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Get 16th Annual Southern Seminar 2012 Any Contribution Please List Who Will Be Manning Your Booth: For

Our booth needs electricity ($40.00 Additional) Break Co-sponsorship + Exhibit Booth Courtesy sign indicating sponsorship Please provide this information as you would like it listed in programs and publications and return by July 2, 2012 to be included in our printed material. Full Name: First Name for Badge: Company Name: Address: City, State, Zip: Telephone: Email: Payment Bill Our Agency (For Members Only) Check Enclosed (Payable to IIANM) Charge my credit card (VS, MC, AMEX, DI.

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