Download hotel and Spring Congress registration forms
in Adobe Acrobat (.PDF) format (34 KB).

Registration Information

Name(last,first)__________________________________________________

Degree____________________________________________________________

Title/Position____________________________________________________

Department________________________________________________________

Institution/Organization__________________________________________

Address___________________________________________________________

City/State/Zip____________________________________________________

Country___________________________________________________________

Phone_____________________________________________________________

Fax_______________________________________________________________

E-mail____________________________________________________________

Badge Information

This is how your badge will read.  If information is the
same as above, skip this section.

Name/Degree_______________________________________________________

Organization______________________________________________________

City/State/Country________________________________________________

Advance Registration Fee
                         Advance    On-Site
Member*                  $395       $475      $_________
Nonmember                $495       $575      $_________
Student**                $295       $375      $_________

Events (included in registration fee)
Do you plan to attend the Welcome Reception & Banquet? ___Yes ___No
Do you plan to attend the Wednesday luncheon?          ___Yes ___No

Guest Tickets
Tuesday Banquet          #______ x $50 each = $________
Wednesday Luncheon       #______ x $30 each = $________

Total Enclosed or To Be Charged               $________

Payment Information

Payment must be made in U.S. dollars payable through a U.S. bank.
Make checks payable to AMIA.
Check enclosed in the amount of               $________
Please charge my credit card in the amount of $________
  ___VISA   ___MasterCard  ___American Express

Card Number______________________________________ Exp._____/_____

Signature________________________________________________________

Submitting Your Advance Registration

AMIA will not process registrations received without payment.
Registrations received after the May 10 deadline will
be processed at the on-site registration rates. Send this
registration form to the address listed above or fax it to
the number above; you may fax only if you are using a credit
card or purchase order for payment.

Additional Information

___ This is my first AMIA Spring Congress
___ I need special assistance. (If you need special accommodations
      to participate fully in the congress, please check here and
      enclose a descrition of your needs.)
___ Please do not include my name on mailing lists given to other 
      organizations.

Advance Registration

Advance registration discounts apply to all registrations received by
AMIA, and paid in full, by May 10, 1999. Registrations not paid in
full by May 10, 1999, will be charged the on-site registration rate,
and attendees will be expected to register on-site. Any attendee with
an outstanding balance must pay it before registration materials
may be obtained. AMIA will confirm advance registrations within
approximately two weeks of receipt of payment. The registration
fee includes all congress activities, including a ticket to the
Welcome Reception & Banquet and Wednesday luncheon and a copy of
the Spring Congress attendee list.

Student Registration**

Student registrations MUST BE ACCOMPANIED BY PROOF OF STUDENT STATUS
(e.g., a letter from a school or department official verifying status).
For registrations received without proof of student status, AMIA will
charge member/nommember registration rates.

Discounted AMIA Member Rates*

Congress registrants who are paid AMIA members for 1998-99 or 1999
qualify for the member rate. (Associate Members do not qualify.)
If you are not an AMIA member and would like to join to receive the
discounted membership registration fee, you may download a membership
application from AMIA's Web site at www.amia.org or call 301-657-1291
to request one by fax.

Payment

Payment must be in U.S. currency and payable through a U.S. bank.
Accepted forms of payment include personal or company check, money
order, VISA, MasterCard, or American Express. Other credit cards
are not accepted. Your account will be charged on the date on which
AMIA processes your registration. If you would like to make a wire
transfer from a foreign bank, please contact the AMIA office for
the appropriate account numbers.

In lieu of payment, you may submit proof of payment (authorization
or purchase order) with your registration. Attendees are responsible
for payment of fees, including those billed to third parties.
Deferred payment must be made within 30 days of billing, or a
service fee of $50 will be charged. You must provide a copy of
your purchase order or authorization along with a correct billing
address. AMIA will not process registrations without a copy of the
purchase order or authorization. Purchase order numbers alone are
not acceptable.

Transfer Policy

Registrants who are unable to attend the Spring Congress may
transfer their registration; if the alternate is not an AMIA
member, he or she will be charged the nonmember rate. Transfer
of registration must be in writing and received by the AMIA
office by May 19.

Cancellations

If a registrant needs to cancel his or her registration, the AMIA
office must receive a request in writing. AMIA will refund the
meeting registration fee, minus a $50 processing charge, if the
written request is received by May 10. If the written request
is received between May 11 and May 20, AMIA will refund half of
the registration fee. Refund requests received after May 20 will
be honored only for a documented medical emergency or a death in
the family. For registrants who cannot attend the meeting and who
did not cancel or transfer their registration, AMIA cannot apply
fees to future AMIA meetings. Refunds will be processed within
four weeks after the meeting.

On-Site Registration

Registration is available on-site during the conference. Registrants
needing assistance at times when the registration is not open should
inquire at the AMIA Information Booth.

Registration Hours

Tuesday, May 25      10:00 AM - 6:00 PM
Wednesday, May 26    7:00 AM - 10:00 AM