Printable Form:

                                      Suncoast Medical Billing Instruction

Registration Form - Please Complete and mail.

Student Name _________________________________
Address: _____________________________________
City: ______________ State: _______  Zip _________
Email: _______________________________________
Daytime Phone: (       ) _________________________
Evening Phone:  (       ) _________________________

                                         Please Circle Payment type:

                                       (Check)       (Money Order)

Yes I would like to be trained by the Professionals of Suncoast Medical Billing. I have Enclosed a check,  or money order in the amount of $___________.  Make check payable to:  Suncoast Medical Billing.

I would like to attend the following classes.

 September 16th  2008____
2009 Session Date:________________________________________
                                              Enter date of session you wish to attend

Please mail to:
Suncoast Medical Billing
c/o I-PLEXUS SOLUTIONS, INC.
8346 FOREST OAKS BLVD
Spring Hill, Fl 34606

Give us a call at 352-684-3537
or
E-Mail at Suncoastmedicalbilling@yahoo.com