Welcome! Bibliomed is pleased to offer you special registration pricing for the Healthcare Information and Management Systems Society (HIMSS) annual conference from February 13th to February 17th in Dallas, Texas. Take advantage of it! If you need more information about the conference program and for hotel reservations visit http://conference.himss.org

The Annual HIMSS Conference & Exhibition is the one must-attend events in the healthcare IT industry and this year’s conference is set to offer even more value. With keynotes by Scott McNealy (of Sun Microsystems), more than 200 education sessions and more than 700 exhibitors featuring new products, cutting-edge interoperability demonstrations, a schedule packed with networking opportunities, and more. HIMSS 2005 is the only place where you can join 18,000 of your peers to find out everything that is going on in the industry, all in one place, all in four days.

To register now, please complete all the information requested in the following form.

Fields marked with * are required .

	First name *
	Last Name *
	Title
	Organization *
	Address *
	City *
	State *
	Zip Code *
	Country *
	Telephone *
	Fax *
	E-mail *
	Professional Role		CEO CFO CIO Chief Medical Officer Clinician CNO Consultant COO Director/Dept. Head Nurse Other Other Senior Management Partner Physician Professor RPH (Pharmacist) Programmer/Developer Senior Staff/Manager Staff Student

Registration choices *

	Attending HIMSS		USD 600 Non-member regular rate USD 945 USD 860 USD 795
	Attending HIMSS and join as international member
	Attending HIMSS and renew a previous international membership

Demographic & Additional Registration questions *

	Please complete the following information as part of your registration:
	1. I am interested in the 5K Fun Run/1 Mile Walk		Yes No
	2. I would like to volunteer to participate in a focus group		Yes No

	3. Did you attend HIMSS 2004 in Orlando?		Yes No
	4. How many previous Annual HIMSS Conferences have you attended?
	0 1 2 3 4 5+
	5. Work site (choose one)		Academic Ambulatory Care Consulting Firm Clinical Group Practice Government/Military/VA Healthcare Consulting Firm Healthcare System (Corp) Hospital Law/Investment Firm Long Term Care Managed Care/HMO/PPO Other Provider Payer Public/Community/Mental Health Vendor Organization
	6. Principal work focus (check all that apply)		Academic Ambulatory Care Consulting Firm Clinical Group Practice Government/Military/VA Healthcare Consulting Firm Healthcare System (Corp) Hospital Law/Investment Firm Long Term Care Managed Care/HMO/PPO Other Provider Payer Public/Community/Mental Health Vendor Organization
	7. Length of time in the systems field (years)
	< 1 1-5 6-10 11-15 >15
	8. Annual budget of your department/area
	< USD 1M USD 1.1 – 5M > USD 5M
	9. Total annual budget of your organization
	< USD 100M USD 101M – 500M > USD 500M
	10. Purchasing authority
	Decision influencer Decision maker Not applicable

Payment info *

	Check Option:
	I will send my payment by check, made payable to Bibliomed:
Bibliomed 3 Bethesda Metro Center - Suite 700 Bethesda, MD 20814 USA
	Credit Card Option:
	Please charge my credit card
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