MNIAAI Conference Registration Section

Name       

Title         

Agency     

Address    

City          

State        

Zip Code  

Phone      

Fax        

E-mail      

Early Registation:

Member            $225.00

Non-member     $250.00

One Day            $150.00

After March 1, 2008:

Member            $235.00

Non-member     $260.00

One Day           $150.00

Additional Banquet Guest @ $25.00 each

I plan to attend the banquet

I will need child care for the banquet (free)

Credit Card Information Section

Name on Card :           

Credit Card Type:          

Credit Card number:   

Expiration date: 

I authorize the Holiday Inn to charge costs to my credit card.