Please complete form below and submit.
(Printable Text Version of Registration Form)

Full Name (required)


Title


E-Mail (required)



Organization/Agency


Address Line 1


Address Line 2


Suite/Room No.


City/State/Zip


Phone (required)


FAX




Current member of IPMA-KC?        Yes    No

Prepaid membership?        Yes    No


Register me for:
Lunch-n-Learn
Member: $20   Non-Member: $25   Prepaid Member: No charge

Breakfast Round Table
No charge.

Spring Conference
Member: $50   Non-Member: $65   Prepaid Member: No charge

NOTE: No shows will be billed to cover catering costs.
Total Fee Due:

Request for Accomodation:

Special Diet
    Specify

Other
     Specify


Please make sure you have completed all information
before submitting your registration.
Click "submit" button once.