ICD-10 Presentation Request Form

Cost

$750 for an 8 hour session (1 trainer for audiences up to 25 attendees)
$1125 for an 8 hour session (2 trainers for audiences greater than 25 attendees)

*Price will be pro-rated for requests less than 1 full day of training (8 hours)

Make check payable to IHIMA and mail to:

IHIMA Central Office
c/o Molly Newkirk
P.O. Box 296
Harrison, OH 45030

If you have any questions please email centraloffice@ihima.org

1. Name of Organization

2. Brief Description of Organization/Audience

3. Contact Name

4. Contact Phone Number

5. Contact Email

6. Date of Event

calendar

7. Type of Event

8. Type of Presentation Requested

9. Project Attendance

10. Work Setting

11. Venue for Presentation (include location and address)

12. Length of Presentation (hours/minutes)

13. Frequency of Presentation

14. Additional Comments