2008 Convention Registration Form

59th Annual
IAMPETH Convention
La Quinta, California
August 4-10, 2008

Online Registration Form

Use this form if you are paying your fees with PayPal.
If you want to send a check, use the snail mail form instead.
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If you are NOT attending the Convention, and
only want to pay your dues, please Click Here
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You must submit a separate Registration
form for each person attending.
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No refunds for cancellations made after July 19, 2008
Register early and receive a Discount!

CONVENTION PRICING
(The Registration fee includes your annual membership dues)

Registration Fee
BEFORE June 1st
Regular Member: ($170 plus $30 dues).......................$200.00
Senior or full-time student ($165 plus $20 dues).........$185.00
AFTER June 1st
Regular Member: ($190 plus $30 dues).......................$220.00
Senior or full-time student ($185 plus $20 dues).........$205.00

Banquet Dinner Saturday, August 9 $45 per person

Group Photo (to be taken Thursday afternoon) $7.00 each

Use the Tab key or your mouse to navigate through the form, not the Enter key.

First Name
Last Name
Address
Address
City
State/Province
Zip/Postal Code
Country/Region
Phone (Home)
Phone (Work or Cell)
Fax
Email Address
Website

This is a New Membership Renewal
I am a Full-time Student Senior Neither

Yes No I would like my phone number listed in the Membership Directory
Yes No I would like my email address listed in the Membership Directory
Yes No This is my first IAMPETH Convention

I will be traveling by: Air Train Car Bus

Arrival Date Departure Date

Yes No I will be staying at the Embassy Suite and Spa, La Quinta, California

My hotel reservation

I will be rooming with

If rooming with an IAMPETH Member, please list their name

Yes No I want to order a Group Photo (to be taken Thursday afternoon)
Number of Group Photos ($7 each)

Yes No I will attend the Banquet Dinner
Number of persons attending the Banquet Dinner ($45 per person)

BANQUET MEAL SELECTION

Herb Roasted Chicken with Roasted Red Pepper Mashed Potatoes and an artichoke relish
Roasted Stuffed Pork Loin with mango and green apple chutney served with herb couscous
Slow Roasted Prime Rib of Beef au jus and creamed horseradish served with mashed red potatoes
Vegetarian Entree: Penne Pasta Provencal with Sun-Dried Tomato, Artichokes, red onion, olives, basil, capers

Select your Banquet Meal

Special dietary needs?

Use the space below to add any
comments or special instructions:

Workshop Selection

Workshops will be taking place in two separate rooms. Please choose the workshop you wish to attend for each session.