Connected International Meeting
Professionals Association
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REGISTRATION FORM
CAMP DIVERSITY - July 21-23, 2007
GENERAL INFORMATION
You may print this form and fax or mail it to us. Your payment may be made
by credit card, check or bank transfer. For online registration, please
visit our registration page. Your registration includes 2 nights shared
lodging, all seminars, most recreational activities, all meals, snacks and
continuous coffee.
FEES: Through June 25th, register at the
discounted Early Bird rates
Minority association officer or member - $350. Includes seminars, workshops,
teambuilding activities, most recreational activities, 2 nights shared
lodging, all meals, snacks, continuous coffee and ticket to Busch Gardens.
$275 with one night lodging only. Registration rate increases to $425 after
July 25th.
Corporate supporters and suppliers - $495. Includes exhibit area, seminars,
workshops, teambuilding activities, most recreational activities, 2 nights
lodging and all meals. $420 with one night lodging only. Registration rate
increases to $525 after June 25th.
Full-time students pay only $180. Children 5- 12 pay half price and below 5
yrs are free of charge.
Day rate: $150 per day including breakfast, lunch and
dinner, continuous coffee break, all seminars, recreational activities and
networking.
Please note: Your registration includes support for
one disadvantaged minority child
1. CONTACT INFORMATION
First Name:
____________________________________
Last Name:
____________________________________
Title:
____________________________________
Organization:
____________________________________
Street address:
____________________________________
Address (cont.):
____________________________________
City:
____________________________________
State/Province:
____________________________________
Zip/Postal code:
____________________________________
Country:
____________________________________
Telephone:
____________________________________
FAX:
____________________________________
E-mail:
____________________________________
URL, if any:
____________________________________
12. HOW TO PAY
Online by PayPal. Please click
on the button By Check: Please make check payable
to CIMPA and mail to CIMPA, Attn: Becky Smith, 9200 Bayard Pl, Fairfax,
Virginia 22032
By Bank Transfer: Send payment to: Navy Federal
Credit Union, Vienna, Virginia, ABA # 2560 7497 4, Account # 106 3918 302
By Credit Card Offline: Call 1 512 684 0889 or
enter your credit card information below and
fax your registration to: 1 267 390 5193
By Credit Card:
Credit Card Type: Visa / MasterCard / American Express
Name on Credit Card:
_________________________________Signature____________________________
FAX TO 1 267 390 5193
Or mail to: CAMP DIVERSITY Registration, Attn: Becky
Smith, 9200 Bayard PL Fairfax, VA 22032 USA
CANCELLATION POLICY:
Full refund with no processing fee if cancelled by May 1, Full refund with $45
processing fee if cancelled by May 15, 50% refund by June 15. No refund after
June 15 . SINGLE TRIP TRAVEL INSURANCE: For a small
fee, you are protected for Trip Cancellation, Baggage, Medical, Dental,
Emergency Evacuation, 24 Hour Traveler Assistance, Baggage Delay, Travel Delay,
and Accidental Death Coverages. Visit
http://www.insuremytrip.com/index-6192-0-0-0.html to compare rates from
different providers.
