IES2011 Registration Form

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please provide the following ordering information:

QTY	DESCRIPTION & COST
	Registration for Early Birds ($450.00) (before 01 April 2011)
	Full Registration ($500.00) (after 01 April 2011)
	Registration (Students) ($250.00) (-$50 for Early Bird)
	Registration (Sponsored Student Program): $50.00
	Registration (Retirees): ($300.00)
	Registration for Retiree Early Birds ($250.00) (before 01 April 2011)
	1-Day or 2-Day Registration: (Both $400.00); $350.00 (Early Bird)
	Extra Awards Luncheon Ticket ($25.00) (May 18th, 2011)
	Extra Pre-Print Document ($75.00) + applicable Tax

 

Registration for Designated Speakers & Session Chairs ($250.00)

 

Note_1: Residents of Virginia will be charged 4.5% sales tax for extra Pre-Print document ($TBD)

Note_2: Student, Retiree, 1-Day, and 2-Day  registrants may register at any time with no change in fee (i.e., no late fees). An Awards Luncheon ticket is included in the registration fee for "Full Registrants" and  for "Unsponsored Students & Retirees". 

Note_3: 1-Day and 2-Day Registrants and sponsored students will be assessed an additional $25.00 to attend the luncheon on Wednesday May 18th (2nd day of conference) ... if they so desire.

Note_4: Excess Page charges for authors only. ($50.00/page in excess of 8 pages.)

$ Excess page charge (authors) total

Please total the fees above to determine the amount required. This is done by summing the cost for each ordered item. Enter the Grand Total in the box provided below: 

$ Grand Total

Registrants may pay JMG directly by check or credit card. VISA, American Express, and Mastercard are accepted by JMG. Checks should be made out to IES-JMG Associates and mailed to IES, c/o JMG Associates Ltd., 8310 Lilac Lane, Alexandria VA 22308-1943.  Note again that the secure PAYPAL Method may also be used.

	CREDIT CARD BILLING
Credit Card (leave blank if using PAYPAL)	VISA MasterCard American Express
Cardholder Name (Leave blank if using PAYPAL)
Card_Number/Expiration_Date (Leave blank if using PAYPAL)
Note that this is free form, so just be sure the credit card number & date both appear in the box somewhere. The order is unimportant. The form is read manually.) MPORTANT NOTE: Do NOT submit any accounting data if using PAYPAL. Simply submit  this form without CC specification, Exp dates, or cardholder name!