Medical Provider Workshops Registration Form

Asuris Medical Provider Workshops
Fall workshops for our participating medical providers and their office staff are being conducted throughout Washington. We encourage you to attend and learn about:

  • Availity
  • New Website Demonstration
  • Utilization Management Programs

Please check the box [✓] next to the date of the workshop you wish to attend and indicate the name(s) of attendees.

*Asterisks indicate required fields.

     

Spokane
Quality Inn   
110 East 4th  Avenue
Spokane, WA  99202                     
         

Capacity: 50 participants

 
* Wednesday - October 8, 2014
 

(Note: There are two sessions. Please register for either the morning or afternoon.)
  9:00 a.m. - 11:00 a.m.
  Names of attendees
   
     
* Wednesday - October 8, 2014
  1:00 p.m. – 3:00 p.m.  
   
     
Office or Facility Information:  
Office name: *
   
Office address: *
   
Office Fax : *
   
Office Phone : *
   
Email: *
   
Tax Identification Number : *