Please provide us with your registration information:

Please provide all registration information so that we may serve you better.

Registrant #1:

Name:

Title:

E-mail:

Do you plan on attending the banquet dinner on Thursday evening?  Yes  No

Are you a member of AAHAM?  Yes  No

If yes, please provide membership #

First Time at an AAHAM meeting: Yes  No

Certification:   CPAM   CCAT   CCAM   CPAT   CCT
 

Registrant #2:

Name:

Title:

E-mail:

Do you plan on attending the banquet dinner on Thursday evening?  Yes  No

Are you a member of AAHAM?  Yes  No

If yes, please provide membership #

First Time at an AAHAM meeting: Yes  No

Certification: CPAM   CCAT   CCAM   CPAT   CCT

Organization:

Street Address:

City/State/Zip:

Phone#:

Fax#:

Additional Dinner Guests

Registration Fees:

Meeting Cost - $135.00 for members - $145.00 for non-members
Room Cost - $93.00 + tax  (Single or Double)
 

Please make your check payable to IL AAHAM and mail your registration form and payment to:

Nancy Vollmer, VP of Sales
Eagle Recovery Associates, Inc.
424 SW Washington Street, 3rd Floor
Peoria, Illinois  61602
Phone: (309) 272-4501
E-mail: nvollmer@eaglerecovery.net

Registration Deadline is November 28, 2011.
Please send your payment by November 29, 2011.
Cancellation policy is 72 hours from date of event for full refund.