CACMSM Forums Registration Form

Instructions

This form may be completed by either:

  1. Completing the registration form online and printing a copy, or
  2. By printing a blank copy and completing the registration form by printing legibly.

In either case, a printed copy of this form should be either mailed, or faxed to CACM.
 
Payment can be by check or credit card. If paying by credit card, the form must be signed and dated otherwise your registration will be delayed. Do not send cash in the mail.

CACM, 23461 South Pointe Dr., Ste. 200, Laguna Hills, CA 92653
TEL: (949) 916-2226      FAX: (949) 916-5557

Contact Information
First name
Last name
Title
Organization
Street address
Address (cont.)
City
State Zip
Work Phone
FAX
E-mail

Forum Selection

Forum

People in Attendance

CACM Member?

Amount*
Attendees Yes 
Yes  
Yes  
Yes  
Yes  
Yes  
Yes  
Yes  
Yes  
Yes  

Total Amt

Total if paid 8 days or more in advance

Billing Information
Payment Method
Cardholder name
Card number
Expiration date (mm/yy)
Billing Zip Code
 

__________________________________________
Signature Date

  

* FORUM FEES are:

 

Member Price
(if paid 8 days
or more in advance)

Member Price
(if paid less than
8 days in advance)

Non-Members
and Walk-ins
Breakfast Forums $30.00 $40.00 $40.00
Luncheon Forums
(all other locations)		 $40.00 $50.00 $50.00

This registration form must be accompanied by your check, money order or Credit Card information. When your registration is confirmed, you will receive written confirmation of your course reservation.

REFUND POLICY Cancellations must be made 7 days prior to event for a full refund.

CONTINUING EDUCATION CREDIT CCAM attendees receive one (1) hour of continuing education credit for each Forum.

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