2010 Online Registration Form for
Hospital Outpatient Mental Health Providers Webinar

This Webinar is designed for the purpose of educating all Mississippi Medicaid Outpatient Mental Health providers.

If you have any questions, please contact the education department at 601-360-4961 or education@hsom.org.

Please complete the registration form and submit it to HSM.
Registration forms may also be faxed to 601-360-4967. Click here for printable registration form.

All Field are REQUIRED
First Name*:
Last Name*:
Phone Number*:
Phone Extension:
Fax Number*:

Email Address*:
Provider Name*:  

MS Medicaid Provider Number*:

  


Select Your Workshop Choice
 
Select Date Time
Thursday December 30 11AM-12PM
     

     

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