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Annual Meeting Registration Form

 


2013 AIM Annual Meeting Online Registration Form

Wednesday, April 17, 2013 – Boston, Massachusetts


Note: All Attendees should complete this online form


For those making meeting registration payments:

Please make checks payable to:
Administrators in Medicine

AIM Federal ID Number: 74-2329314

Print this Form and mail along with your payment to:
Administrators in Medicine

c/o Operations Management
PO Box 403
Augusta, ME 04332

Refund Policy:
All cancellations must be in writing. Individuals who cancel more than 15 business days prior to the meeting are entitled to a refund of their registration fee, less a $30 processing charge. Cancellations made less than 15 business days of the meeting are non-refundable.

• Instructions: Meeting Registration Fee: There is NO Registration Fee for AIM Members, (Please note that AIM Associate Members receive a free registration for each membership at the organization; extra non-member attendees from Associate Member organizations must pay the fee) attending the Annual Meeting but there is a flat $150 per person Registration Fee for Non-Members attending.

• MULTIPLE MEMBER ATTENDEE POLICY: FULL Members will be given three registrations for free (voting delegate plus two others). More than three representatives from full members will have to pay the registration fee of $150 each. AIM Associate Members receive a free registration for each membership at the organization; extra non-member attendees from Associate Member organizations must pay the $150 fee.

• Luncheon for Members & Non-Members:  A complimentary continental breakfast and lunch are provided to each Board's Voting Delegate (You are eligible to vote if your dues are up-to-date). If other registrants would like to join us for lunch, just check the box "Count me/us in for breakfast and lunch at no extra charge" on the form below.


Check Applicable Boxes Below:

 Meeting Registration Fee - $150.00

 Count me/us in for breakfast and lunch at no extra charge.

Note the names of registrants covered by these fees and the total dollar amount submitted below (Please note if any of your attendees are not planning to be there in time for breakfast or lunch):

Names of Registrants:    
Total dollar amount submitted: $  

The first three lines of this information will be used for your name badge:
Name:  
Title  
Board/Organization:  
Address:  
City:  
State:  
Zip:  
Email:  
Telephone:  

The first three lines of this information will be used for your name badge:
Name:
Title
Board/Organization:
Address:
City:
State:
Zip:
Email:
Telephone:

The first three lines of this information will be used for your name badge:
Name:
Title
Board/Organization:
Address:
City:
State:
Zip:
Email:
Telephone:

The first three lines of this information will be used for your name badge:
Name:
Title
Board/Organization:
Address:
City:
State:
Zip:
Email:
Telephone:

The first three lines of this information will be used for your name badge:
Name:
Title
Board/Organization:
Address:
City:
State:
Zip:
Email:
Telephone:

   

Please let us know if any of your attendees are not planning to be there in time for breakfast or lunch; this helps keep our costs down since we must give a head count ahead of time to the Hotel's Catering Department. Thanks.