AFFIRM

Dec. 18, 2008 AFFIRM Luncheon

(Please use one form per registrant; tab through the form to move
from field to field, as hitting the enter key will submit the data)

Prefix/Rank

First Name

Last Name

Title/Position

Company/Service/Org

Company Size

Email

Tel

Fax

Address Street

Address City

Address State

Address Zip

Special Needs

Registration Rate

	Industry Member Pre-Registered -- $65
	Industry Non-member Pre-Registered -- $75
	Industry Subscription Holder -- No additional charge
	Government Member Pre-Registered -- $25
	Government Non-member Pre-Registered -- $30
	Government Subscription Holder -- No additional charge

COMMENTS

How did you hear about
the AFFIRM Luncheon?

PAYMENT

Payment Method

All Check Payments
Should Be Mailed To:

AFFIRM
P.O. Box 2848
Alexandria, VA 22301
tel: 703-549-1160

Deadline for cancellations or refunds:
48 hours prior to the event.
No refunds thereafter.