- REGISTRATION FORM - ITMIC PUERTO RICO
- OCTOBER 8 - 11, 2009
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GENERAL INFORMATION |
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- You may print this form and
fax or mail it to us. Your payment may be made by credit card or check.
Registration include 3 nights at Caribe Hilton (Oct 8-10), All
conference pass & exhibit, all scheduled meals. Optional Tours
are not included.
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1. CONTACT INFORMATION
| First Name: |
____________________________________ |
Last Name: |
____________________________________ |
| Title: |
____________________________________ |
Organization: |
____________________________________ |
| Street address: |
____________________________________ |
Address (cont.): |
____________________________________ |
| City: |
____________________________________ |
State/Province: |
____________________________________ |
| Zip/Postal code: |
____________________________________ |
Country: |
____________________________________ |
| Telephone: |
____________________________________ |
FAX: |
____________________________________ |
| E-mail: |
____________________________________ |
URL, if any: |
____________________________________ |
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2. TYPE OF REGISTRATION
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3. TRAVEL INFORMATION
Departure City:
___________________________
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Departure
Country: ___________________________
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| Date of Arrival in San Juan:
__________________________
(mm/dd/yyyy) |
Return Date:
___________________________
(mm/dd/yyyy) |
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4. OPTIONAL TOURS
(check the website for description of each tour) |
5. SPECIAL EVENT FOR
DISADVANTAGED CHILDREN (Voluntary)
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CIMPA invites disadvantaged children from the area to the
conference site for an afternoon of fun and caring. Toys, books and school
supplies are distributed. Thank you for sharing! Indicate how many
children you would like to sponsor for $25 each. ______ |
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6. Certification
Examination
CPPM
($195)
CGMP
($195)
CIMP
($195)
7. EXHIBITORS ONLY: TAKE A PLANNER TO THE MEETING
$550
if registered as exhibitor
Please use separate registration form for the planner
you are sponsoring)
8. OTHER REQUESTS, COMMENTS OR
CLARIFICATION, If any
If you are a speaker. a member of a
cooperating organization or if you participated in an Early Bird promotion,
please indicate here:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________ |
9. TOTAL AMOUNT TO BE PAID: $_________________________ |
10. HOW TO PAY
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FAX TO 1 267 390 5193
Or
mail to: ITMIC Registration
9200 Bayard Pl
Fairfax, VA 22032 USA
CANCELLATION POLICY: Full refund with $95 processing fee if cancelled by
August 1
50% refund by August 15. No refund after September 15
SINGLE TRIP TRAVEL INSURANCE: For a small
fee, you are protected for Trip Cancellation, Baggage, Medical, Dental,
Emergency Evacuation, 24 Hour Traveler Assistance, Baggage Delay, Travel Delay,
and Accidental Death Coverages. Visit
http://www.insuremytrip.com/index-6192-0-0-0.html to compare rates from different providers.
( ) PLEASE CHECK HERE IF YOU WANT CIMPA TO CONTACT YOU ABOUT THE LOWEST
POSSIBLE AIRFARE AT THE TIME OF REGISTRATION.
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