IFPAC - PAT Summer Summit 2004 Registration Form

July 27-29, 2004
Westin Rio Mar Resort Hotel
Rio Grande, Puerto Rico

* Indicates a required field
 Last/Family Name: *
First Name: *
Middle:   


Title:  Mr. Mrs. Ms. Dr. Prof.
Organization:*
Address Line 1:*
Address Line 2: 
Address Line 3: 
City:*
State:*
Zip:*
Country:*
Address Location:  Office Home
Phone: 
Fax: 
E-mail address: 
Registration Fee's:
3 Day Registration DOES NOT INCLUDE Lodging
Registration IFPAC Member $695.00 US (Before July 16, 2004)
IFPAC Member $795.00 US (After July 16, 2004)
Non-Member $795.00 US (Before July 16, 2004)
Non-Member $895.00 US (After July 16, 2004)

Select Payment Method:*


Choose Your Method of Payment.


I wish to pay On-Line by Credit Card ( Visa/MasterCard/Discover/American Express)
  • Credit Card Number
    Visa
    MasterCard
    American Express
    Discover
    Expiration Date

I will FAX in Credit Card Information to the IFPAC Office
I will Phone in Credit Card Information to the IFPAC Office
I will mail a Check to the IFPAC Office

Checks must be in US Dollars drawn on a US Bank
For those who wish to Mail the Application Form and Payments
Please use the following address:

IFPAC
253 Commerce Dr. Suite 103
P.O. Box 7100
Grayslake, IL 60030
Tel: 847-543-6800 Fax: 847-548-1811
email: info@ifpacnet.org

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Note: After clicking the Submit Button above it may take a few minutes to process your application
please wait for the acknowledgement form to appear on your screen before continuing.

© Copyright 2004

Cancellations
If you are unable to attend, another person can be substituted, or your registration may be transferred to a future symposium. Some penalties may apply. Notification to be received in writing by 1 July. 2004..

Disclaimer
For unforeseen circumstances, whereby meeting facility is not operating for business, due to acts of God, government authority, disaster, strikes, construction, remodeling or other reasons outside our control, an alternative venue and dates of comparable quality will be confirmed.