MASTER CARD         VISA       AND            ACCEPTED


For this IPA event only, each spouse must be a member to receive the members rate and hotel subsidy

Registrant (Enter the name) as you would like to appear on your name badge)
 Fields in Red Required
Mr.   Mrs.    Ms. 
First Name:       
Last Name:    		 Company:  
 

Address:    
 Address(2): 

Home Phone No:
 Work Phone No.: 
 		Mobile No.:
Fax No.:
City:
  		 State/Province:
  		 Zip/Postal:
  		 Country:
  		 E-mail Address: 
  
Registrant (Second Individual) (Enter the name) as you would like to appear on your name badge)
Fields in Red Required
Mr.   Mrs.    Ms. 
First Name:     
Last Name:  		 Company:  
 
Address:     
Address(2):  		Home Phone No:

Work Phone No.: 
 		Mobile No.:
Fax No.:
City:
  		 State/Province:
  		 Zip/Postal:
  		 Country:
  		 E-mail Address:
Registration  for:
Activity

Membership Status

IPA Member              

Membership Status
Non-Member                   
Number of Registrants Amount
US$
IPA Non-IPA

Full Symposium
 

 Early Registration
 Before and on 01/15/07
US$  100.00               
Late Registration

After 01/15/07
US$  120.00                 

Early Registration
 Before and on 01/15/07
US$  120.00                     
Late Registration After 01/15/07  
US$  140.00                     

IPA Membership Special
 		 Continental Membership
US, Canada & Mexico
1 Year   -  US$  36.00 
2 Years -  US$ 70.00   
 Overseas Membership
All other Countries
1 Year  -   US$   60.00  
2 Years -  US $115.00  

Single Subsidy@$50.00
per night (if Available)

  $50.00  per Person
One Reservation
Only paid members as of
November 15, 2006, qualify for room subsidy
Totals $  $      $
I request the IPA members Hotel Subsidy for March 9-11, 2007
I agree to the terms for the subsidies shown above, Signature(s) please;
X___________________________________________________________________________________________
I request the following additional nights at the hotel at my expense.  Select dates please. 
I request the following roommate 
I request free transfer from Kaohsiung Airport to the hotel

               Check Number     Total:  $

Revised: