Risk Analysis Tools for Effective Risk Management March 18 - 19, 2010 • Las Vegas, NV Name: __________________________________________________________________________________________ Title: ____________________________________________________________________________________________ Organization: _____________________________________________________________________________________ Address: ________________________________________________________________________________________ City: ______________________ Prov/State: __________ Postal/Zip: __________ Country: ______________________ Telephone: ________________ Fax: ________________ E-mail: ___________________________________________ Registration Information RIMS Deputy Members or Associates: US$595.00 Non-Members: US$995.00 th Early Bird Special: Deduct $50 if registered and paid by February 18 TOTAL DUE: Form of Payment: Check American Express MasterCard Visa Credit Card Number: Expiration Date: _________________ Print Name as shown on card: _______________________________________________________________________ Credit Card Authorization Signature: __________________________________________________________________ Registration fees must accompany this form. To register and pay by check: To register and pay by credit card: Make check payable to: Risk and Insurance Management Society, Inc. Fax to: 212.655.5929 Mail to: Risk and Insurance Management Society, Inc. POB 95000-2345 Philadelphia, PA 19195-2345 Since enrollment is limited, please send your registration and payment as soon as you can. For quick registration, return to the page with course details and pay on-line by credit card. Confirmation will be sent via e-mail. For additional information, email us at firstname.lastname@example.org or call our Education Associate at 212.655.6212.
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