PAMIC's 100th Annual Convention Registration

PAMIC's 100th Annual Convention Registration Form
August 5–7, 2007
Rocky Gap Resort • Flintstone, MD


Registration includes the Welcome Reception, Continental Breakfasts, Luncheon on Monday, Refreshment Breaks, Dinner Dance Celebration, Closing Reception, Convention Registration Materials and all Convention sessions.

Name
Company
Address
City	State ZIP Code
Phone
Email

select convention events to attend
Welcome Reception Dinner & Dance The Larry Kauffman Interfaith Breakfast (add $30)

registration fee
PAMIC Member : $395 Non-Member : $500 Spouse : $295 Children (12 & older) : $50 Children under 12 : FREE

Spouse Name
Child 1 Name & Age
Child 2 Name & Age
Child 3 Name & Age
Child 4 Name & Age

registration total $

I will be sending a check to pay for my registration. I will pay online using Paypal.* Please send an invoice. * Please note that a $5 service fee will be charged for using this service.