Association of Medical Diagnostic Manufacturers -- AMDM

Registration Form

Please complete one form for each attendee. Check all that apply.	Rate	Charges
Pre-Meeting RA 101	$100.00
510(k) Workshop	$175.00
Annual Meeting:
Member Rate	$595.00
3 or more, same company	$500.00
Non-Member Rate	$895.00
3 or more, same company	$800.00
Government Employee	$300.00
Press (Circle day T / W / Th / F )	$30/day	___________
Total

Please complete one form for each attendee. Check all that apply.	Rate	Charges
Pre-Meeting RA 101	$100.00
510(k) Workshop	$175.00
Annual Meeting:
Member Rate	$595.00
3 or more, same company	$500.00
Non-Member Rate	$895.00
3 or more, same company	$800.00
Government Employee	$300.00
Press (Circle day T / W / Th / F )	$30/day	___________
Total

Please complete one form for each attendee and send a pdf file to amdm_secretary@sbcglobal.net

Check all that apply:

Rate

Charges

RA 101 Pre-Workshop Session -- Monday April 20th 5:00 to 8:30 PM (Dinner included)

$150.00

510(k) Workshop -- Tuesday, April 21th thru Wednesday, April 22nd (Lunch included)

$385.00

Pre-IDE / Pre-Submission Workshop -- April 22nd 5:30 to 8:30 PM (Dinner included)

$150.00

Annual Meeting (check boxes below) -- Thursday, April 23rd thru Friday, April 24th (Lunch included):

----------

AMDM Member Rate

$695.00

3 or more attendees from the same member company (each); registering at same time

$600.00

Non-member Rate

$995.00

3 or more attendees from the same non-member company (each)

$900.00

Government Employee

$495.00

Press (Circle day of attendance -- Tues, Wed, Thurs, Fri)

$ 30.00/day

Total

Attendee's Name:

Company / Organization Name:

Address:

Address:

City / State / Zip:

Phone:

Fax:

E-mail:

Method of Payment (check one):

   Check Enclosed -- Payable to "AMDM"

   Corporate Check -- Mailed separately

   MasterCard

   Visa

   American Express

Credit Card Number:

Expiration Date:

Security Code on Back of Card (Front for AmExpress):

Print Name as appears on Card:

Card Billing Address if different:

Authorization Signature:

Cancellations must be received in writing no later than March 20th for a full refund. Substitutions from the same company will be accepted.

Updated January 11, 2009