Registration Form

Please fill in the information below. Registration confirmation
will be sent to you.

Please indicate which agency management system you use.

 Applied Systems

 AMS

 Other:

Name
Name as you would like it to appear on badge
Designation(s)
Agency or Company
Agency/Company Mailing Address
City State Zip
Phone Fax
Email (All confirmations are sent via email)

Please place a checkmark next to the afternoon user group you will be attending:
Michigan Applied Systems Meeting
Michigan AMS User Meeting

First Additional Registrant

Name
Name as you would like it to appear on badge
Designation(s)
Agency or Company
Agency/Company Mailing Address
City State Zip
Phone Fax
Email (All confirmations are sent via email)

Please place a checkmark next to the afternoon user group you will be attending:
Michigan Applied Systems Meeting
Michigan AMS User Meeting

Second Additional Registrant

Name
Name as you would like it to appear on badge
Designation(s)
Agency or Company
Agency/Company Mailing Address
City State Zip
Phone Fax
Email (All confirmations are sent via email)

Please place a checkmark next to the afternoon user group you will be attending:
Michigan Applied Systems Meeting
Michigan AMS User Meeting

Third Additional Registrant

Name
Name as you would like it to appear on badge
Designation(s)
Agency or Company
Agency/Company Mailing Address
City State Zip
Phone Fax
Email (All confirmations are sent via email)

Please place a checkmark next to the afternoon user group you will be attending:
Michigan Applied Systems Meeting
Michigan AMS User Meeting

Registration Fees:

$120 - I am an MAIA Member or Member of a User Group
 $50 - Attending User Group Meeting Only

 $85 - First Additional Registrant (Full Registration)
 $50 - First Additional Registrant (Attending User Group Meeting Only)

 $80 - Second Additional Registrant (Full Registration)
 $50 - Second Additional Registrant (Attending User Group Meeting Only)

 $80 - Third Additional Registrant (Full Registration)
 $50 - Third Additional Registrant (Attending User Group Meeting Only)

 $160 - Non-Member
 


Comments (please enter special requests here):

Total 
Please charge my:

*

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Card Number *
Name on Card *
Expiration date *

You may register in one of two ways:

1. over MAIA's secure server.

2. Print this form out and fax or mail it to MAIA, P.O. Box 80620, Lansing, MI 48908-0620

Cancellation Policy: There will be  no refunds for cancellations made after November 7, 2008.

Hotel Accommodations: Please call the Kellogg Center directly to make your reservations at (517) 432-4000.

Special Requests. If you have special dietary needs or need special accommodations, please submit them in writing with your registration form - in comments section, above.

Questions? Contact Wayne Joubert at (517) 323-9473, wjoubert@michagent.org or Jennifer Burnett at (517) 323-9473, jburnett@michagent.org.