2006 AIM Orlando Eastern & Southern Regional Meeting Registration Form

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 ORLANDO REGIONAL MEETING

FEES AND POLICIES:

• One Meeting Registration Fee for the Fall Regional Meetings: Members get two free registrations per Board.  For Members, additional staff members in excess of two are $100 per person. Non-members pay $150 per person  

• Registration Payment Information: 1) The registration fee includes admission to the meeting program, 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 AIM Orlando Eastern & Southern Regional Meeting - September 28-29, 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