
I plan on attending Monday's reception luncheon.
Yes     No
 
  Call 1-888-ASK-AHIA if there are questions.
AHIA Tax ID #36-3666960		  
 

*$100 discount for individuals from same organization at same mailing address. Click here for specific group policy.

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