Drug Rebate Conference
2009 Registration Form

2009 Early Registration is now open

The registration fee is waived for state representatives.

Early registration fees* will be applied if you register and we receive payment by the specified dates. (Registration fee is waived for state Medicaid representatives) *Payment should be accompanied by the registration on the above specified dates in order to receive the lower registration fee.

Please send checks payable to the following:

Data Niche Associates
A Unit of IMS
9 Parkway North, Suite 350
Deerfield, IL 60015-2544
Attn: Christa Kupferman

NOTE: If you are planning to bring a guest to our Thursday Event, please contact Pat Dobbin at 847.444.2481 or pdobbin@us.imshealth.com for additional information.

* Required fields.

Will You Represent:
First Name:
Last Name:
Company:
Title:
Mailing Address 1:
Mailing Address 2:
City:
State:
Zip:
* Telephone
Fax:
E-Mail Address:
How Did You Learn About the Conference?
* Would You Like to Schedule Data Niche Systems Training With Your Client Service Contact?
* Would You Like to Schedule a Dispute Resolution Meeting?
* Will You Attend Thursday Night's Event?
* Payment Type: