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 Registration Form Annual Spring Conference sponsored by The IMA Northern Lights Regional Council Thursday April 23 and Friday April 24, 2015 Holiday Inn Airport South 1201 West 94th St Bloomington, MN 55431 Up to 16.0 hours of Continuing Education Name:
________________________________________________________________ Company:
________________________________________________________________ Address:
________________________________________________________________ City, State, Zip:
________________________________________________________________ IMA Member #:
____________ IMA Chapter: ________________ Phone #:______________ Email Address:
________________________________________________________________ Lunch Dietary Requirements: ____________________________________________________________ Please print clearly, especially your email address, so that we may communicate any changes to you. Attending:
___ Thursday & Friday – 16 hours of Continuing Education – ​
$250.00 ($225 if th​
received by April 6​
) th​
___ Thursday only – 8 hours of Continuing Education – ​
$150 ($135 by April 6​
) th​
___ Friday only – 8 hours of Continuing Education – ​
$150 ($135 by April 6​
) Attending:
Payment Options:
___ Thursday’s Lunch Round Table ___ Happy Hour th​
**If payment is received by April 6​
​
there is a 10% discount** ___ Check Enclosed
Payable to IMA Northern Lights Regional Council ___ Paypal payment
Payable to Paypal account: ​
[email protected] ___ Check on day of the seminar – No discount available Email form to:
[email protected] ​
Please print form, fill it out, scan it, and email it. Mail check to:
Larry Zorn, Eau Claire Press Company P.O. Box 570, Eau Claire, WI 54702­0570