RegistRation FoRm

January 15, 2018 | Author: Anonymous | Category: N/A
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Registration Form You may also register online at Boxes indicate maximum characters on the conference badge. This information will also be used to update your RIMS record.

Registration Deadlines

EARLY BIRD February 26



February 27 – March 26

April 25 – 29

(On-site fees apply after March 26)

RIMS Corp. Member/Associate Full Conference Pass $850 $960 $1,100 Corporate 3rd Member $600 $675 $775 One Day Pass $400 $455 $500 Non-Member Full Conference Pass One Day Pass

$1,175 $475

$1,285 $525

$1,425 $575


Affiliate Member $360 Retired Member $360 Educational Member $360 Student Member $150 Student Non-Member $200

Name (Last)



Title Company Name Address City



Zip/Postal Code

Phone:____________________________Fax:_ __________________________ E-mail:_ __________________________________ (include country code)

Emergency Contact Name:_ ________________________ Phone: _ __________________ Twitter username:_ ________________ The Full Conference Pass is all-inclusive. The One Day Pass entitles you to sessions, entrance to the Exhibit Hall and admittance to that day’s events. One Day Pass Registrants for Monday may attend the Opening Reception, Thursday registrants may attend the Wednesday night event. * Please check day(s) selected for one day registration: Mon Tues Wed Thurs [Multiple one day passes may be purchased.] Guest passes are available for: Opening Reception ($65) Wednesday Social ($65) both events ($100) I would like to participate in RIMS 2010 Community Service Day: Credit Card Authorization Credit Card: Amex Visa MasterCard Card number:____________________________________ Expiration Date:____________ I have read and agree to RIMS Annual Conference & Exhibition Policies and Procedures. Signature: _____________________________________ Print Name:_ ____________________________________ Date:_ _____________ v Is this your first RIMS Annual Conference & Exhibition? Yes No v Years of risk management experience: 0-6 7-12 12+ v If you are disabled and need assistance with transportation or facilities, check this box and attach a written description of your needs: v RIMS shares the attendee mailing list. Check appropriate box(es) to be excluded from: Exhibitor Correspondence Post Conference Correspondence v To exclude demographic information from your conference badge, check this box: v E-Mail  Addresses: RIMS does not share your e-mail address. However, we may on occasion allow relevant, third parties to communicate with you, executed by a third party to retain your confidentiality. Check here to be included:

Payment Online Register with a credit card at RIMS accepts American Express, Visa and MasterCard. Registrations completed online choosing check or bank transfer payments will not be processed until payment is received. You will receive an e-mail confirmation after completing the process.

Mail If you are paying by credit card and unable to use the online system, mail the registration form on page 29 to: Risk and Insurance Management Society, Inc., 1065 Avenue of the Americas, 13th Floor, New York, NY 10018, Attn: Conference Registration; or fax your credit card payment to: 212-655-7429. If you are paying by check or money order, make checks payable to: Risk and Insurance Management Society, Inc. Corporate/personal/traveler’s checks or money orders must be payable in U.S. funds drawn on a U.S. bank. Purchase orders are not an acceptable form of payment. For regular mail delivery: Risk and Insurance Management Society, Inc. P.O. Box 95000-2345 Philadelphia, PA 19195-2345 For express or overnight mail delivery: Image Remit 205 North Center Drive North Brunswick, NJ 08902 Attn: P.O. Box 95000-2345

Bank Transfer Bank Transfers are payable only in U.S. dollars drawn from a U.S. bank. Transferred funds must be sent to: TD Bank, 469 Seventh Avenue, New York, NY 10018, ABA #026013673, Swift Code: CBNAUS33, Account Name: Risk and Insurance Management Society, Inc Operating Account. Account Number: 7920319089. Registrant is responsible for all bank charges, including a $30 RIMS processing fee, which must be added to the total amount transferred. The bank order must include the registrant name(s) and company. Please enclose a copy of your bank order with your registration form. RIMS Federal Tax ID # 13-1860397 Reminder: Keep a photocopy of the registration form for your files. Please note: Registrations not postmarked by their respective cut-off dates will be subject to additional fees. Any registrations postmarked after March 26 will be treated as on-site registrations and subject to on-site fees. Registrations received via mail will be processed within 10-15 business days. RIMS is not responsible for delayed mail or incorrectly addressed correspondence.

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