MGMA Order Form
MGMA #
First name
MI
Title
Organization
Last name
Work address
Address
City
Phone
Ext .
Male
Female
State
ZIP
Fax
E-mail
Please send me a FREE brochure about
MGMA membership. (MAA)
Please send me a FREE brochure about
ACMPE® board certification in medical
practice management. (AMD)
Yes
No
Medical practice:
Multispecialty (Primary and specialty care)
Multispecialty (Specialty care)
Multispecialty (Primary care)
Single-specialty:
__________________________________
Group size (FTE):
_________________________________
If not a medical practice, type of organization:
_____________________________________
Birth year ___________
Year started in
medical practice
management ________
Item No.
Qty.
Personal address
Description
Member
The Store at
mgma.com
Search by item number.
Fax
Fax this form and
credit card
information to:
303.784.6110
(Credit card orders only)
Phone
For credit card
orders: Call toll-free
877.ASK.MGMA
Applies to orders only, not membership.
Orders are shipped via UPS. Federal Express
is also available by request.
Special mail
Add
UPS Priority (next day air)
UPS 2nd Day
$15.50
$10.50
Shipping/Handling
International shipping is available.
Call for pricing.
All orders must be prepaid
VISA
MasterCard
Mail
Mail this form with your
check made payable to:
Medical Group
Management Association
P.O. Box 17603
Denver, CO 80217-0603
Special mail
Total
* Please add sales tax if
a resident of Colorado:
Denver metro area 3.7%
outside Denver metro area 2.9%
Arapahoe County .25% or
District of Columbia 5.75%
Texas 6.25%
AMEX
The Medical Group Management
Association® and the American College of
Medical Practice Executives® do not sell
or rent e-mail and/or fax to third parties.
See our privacy policy at mgma.com.
Exp. date
Card holder’s name
Authorized signature
$9.50
Sales tax*
(Please have your
credit card ready)
Card #
Total Price
Subtotal
Shipping and handling
Check enclosed
Please charge my:
Other
$460
MGMA membership (one-time $95 application fee included)
Online
Affiliate
Date
4 Easy ways to order
Online
Questions?
Search by item numbers in the Store
at mgma.com. Place secure orders
The MGMA Service Center is here to help.
Please have all relevant information about
24 hours a day.
your order available. Call toll-free
877.275.6462 or e-mail service@mgma.com.
Phone
Toll-free 877.ASK.MGMA (275.6462)
Monday-Friday
8:00 a.m.-5:00 p.m. (MT)
Volume discounts
Discounts apply for quantity
orders of the same item.
5-14 copies – 5%
Fax
15-99 copies – 15%
100 or more copies – 20%
303.784.6110
Fax the order form and credit card
information. (Credit card orders only.)
Resellers: Please contact the MGMA
Information Center for pricing details.
Mail
Return policy
Medical Group Management
Association
P.O. Box 17603
Denver, CO 80217-0603
Include your completed order form
with check or credit card information.
Please remember to
include the following:
MGMA member number (if applicable)
Credit card number
(Visa, MasterCard or American Express)
Federal Express number (if desired)
Shipping and handling
Shipping and handling for all orders is $9.50.
Express delivery is available for an additional
$15.50. Two-day delivery is available for an
additional $10.50. International shipping is also
available for an additional fee. Call for pricing.
*All catalog prices are subject to change without notice.
You may return your purchase for any reason
for a full refund within 30 days of receiving
your shipment, if:
The item(s) is in its original condition
Media (CDs and DVDs) are unopened.
Returns and refunds are processed only for
items purchased from MGMA. Same-item
exchanges are provided for items that are
defective or damaged. MGMA reserves the
right to deny any returns or exchanges.
You can expect a refund in the same form of
payment originally used for purchase within
14 business days of MGMA receiving your
return. MGMA issues refunds for the price of
the items purchased, excluding shipping fees.
Toll-free 877.ASK.MGMA (275.6462)
mgma.com