New Member Application

MASTER CARD VISA

AND

ACCEPTED

Registrant: Form Help Problems Submitting?
(Enter the name) as you would like to appear on your name badge, a separate registration is needed for each attendee)

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:

AOS Judging Registration: Request to Judge
(This section only if you are an AOS judge and plan to judge)

Judging Status

Accredited

Probationary

Student

IPA Membership Special: Not a Member? Join now and register at IPA Member Rate

Join or extend your current IPA Membership	Subscribe to the Phal Digest YES NO Phal Digest . . Member benefit . . . No Charge
One Year Membership . . . US and Canada		US$ 36.00
Two Year Membership . . . US and Canada		US$ 60.00
One Year Membership . . . Overseas		US$ 70.00
Two Year Membership . . . Overseas		US$ 115.00

Full Symposium Registration

*IPA Member*		Non-Member
Early Registration Before and on 01/31/07	US$ 100.00	Early Registration Before and on 01/31/07	US$ 120.00
Late Registration After 01/31/07	US$ 120.00	Late Registration After 01/31/07	US$ 140.00
I request the IPA members Hotel Subsidy for March 9,10, 11, 2007 (only 50 available)	Room Subsidy	Only paid members qualify for room subsidy

I request the following roommate
I request free transfer from Kaohsiung Airport to the hotel

Select Payment Method: . . . Payable in US Dollars

Check Number

Form Help Problems Submitting?