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2011 Annual Symposium Attendee Registration

2011 Annual Symposium Attendee Registration
Hyatt Regency Washington DC
on Capital Hill
July 31-August 2, 2011

Symposium

Name(First Middle Last):

Agency:

Address:

City:

State:

Zip:

Country:

Phone:

Email:

Registration Fee:

Pre-register Today! Registration Fee: Before 7/1/11: Member $495, Non members $575 Pre-register today! Before 7/1/11: Member $495, Non members $575 7/1/11 and after: Members $550 Non members $575

Spouse/Guest Ticket $75:

This ticket will provide access to the Thursday evening Awards Banquet and the Spouse/Guest Welcome Event.

Spouse/Guest Name:

Shirt Size:

All shirt sizes above are men's sizes.

Your information above will be provided to the exhibitors of the IHIA Annual Symposium and also online in the members only section of the IHIA website.

Please indicate by checking this box if you would like your name and contact information removed from these lists:

Do you require an invoice for this registration:

Notes / Special Instructions:

Payment in the form of a check should be sent to IHIA PO Box 5507 Tampa, FL 33675-5507. All checks payable to IHIA.

Credit card payments may be submitted by printing and mailing to the address above or faxing the form to 1-540-898-5594.

Questions regarding registration?
Bill Hagmaier, Executive Director
Toll Free 1-877-THE IHIA (1-877-843-4442)
Fax 1-540-898-5594
ihia@ihia.org

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