May 2007 IAB Registration Form
PLEASE REMEMBER TO LOG OUT WHEN YOUR VISIT TO THE MEMBERS ONLY SECTION IS COMPLETE
IAB Registration Form (Please Type or Print)
NOTE: A registration form is required for each person attending the IAB. Please print this page, fill out the form and fax it to Susan at the address below.
Name for Badge:
If you have special dietary needs, please provide a brief description.
*Are you a speaker? Yes___________ No_______________
*Speakers please provide and abstract and list of audio-visual equipment needs and return it with your registration.
Please contact Susan at the address below with any questions or for more detailed information.
Susan C. Charnley, CLPAM Secretary