EDUCATIONAL FORUM • HILTON LOS ANGELES AIRPORT HOTEL • LOS ANGELES, CA MAY 16 – 18, 2008

  REGISTRATION FORM

Your Information:

First & Last Name:
I am a:
Street Address:
City:
State:
Zip Code:
Country:
Phone:
Email Address:
First Time:
Are you the leader of an IWMF Support Group
Are you a member of IWMF:

Will you be attending the early-bird session on Friday morning?
   
Additional Attendees
If you would like to bring anyone else, please enter their names here.

Second Name
City:   State:
Third Name
City:   State:

Wireless head phones will be available for hearing impaired attendees @ $23/day, payable at the IWMF registration table at the hotel.

You may include my name and contact information on the printed roster of Forum Attendees
Yes     < No
 
Payment Calculation
The cost per person is $175/member and $225/non-member before April 25, 2008. After stated date, cost will increase to $225 and $275 respectively. The registration fee covers dinner on Friday, breakfast and lunch on Saturday, and breakfast on Sunday.
Number of people:
Payment Amount:
Please DO NOTadd a "$" to your order amount


You are responsible for making your own hotel reservations either online (Hilton.com) or by phone 310-410-4000 or 800-445-8667. Mention group code IWM to obtain the discounted room rate of $109 per night plus tax (effective 3 days before an after the forum based on availability). Please reserve by May 2, 2008, the cut-off date for the special rate. Check-in is at 3 p.m.; check-out is at noon. Your room must be guaranteed by a credit card or deposit for the first night

Please enter your credit card information
First Name:
Last Name:
Billing Address:
City:
State:
Zip Code:
Country:
Phone:
Cardholders Name:
Card Number:
Please Note:
CREDIT CARD INFORMATION MUST NOT CONTAIN SPACES OR DASHES!
Card Expires: Month:   Year:
CCV2 Number:
This is the number on the back of your credit card, usually on the right side of the signature strip. If any spaces exist in the number, use the last number shown.
 

     

 

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