19th International VMIC Conference - November 18 - 20, 2002
to be held at the Singapore Marriott - Advance Registration

 Note: If you have problems printing form - check your browser printer/page setup and make sure the printer is set for black ink and the margins are correct.

Name: (type or print)
(Last) First Middle

Company/University:

Address:


____________________________
City/State/Country/Zip		 Phone:_____/______________________

FAX: _____/______________________

Email:____________________________

Postmarked BEFORE
 Nov. 7th, 2002		 Postmarked
AFTER
 Nov. 7th, 2002

Advanced Registration for VMIC SHORT COURSE
Monday, Nov. 18th -9:00 a.m. to 5:00 p.m.

(Fees for Short Course includes lunch, coffee breaks and visuals booklet)

 $295 $350
Advance Registration for CONFERENCE:
Tuesday - Wednesday, November 19 - 20th, 2002

(Fee Includes Proceedings, coffee breaks,  daily lunch  and Admission to Sessions)		 $365 $425

Cancellations received in writing after November 8th are subject to a $50 administration charge. Thereafter, no refunds. All paperwork must be RECEIVED at VMIC office by 11/8/2002, or register at the Conference Door.

Additional copies of the '02 Proceedings will be available for $110 for conference attendees only. After the conference, mail orders will be accepted at a charge of US $125 plus $15.00 (US & Canada) or $30 (foreign) per book for shipping and handling.  Proceedings for past years' VMIC conferences (for attendees): $100 for 2001; $95 for 2000; $90 for 1999 VMIC.

Additional '02 Proceedings (specify number ________x's Cost - $110 (to be picked up at conference)

 		 $
Past Year's Proceedings (specify number and years) $
Registration Conference $
Registration Short Course: $

TOTAL

 $

Make checks payable to: '02 VMIC and mail to:
Dr. Thomas E. Wade, General Chairman
5316 Witham Court
Tampa, Florida, 33647-1026; USA
FAX: 813/978-3552

PAYMENT METHOD (please check one)

______ Check enclosed (U. S. Funds Only)
______ Charge my: Visa _____ Mastercard _______Discover______ American Express______
(Visa/MC/Discover/American Express ONLY for Conference registration)

Card Name:___________________________________________
Credit Card # _________________________________________
Expiration Date________________________________________
Cardholder Name______________________________________
(PLEASE PRINT LEGIBLY)

Signature_________________________________Date________________
(REQUIRED)

Phone # to call if problems with card_______________________________________

To Advance Register for 2002 VMIC:
  1. MAIL check and completed registration form to VMIC
    (to arrive at IMIC Office on or before November 8, 2002)
  2. FAX completed registration form to 813-978-3552
    (credit card payments ONLY) to arrive on or before November 8, 2002
  3. Otherwise, plan to register at the door on-site at times indicated.

IMIC Tax I.D. # 59-3176166 (or mail / fax W9)

CONFERENCE FISCAL POLICIES:

Checks must be in U.S. Dollars and drawn from bank account with U. S. Offices. If foreign financial instruments are used (e.g., Eurocheck), please add $50 processing fee. Cancellations: Refunds for cancellation of advance registration will be honored provided the request to cancel are made in writing and are received no later than November 8, 2002. Thereafter, no refund will be given. No telephone calls will be acceptable. All refunds for cancellation will be subject to a $50 handling charge. Refunds will be sent after the conference.

Applications received without payment will not be honored as Advance Registration. Payment must be in the form of a check, money order or credit card (Visa/MC/Discover/American Express). Purchase orders NOT accepted. Registration Form and fees must be received by November 8th. Receiving of payment after November 8,2002 will require full payment again at the conference, and reimbursement of prepayment after the conference, less a $50 service charge.

Use one form per person, please (photocopies accepted). Please enclose a check (U. S. Funds only) made payable to "2002 VMIC." Or you can include your Visa / Mastercard / Discover number and fax the form to the IMIC Secretary at 813-978-3552 (on or before November 8th only, thereafter plan to register at Conference). Check, cash and credit cards (Visa/MC/Discover/American Express) accepted at Conference registration desk on-site. Pre-registered attendees may pick up their materials at on-site Conf. Registration Desk.