Affiliated Computer Services, Inc., Alaska Medical Assistance | Training

Training • Online Registration Form

Alaska Medicaid is currently updating the Online Training Registration with the new 2010 training schedule.

Providers can register for upcoming classes by completing the registration form and returning it by mail, fax, or email. See the Training Schedule page for the ACS Training & Publications mailing address, fax number and email address.

Registration Form

Online Registration | Please complete the participant information. For multiple participants from the same Organization, please register one participant at a time.

denotes required fields
Provider/Submitter Number: (enter 9999999 if you do not have a Provider or Submitter number)
Organization Name: (required if no Provider or Submitter number)
Participant First Name:
Participant Last Name:
Telephone Number: / - (example: 555/555-5555)
Fax Number: / - (example: 555/555-5555)
E-mail Address: (example: someone@domain.com)
Mailing Address 1:
Mailing Address 2:
City:
State: (please use two-character abbreviation, e.g., AK)
Zip: (example: 12345 or 123456789)