CTSMA 63rd Educational Conference Registration

Conference Registration

Please book for conference by completing the form below. Please read and choose carefully as All Payments are Final - No Refunds, No Exceptions.
AAMA Member Number
Leave blank if you are not a member
Full Name*

First NameMiddle NameLast NameCredentials
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Select which describes you best
School Name
Student Only!
** A Medical Assistant Student is defined as a student currently enrolled in a Medical Assisting Program. If you are a student of another discipline, you do not qualify for the student rate. If you hold a current CMA (AAMA), RMA (through the AMT), or CCMA (Through the NHA) you are not eligible for the student rate. The member rate is for members of the AAMA **
Welcome Dinner Attendance (head count is needed):

I will attendI will not attendI will attend with a guest (must select meal ticket for guest)
Early Bird Rate! *Valid until 3/13/23*

*The agenda is available on our website www.CTSMA.org please print before arrival to the conference.
Please note prices are populated once you select the correct rate type (Free is a default on the form not the actual price):
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Conference 2 days $225.00
Includes continental breakfast each morning, Lunch each day and dinner on Friday.

Choose Rate

Conference Friday Only $200.00
Price includes continental breakfast, lunch and dinner.

Choose Rate

Conference Saturday Only $175.00
Price includes continental breakfast, and lunch.

Choose Rate

General Assembly Lunch Ticket$35.00
Choose if you are ONLY attending the General Assembly. DO NOT CHOOSE IF you paid for Both days or Friday only Conference.

Guest Meal Ticket for Welcome Dinner$45.00
Choose this option if you are bringing a guest to our Welcome Dinner

CPR Class$60.00
This class has a separate cost which is not included in the registration. Price is set by the instructor. Space is very limited!

Dress Down for Charity$5.00
For the price of a Latte, you can support a worthy cause. Wear jeans on Friday and 100% of the proceeds go to this year's charity!

Total $0.00
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The payment is ready! It will be completed once you submit the form.
Paying by check?

Print your form and mail along with check payable to CTSMA:

Wendy Carros 203 Belridge Rd, Bristol, CT 06010
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