ITMS Conference Registration Form:

Open the Registration Form as a PDF Document

Name:        __________________________________________________________________

Address:    __________________________________________________________________

City:            ___________________________ State, Zip:   _____________________________

Phone:       _____________________        Email: ____________________________________


Registration Fees for the conference and all meals:

          □ ITMS Member - $290.00

          □ Non-Member - $350.00
          □ I prefer a vegetarian entrée at the banquet.
          □ Handicapped/special needs (attach explanation)  (Cancellation Policy)
 

$_______


Accommodation:
          □
$195.00 (single room for three nights - per person)
          □ $120.00 (shared room for three nights - per person)
               
          If sharing, preferred roommate: ________________________
 

$_______


Additional Lodging Fee:
         
Wednesday, June 14 - $65.00 (no meals)
          □ Sunday, June 18 - $65.00 (no meals)

$_______


Daggy Scholarship Fund:

          Would you like to make a donation to the Daggy Youth Scholars Fund?
          Donations to the Daggy Scholarship Fund are tax deductible to the extent allowed by law.
 

$_______


Total
(made payable to ITMS):  
 

$_______

Please print and return this form, with check or money order, in US Dollars, made out to ITMS, to:
Julianne E. Wallace

P.O. Box 845.

Reading PA 19607