2010 MYPAC Webinar Online Registration Form

This educational Webinar is designed for all Mississippi Medicaid

MYPAC 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
Wednesday November 10 11AM-12PM
Wednesday December 9 11AM-12PM

     

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