IMI Registration / Order Form

Print this form, fill in the appropriate information, and mail or fax it to:

Conference Name:

___________________________________________________________________

Title:    Mr.      Mrs.     Ms.     Dr.
Name:	______________________________________________________________

Job Title:

______________________________________________________________

Company:

______________________________________________________________

Mailing Address:

______________________________________________________________

City/Town:

____________________________________________

State:

________________

Zip/Postal Code:

________________________________

Country:

_______________________

Email Address:

___________________________________________________________

Daytime Phone:

__________________________________________

Fax:	__________________________________________

All checks should be in U.S. dollars drawn on a U.S. bank and be made payable to Information Management Institute, Inc., or you may request information for a bank transfer.