Registration Assistance Program

 HEATLHCARE FINANCIAL MANAGEMENT ASSOCIATION NORTHWEST OHIO CHAPTER

REGISTRATION ASSISTANCE PROGRAM FORM

In an effort to make the Healthcare Financial Management Association Northwest Ohio educational
meetings affordable to all of our members, the Chapter is sponsoring a Registration Assistance
Program. As part of this program, $1,000 will be annually budgeted to assist those members who
would like to attend the educational meeting(s), but are not able to pay the registration fee.
By applying for assistance and receiving Chapter approval prior to the meeting date, the fee
would be waived for the member for that meeting. The fund will be used on a first-come, first-
serve basis and will be limited to $1,000 as based on the Chapter’s fiscal budget year. 

Program Title:  _________________________________________________________________________

Program Date:  ________________

Please check one box:

□ Employed by an institution of higher learning – Institution: ___________________________________ 
□ Retired
□ Unemployed
□ Student

HFMA Member Number: _____________________________

Chapter Treasurer Approval: __________________________