2006 AIM Institute Orlando Meeting Registration Form

Physician Licensing, Profiles and Technology Workshops

Administrators in Medicine (AIM)

National Organization for State Medical and Osteopathic Board Executives

USE THIS FORM FOR PAYMENT OF FEES 

·         Please make checks payable to: Administrators in Medicine

·         AIM Federal ID Number:  74-2329314                

·         Send Check to the AIM Treasurer at this address: Randal C. Manning, AIM Treasurer, c/o Maine Board of Licensure in Medicine, 137 State House Station, Augusta, ME 04333 

EASY REGISTRATION TO ADD YOUR NAME TO THE CURRENT ATTENDEE LIST: Send an e-mail with your list of registrants to AIM Executive Director Barbara Neuman at aim.docfinder@verizon.net  Please put the word REGISTRATION in the subject line of your e-mail message.  Further details below.

        SPECIFY:  AIM Institute: A) Physician Licensing Workshop; B) Physician Profiles & Technology Workshop; OR C) Both Workshops

FEES AND POLICIES:

• EVERYONE PAYS FEE FOR AIM INSTITUTE INCLUDING AIM MEMBERS: Separate Meeting Registration Fees for each Workshop at the AIM Institute: Members pay $100 per program per person and non-members pay $125 per program per person.  Example: A Member planning to attend both Workshops pays $200.  A non-member attending both Workshops pays $250.

• Registration Payment Information: 1) The registration fee includes admission to the meeting program/exhibits, meals/refreshments and electronic meeting materials; 2) All registrations and appropriate fees must be mailed to the AIM Treasurer Randal C. Manning, AIM Treasurer, c/o Maine Board of Licensure in Medicine, 137 State House Station, Augusta, ME 04333; 3) All registration fees must be paid at least 10 days in advance of the meeting; 4) All checks must be payable to Administrators In Medicine; 5) Credit cards are not accepted; 6) The AIM Federal ID Number is 74-2329314.
• 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.

Check Applicable Boxes Below:

Registering for BOTH AIM Workshops in Orlando - 1) Physician Licensing and 2) Physician Profiles and Technology - September 27-28, 2006

Registering ONLY for Physician Licensing Workshop - September 27, 2006

Registering ONLY for Physician Profiles and Technology Workshop - September 28, 2006

• 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:  $_________________  

END OF REGISTRATION FORM