Join Us for Millennium Magic

“Hit Your Professional Peak With HHP/CA: Reaching New Heights Through Education” April 16 – 18, 2009 Embassy Suites Lake Tahoe Hotel & Ski Resort, South Lake Tahoe, CA Registration Form for HHP/CA 2009 Annual Convention Print or type all information. Please use a separate form for each individual registration (not including guest registration). Attendee Name: Company: Address: E-Mail: City: Phone: State: Fax: Zip Code: Student: Yes / School: California HA License Number Other State License Number Registration Fees Registration Type Fee Includes* Cost before 3/27/09 Cost after 3/27/09 Total Member of HHP/CA Friday and Saturday lunch; exhibit hall $379.00 $429.00 admission; all evening functions. Non-Member** Same as above $499.00 $549.00

Guest or Student Friday and Saturday lunch; all evening functions. $199.00 $199.00 Please enter guest’s name below Name of Guest: Saturday ONLY Saturday lunch; Saturday exhibit hall admission; $275.00 $300.00 Saturday dinner; 10 CE hours *Breakfast is provided in the hotel atrium daily to all registered hotel guests. **$130 will apply to membership dues if membership application is received before the conference ends. Additional Event Tickets Event Type Cost Per Ticket Quantity Total Friday Lunch $35.00 Friday Evening Reception $40.00 Saturday Box Lunch $30.00 Saturday Golf (Not included in any registration fees) $75.00 Saturday Dinner $60.00

Total Registration Fees and Additional Event Tickets Payment Check (payable to HHP/CA) Check #: Credit Card (complete information below)

American Express Mastercard Visa Card Number: Name on Card: Expiration Date: Billing Zip Code: Cardholder Signature:

Send completed form via mail (checks and credit cards): ROOM RESERVATIONS HHP/CA Call 877-497-8483 and reference Hearing Healthcare Providers, c/o Diane Williams, CMP or visit www.hhpca.org to access online hotel reservations. In 517 South Francisca Ave. order to receive the group rate, reservations must be made by Redondo Beach, CA 90277 Friday, March 27. Send completed form via fax (credit cards only): QUESTIONS 866-793-5727 866-793-5727, ext. 1 or [email protected]