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healthcare financial management association
HomePurchase CPAR/ACPAR with check
Georgia HFMA 
Certified Patient Accounts Representative 
Course Order Form
To purchase CPAR or ACPAR by check: print the form below, select your courses then mail with your payment to the address below.
In the form below you are asked to provide your email address. It is not recommended that you use your employer email address. Your email address will be your permanent user name and this is how you will receive communications about CPAR/ACPAR. If you change jobs and your email changes, you will no longer receive CPAR/ACPAR notices.
First Name:           __________________________________________________________________________________________ 
Last Name: __________________________________________________________________________________________  
Email:  __________________________________________________________________________________________  
Address:  __________________________________________________________________________________________  
City:  __________________________________________________________________________________________  
State: __________________________________________________________________________________________  
Zip Code:  __________________________________________________________________________________________ 
Phone:  __________________________________________________________________________________________ 
Company: __________________________________________________________________________________________

Please select the courses you are purchasing: 
You must be CPAR certified before purchasing any ACPAR course.
________ CPAR - Certified Patient Accounts Representative  $150
________ Re-test CPAR - Certified Patient Accounts Representative    $29
________ ACPAR - Advanced Certified Patient Accounts Representative, Compliance    $75
________ ACPAR - Advanced Certified Patient Accounts Representative, Patient Access    $75
________ ACPAR - Advanced Certified Patient Accounts Representative, Patient Financial Services    $75
________ ACPAR - Advanced Certified Patient Accounts Representative, Physician Practice    $75
________
ACPAR - Advanced Certified Patient Accounts Representative, Revenue Integrity
   $75
Total _______


Make check payable to Georgia HFMA

Mail your payment and this completed form to:

Georgia HFMA

4506 N Slope Circle

Marietta GA 30066