RIMS 2009 Conference Program - (Page 19) REGistRAtiON FORM You may also register online at www.RIMS.org/RegisterNow Boxes indicate maximum characters on the conference badge. This information will also be used to update your RIMS record. Name (Last) (First) (M) Title Company Name Address City Country (include country code) State/Province Zip/Postal Code (include country code) Phone: Fax: E-mail: Emergency Contact Name: Phone: Registration Deadlines RIMS Corp. Member/Associate Full Conference Pass Corporate 3rd Member One Day Pass Thursday Pass (half day) Non-Member Full Conference Pass One Day Pass Thursday Pass (half day) EARLY BIRD February 20 $840 $580 $355 $290 $1,155 $405 $315 REGULAR February 21 – March 20 (On-site fees apply after March 20) ON-SITE April 19 – 23 $995 $685 $455 $290 $1,310 $505 $315 ADDITIONAL FULL CONFERENCE REGISTRATION OPTIONS Affiliate Member Retired Member Educational Member Student Member Student Non-Member $360 $360 $360 $150 $200 $945 $635 $405 $290 $1,260 $455 $315 The Full Conference Pass is all-inclusive. The One Day Pass entitles you to sessions, entrance to the Exhibit Hall and admittance to that day’s events. Attendees registered for a One Day Pass for Monday may attend the RIMS Opening Reception on Sunday evening. * Please check day(s) selected for one day registration: Mon Tues Wed Thurs [Multiple one day passes may be purchased.] I would like to participate in the Sunday RIMS Community Service Day: Credit Card Authorization Credit Card: Amex Visa MasterCard Card number: Expiration Date: I have read and agree to RIMS Annual Conference & Exhibition Policies and Procedures. Signature: Date: Print Name: v Is this your first RIMS Annual Conference & Exhibition? Yes No v Years of risk management experience: 0-6 7-12 12+ v If you require handicap transportation or facilities, check this box and attach a written description of your needs: v RIMS shares the attendee mailing list. Check appropriate box(es) to be excluded from: Exhibitor Correspondence Post Conference Correspondence v To exclude demographic information from your conference badge, check this box: Reference Code CP2009 19 http://www.RIMS.org/RegisterNow
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