Sept 03 20th VMIC Registration Form

2003 VMIC Conference
to be held at Marina del Rey, CA - Advance Registration

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Name: (type or print)

(Last) First Middle

Company/University:

Address:

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

Postmarked BEFORE
Sep. 11th Postmarked
AFTER
Sep. 11th

Advance Reg. for State-of-Art Seminar
(Monday, Sept 22)

(Seminar fee includes lunch, coffee breaks & visual booklet)
$375 $415

Advance Registration for VMIC
(Tues., Wed. & Thur., Sept 23 - 25)
(Conference fee includes Proceedings, all sessions, coffee breaks and designated luncheons)
$425 $465

Cancellation in writing by Sept. 11 is subject to $50 administrative charge, there-after, no refund rendered. Fees must be received at IMIC office by 9/12/03, other-wise, register at the Conference door.

Additional copies of 2003 Proceedings will be available at $110 for conference attendees only. After the conference mail orders will be accepted at a charge of $US 125 plus $15 (U.S. & Canada) or $30 (foreign) per book for shipping and handling.

Registration - Seminar $

Registration - Conference $

Additional ‘03 Proceedings #__________ $

          IMIC Tax I.D. # 59-3176166 -         TOTAL
$

Make checks payable to: 2003 IMIC
Mail to:
Dr. Thomas E. Wade, Gen. Chmn.
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_______________________________________

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 $75 processing fee. Cancellations: Refunds for cancellation of advance registration will be honored provided the requests to cancel are made in writing and are received no later than September 11, 2003. 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/AMX only). Purchase orders not accepted. All Registration Forms and fees must be received at IMIC Office by September 12, 2003. Receiving of payment after September 12 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 (photocopies encour-aged). Please enclose a check (U. S. Funds only) made payable to ‘2003 IMIC’. Or you can include your Visa, Mastercard, Discover or American Express credit card number and fax the form to the VMIC Secretary at 813-978-3552 (on or before September 12 only, thereafter plan to register at Conference Door). Note: September 11 is the last day to get Advance Registration rates. Check, cash and credit cards (Visa/MC/Discover/AMX) accepted at Conference Registration Desk on-site at the door (see back of front cover for times). Pre-registered attendees may pick up their materials at on-site Conference Registration Desk.

ADVANCE REGISTER FOR 2003 VMIC:

MAIL check and completed registration form to IMIC (to arrive at IMIC Office by September 12)

FAX completed registration form to 813-978-3552 (credit card payments ONLY) to arrive on or before September 12 (Note: Sept. 11 is cutoff date for Advance Registration Rate)

Otherwise, plan to register at the door on-site at times indicated.

Name: (type or print)
(Last) First Middle Company/University:
Address:
____________________________ City/State/Country/Zip	Phone:_____/______________________ FAX: _____/______________________ Email:____________________________	Postmarked BEFORE Sep. 11th	Postmarked AFTER Sep. 11th
Advance Reg. for State-of-Art Seminar (Monday, Sept 22) (Seminar fee includes lunch, coffee breaks & visual booklet)		$375	$415
Advance Registration for VMIC (Tues., Wed. & Thur., Sept 23 - 25) (Conference fee includes Proceedings, all sessions, coffee breaks and designated luncheons)		$425	$465
Cancellation in writing by Sept. 11 is subject to $50 administrative charge, there-after, no refund rendered. Fees must be received at IMIC office by 9/12/03, other-wise, register at the Conference door.
Additional copies of 2003 Proceedings will be available at $110 for conference attendees only. After the conference mail orders will be accepted at a charge of $US 125 plus $15 (U.S. & Canada) or $30 (foreign) per book for shipping and handling.
Registration - Seminar		$
Registration - Conference		$
Additional ‘03 Proceedings #__________		$
IMIC Tax I.D. # 59-3176166 - TOTAL		$
Make checks payable to: 2003 IMIC Mail to: Dr. Thomas E. Wade, Gen. Chmn. 5316 Witham Court Tampa, Florida 33647-1026; USA Fax # (813) 978-3552