Medical Office Workshop Registration Form

Regence Provider Workshops
Participating medical providers and their office staff - We encourage you to attend the fall provider workshop near you to learn about:

  • Availity
  • BlueCard®
  • Care Management Programs
  • Medicare Star Ratings & Risk Adjustment

View the list of locations, dates and times and register now.

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.

     
   

Salt Lake City
SLCC at LHM Conference Center
9750 S. 300 W.
Sandy, UT 84070
* Wednesday - September 24, 2014
  9:00 a.m. - 12:00 p.m.
  Names of attendees
   

Ogden
Ogden Regional Medical Center
5475 S. 500 E.
Ogden, UT 84405
* Thursday - September 25, 2014
  9:00 a.m. - 12:00 p.m.
  Names of attendees
   

St. George
Crystal Inn Hotel and Suites
1450 South Hilton Drive
St. George, UT 84770
* Tuesday - September 30, 2014
  9:00 a.m. - 12:00 p.m.
  Names of attendees  
   
 
Office or Facility Information:  
Office name: *
   
Office address: *
   
Office Fax : *
   
Office Phone : *
   
Email: *
   
Tax Identification Number : *