Order Form

Payment Information
Credit Card #: __________________________
Expiration Date: ____/ ____/  (mm/YY)
Cardholder's name: _____________________
CVV or CVC: _____________________________
Signature : ______________________________
Billing Info : ____________________________

Visa    MasterCard    Discover   
American Express   
Others (Type Here)   _________________

Personal Information
Name: _____________________________________
Address: ___________________________________
Address Line 2: ____________________________
City: _______________________________________
State: ______________________________________
ZIP: ________________________________________
Phone: _____________________________________
Fax: ________________________________________
Email: ______________________________________
Job title*: _________________________________

If you want to make the payment through check or ACH please E-mail us at: cs@profeducations.com

Conference Title: CMS CAH Swing Bed Requirements and Changes 2023
Conference Date: Dec 21, 2023
Quantity Price Total
Recording $149
DVD $159
Recording + DVD $309
Transcript (Pdf) $149
Recording & Transcript (Pdf) $299
DVD & Transcript (Pdf) $309
Coupon Code
Total
Please send the completed order form via fax or e-mail
Note: All the order related material (Presentation, Transcript etc.) shall be fulfilled through the included email address only.

For any queries call at +1 (855) 718-3101 or email at cs@profeducations.com