Phone
(319) 626-2302
To phone in your reservation,
call Instruct-online at 319-626-3295
and give the following information:
Catalog Number : cca1765-iol
Webinar Name : Developing a Critical Access Hospital Compliance Plan
Speaker : Duane Abbey
Price : $225 per connection
Date : ____________________
All the information below is required:
Organization's Name : ______________________________
Address : ____________________
City/State/Zip : ____________________
Contact Name : ____________________
E-mail address : ____________________
Phone Number : ____________________
___ Pay by Check (Payable to : Instruct-online)
___ Pay by PO (Payable to : Instruct-online)
PO#____________________
___ Pay by Credit Card (Mastercard or Visa)
Card Number____________________
Name on Card____________________
Expiration Date______
Credit Card Verification Number (from back of card)______