On-Demand Webinar Purchase Form

Name(Required)

First Last

Title(Required)

Department(Required)

Organization/Facility Name(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number(Required)

Email(Required)

Webinar Purchase Selection(Required)

Select one or more on-demand webinars you’d like to purchase (prices listed below):

2025 CMS Conditions of Participation – Member $500/ Non-member $650

2025 Critical Access Hospital Conditions of Participation: Ensuring Compliance 2025 – Member $500/ Non-member $650

EMTALA Update 2025 – Member $200/ Non-member $350

Payment Method(Required)

Select your preferred payment method:

Paying by ACH

Paying by Check

Paying by Credit Card

If paying by Credit card, please provide the following information to receive the secure payment link

Name

First Last

Title

Phone