Combined Annual Convention Registration

PAMIC/VAMIC/WVAIC Combined Annual Convention Registration Form
August 3–5, 2008
Nemacolin Woodlands Resort • Farmington, PA


Registration deadline is July 12, 2008. Registration includes the Welcome Reception, Continental Breakfasts, Luncheon on Monday, Refreshment Breaks, Chairman's Reception, Closing Reception, Convention Registration Materials and all Convention sessions.

Name
Badge Name
Company
Address
City	State ZIP Code
Phone
Email
Please describe any Dietary or Accessibility Needs, if applicable:
registration fees
PAMIC / VAMIC / WVAIC Member : $195 Non-Member : $300 Spouse : $125 Children (12 & older) : $50 Children under 12 : FREE I would like to attend the Larry Kauffman Interfaith Breakfast (add $30) Number Attending the Breakfast:
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.