Meeting Registration Form

Administrators in Medicine (AIM)

National Organization for State Medical and Osteopathic Board Executives

 

2006 AIM Annual Meeting - Wednesday, April 19, 2021

Salon E of the Ballroom - Boston Marriott Copley Place - 110 Huntington Avenue - Boston, MA 02116 - Hotel Phone: 617-236-5800

      Hotel Room Rates: FSMB Rate: Single/Double - $199.00

Book your room starting Tuesday Night, April 18, 2006

To take advantage of special convention rates, participants must make reservations by March 29, 2006. Reservations made after this time will be honored on a space-available basis. For room reservations, please call (800) 266-9432 and identify yourself as part of the Federation of State Medical Boards Annual Meeting (room block is not under AIM's name).

 


         MEETING REGISTRATION FEE IS $150 PER PERSON - USE THIS FORM FOR AIM MEETING REGISTRATION AND 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 

Instructions: Meeting Registration Fee: There is NO Registration Fee for AIM Members, including AIM Associate Members, attending the Annual Meeting but there is a Flat $150 Registration Fee per person for Non-Members attending.

MULTIPLE MEMBER ATTENDEE POLICY: Members will be given three registrations for free (voting delegate plus two others). More than three representatives from members will have to pay the registration fee of $150 each.

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 but see the Multiple Member Attendee Policy in the paragraph above.

Please note 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 to the Hotel's Banquet Department. Thanks.

Meeting Registration Fee Refunds:  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 within 15 business days of the meeting are non-refundable.

Check Applicable Boxes Below:

Meeting Registration Fee - $150

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 Code: __________________________________________________________________________________________

 

e-mail address: _______________________________________________________________________________________________

 

Telephone:____________________________________________________________________________________________________

 

END OF REGISTRATION FORM