Register for Practice Management Webinars offered by PCC's Pediatric Solutions Team/title> <link href="/css/05headerstyle.css" type="text/css" rel="stylesheet"/> <link href="/css/05bodystyle.css" type="text/css" rel="stylesheet"/> <link href="/css/05footerstyle.css" type="text/css" rel="stylesheet" /> <style type="text/css"> form {font-size: .7em;} input, select {margin-bottom: .4em; border: .1em solid black; hr {padding: .1em; background-color: #19773c; margin: .7em;} div#rtnav img {float: right; border: 2px solid #1a76bc; margin: 0;} div#rtnav {background-color: transparent; border-width: 0px;} </style>  <script src="http://www.google-analytics.com/urchin.js" type="text/javascript"> </script> <script type="text/javascript"> _uacct = "UA-664230-1"; urchinTracker(); </script>  </head> <body>  <div id="logotop"> <a href="http://www.pcc.com"> <img class="logo" src="/images/05PCCLogo220.gif" alt="PCC - Physician's Computer Company" border="0" /></a> <img class="tagline" src="/images/tagline.png" alt="Pediatric Software Just Got Smarter. Your Practice Just Got Healthier." /> </div> <div id="navwrap"> <div id="topnav"> <ul> <li class="(none)"> <a href="/">Home<br/> </a></li> <li class="(none)"> <a href="/pedguide/">Pediatric<br/> Software</a></li> <li class="current"> <a href="/practmgmt/">Management Resources</a></li> <li class="(none)"> <a href="/clients/">PCC Client Resources</a></li> <li class="(none)"> <a href="/info/">About<br/>PCC</a></li> </ul> <div id="search"> <form method="get" action="/cgi-bin/namazu.cgi"> <fieldset> <input type="text" name="query" size="12" value=""/> <input class="button" type="submit" value="Go"/> <input type="hidden" name="idxname" value="full"/> </fieldset> </form> </div> </div> </div> <div id="sectionhead"> <h2>Practice Management Webinar Registration</h2> </div> <div id="breadcrumb"> <p> <strong>You are here:</strong> <a href="/">Home</a> > <a href="/practmgmt/"> Managment Resources</a> >>Web Conference Registration </p> </div>  <div id="wrapper"> <div class="content"> <p><a href="pmwebinar.php"><< Back to Webinar information</a></p> <h3 class="dkgreen">Practice Management Webinar Registration</h3> <form method="post" action="pmwebinarreg_.php"/> <br/> <strong>How did you hear about the Webinars?</strong> <select name="source"> <option value="">Choose one</option> <option value="PCC mail">Received mailing from PCC</option> <option value="friend">From a friend or colleague</option> <option value="PCC site">Discovered it on the PCC Web site</option> <option value="Web">Random Web search</option> <option value="other">Other</option> </select> <hr/> <h3 class="dkgreen">Attendee(s)</h3> <p><strong>Registration prices are per person/Webinar.</strong> PCC will invoice you.</p> <strong>Name</strong> <input type="text" name="attendee_1" size="30"/> <select name="title_1"> <option value="none">choose title</option> <option value="MD">M.D.</option> <option value="DO">D.O.</option> <option value="RN">R.N.</option> <option value="LPN">L.P.N.</option> <option value="PNP">P.N.P.</option> <option value="NP">Nurse Practitioner</option> <option value="MA">Medical Assistant</option> <option value="OM">Office Manager</option> <option value="Other">Other</option> </select><br/> <strong>Webinar</strong> <select name="webinar_1"> <option value="17">Choose one</option> <option value="20">How to be an Expert Witness, $75, 8/8/07</option> </select><br/><br/> <strong>Name</strong> <input type="text" name="attendee_2" size="30"/> <select name="title_2"> <option value="none">choose title</option> <option value="MD">M.D.</option> <option value="DO">D.O.</option> <option value="RN">R.N.</option> <option value="LPN">L.P.N.</option> <option value="PNP">P.N.P.</option> <option value="NP">Nurse Practitioner</option> <option value="MA">Medical Assistant</option> <option value="OM">Office Manager</option> <option value="Other">Other</option> </select><br/> <strong>Webinar</strong> <select name="webinar_2"> <option value="17">Choose one</option> <option value="20">How to be an Expert Witness, $75, 8/8/07</option> </select><br/><br/> <strong>Name</strong> <input type="text" name="attendee_3" size="30"/> <select name="title_3"> <option value="none">choose title</option> <option value="MD">M.D.</option> <option value="DO">D.O.</option> <option value="RN">R.N.</option> <option value="LPN">L.P.N.</option> <option value="PNP">P.N.P.</option> <option value="NP">Nurse Practitioner</option> <option value="MA">Medical Assistant</option> <option value="OM">Office Manager</option> <option value="Other">Other</option> </select><br/> <strong>Webinar</strong> <select name="webinar_3"> <option value="17">Choose one</option> <option value="20">How to be an Expert Witness, $75, 8/8/07</option> </select><br/><br/> <strong>Name</strong> <input type="text" name="attendee_4" size="30"/> <select name="title_4"> <option value="none">choose title</option> <option value="MD">M.D.</option> <option value="DO">D.O.</option> <option value="RN">R.N.</option> <option value="LPN">L.P.N.</option> <option value="PNP">P.N.P.</option> <option value="NP">Nurse Practitioner</option> <option value="MA">Medical Assistant</option> <option value="OM">Office Manager</option> <option value="Other">Other</option> </select><br/> <strong>Webinar</strong> <select name="webinar_4"> <option value="17">Choose one</option> <option value="20">How to be an Expert Witness, $75, 8/8/07</option> </select><br/><br/> <strong>Name</strong> <input type="text" name="attendee_5" size="30"/> <select name="title_5"> <option value="none">choose title</option> <option value="MD">M.D.</option> <option value="DO">D.O.</option> <option value="RN">R.N.</option> <option value="LPN">L.P.N.</option> <option value="PNP">P.N.P.</option> <option value="NP">Nurse Practitioner</option> <option value="MA">Medical Assistant</option> <option value="OM">Office Manager</option> <option value="Other">Other</option> </select><br/> <strong>Webinar</strong> <select name="webinar_5"> <option value="17">Choose one</option> <option value="20">How to be an Expert Witness, $75, 8/8/07</option> </select><br/><br/> <hr/> <strong>Are there specific issues you would like to see addressed in the Webinar you've chosen?</strong><br/> <textarea cols="40" rows="4" name="sr"></textarea><br/> <hr/> <h3 class="dkgreen">Practice Information</h3> <p><strong>Contact information is required for invoicing.</strong></p> <strong>Practice Name</strong> <input type="text" name="practice" size="40"/><br/> <strong>Contact Name</strong> <input type="text" size="30" name="contact_name"/><br/> <strong>Address</strong> <input type="text" size="30" name="address"/><br/> <strong>City</strong> <input type="text" size="20" name="city"/> <strong>State</strong> <input type="text" size="2" name="state"/> <strong>Zip</strong> <input type="text" size="5" name="zip"/><br/> <strong>Phone Number</strong> <input type="text" size="30" name="phone"/><br/> <strong>Email Address</strong> <input type="text" size="30" name="email"/><br/> <strong>Fax</strong> <input type="text" size="30" name="fax"/><br/> <hr/> <h3 class="dkgreen">Promotional Code</h3> <p><strong>Please enter your promotional code if applicable</strong></p> <input type="text" name="promocode" size="20"<br/> <hr/> <h3 class="dkgreen">Invite a Friend and Save $25</h3> <p><strong>Invite a friend to join you at the workshop. If you both attend, you and your friend will receive a $25 discount on your registration. Just give us the friend's contact information below, and the discount will be reflected on your invoice.</p> <strong>YES! I'd like to invite a friend.</strong><br/> <strong>Friend's name</strong> <input type="text" name="friendname" size="40"><br/> <strong>Address</strong> <input type="text" size="30" name="friendaddress"/><br/> <strong>City</strong> <input type="text" size="20" name="friendcity"/> <strong>State</strong> <input type="text" size="2" name="friendstate"/> <strong>Zip</strong> <input type="text" size="5" name="friendzip"/><br/> <strong>Phone Number</strong> <input type="text" size="30" name="friendphone"/><br/> <strong>Email Address</strong> <input type="text" size="30" name="friendemail"/><br/> <br/><br/> <input type="submit" value="Register"/> </div> <div id="leftnav"> <ul> <li class="pmconf"><a href="/practmgmt/psconfs.php" title="Annual Practice Management Conference">Conferences on<br/> Practice Management</a></li> <li class="webinar"><a href="/practmgmt/pmwebinar.php" title="Practice Management Webinars">Webinars on<br/> Practice Management</a></li> <li class="pmwkshop"><a href="/practmgmt/pmworkshop.php" title="Practice Management Workshops">Workshops on<br/> Practice Management</a></li> <li class="busres"><a href="/practmgmt/business/" title="Articles and resources on pediatric practice and office management">Business Resources</a></li> <li class="lists"><a href="/lists/" title="E-mail lists sponsored by PCC">E-mail Discussion Forums</a></li> <li class="samples"><a href="/practmgmt/sample/" title="Form and document samples">Sample Documents</a></li> <li class="bench"><a href="/benchmark/" title="Financial, clinical, and practice benchmarks for pediatric practices">Pediatric Benchmarks</a></li> <li class="calc"><a href="/practmgmt/calculators.php" title="Calculators for evaluating Coding and RBRVUs">Coding Calculators</a></li> <li class="alert"><a href="/clients/prot/alert/" title="Pediatric Coding Alert available to PCC clients only">Pediatric Coding Alert</a></li> <li class="ehr"><a href="/practmgmt/ehr.php" title="Information on EHRs and EMRs">Electronic Health Records</a></li> <li class="hipaa"><a href="/practmgmt/hipaa.php" title="HIPAA guides and references">HIPAA</a></li> <li><a href="/form.html" title="Get more information about PCC's products">Request Information</a></li> <li class="noborder"><a href="/clients/contact.php" title="Contact information for PCC">Contact PCC</a></li> </ul> </div> </div> <div id="footer"> <p> <a href="/clients/contact.php"> Contact PCC</a> | <a href="/form.html">Request Information</a> | <a href="/disclaim.html">Copyright and Disclaimer</a> | <a href="/privacy.html">Privacy Policy</a> </p> </div> <div id="address"> <p>www.pcc.com • Physician's Computer Co. • 1 Main St., Winooski, VT 05404 • 800.722.7708</p> </div> <div id="icons"> <p><a href="http://www.spreadfirefox.com/?q=affiliates&id=0&t=83"> <img alt="Get Firefox!" title="Get Firefox!" src="/art/newart/firefox_80x15.png"/> </a> <a href="http://www.mozilla.org/products/thunderbird/" title="Get Thunderbird - Reclaim Your Inbox"> <img src="/art/newart/thunderbird_blog1.png" width="94" height="15" alt="Get Thunderbird"/> </a> <a href="http://validator.w3.org/check?uri=referer"><img src="/art/newart/valid-xhtml10.png" alt="Valid XHTML 1.0 Strict" height="17" /></a> </p> </div> </body> </html>