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Online Registration Form




2012 AIM Institute Physician Licensing, Profiles and Technology Seminar

November 9-10, 2012
New Orleans LA


• Meeting Registration Fee for the AIM Institute
• Members pay $200 per person
• Non-members pay $250 per person
    • Please make checks payable to: Administrators in Medicine
    AIM Federal ID Number: 74-2329314

Mail this Payment Form along with your check payable to Administrators in Medicine:
Administrators in Medicine (AIM)
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.

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Registering for AIM Institute Seminar in New Orleans on November 9-10, 2012

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