Fill in this form and print it out using the "PRINT" command on your web browser.


2003 Fire Museum Network Seminar Registration Form
Dallas, Texas, August 22-25, 2003



Each registrant must complete a registration form (photocopy if necessary)
Please print/type to ensure accurate information is provided for badges -
a $15.00 badge replacement fee will apply).

Name:. . . . . . . . . . . . . . . . . . . . . . . . . . . .Title:


Museum Affiliation or Organization:


Address:


City: . . . . . . . . . . . . . . . . . . . . . . . . . .State. . .Zip


Phone: . . . . . . . . . . . . . . . . . . . . . . . . Fax


E-mail:


SEMINAR REGISTRATION FEE

Non-FMN Member Registration (each person). . . . . . . . . . . . . . $105 =


FMN Member Registration (single person). . . . . . . . . . . . . . $75 =

FMN Member Registration for two or more persons
who are affiliated with the same organization . . . . . . . . . $ 65 each =
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . -----------------
. . . . . . . . . . . . . . . . . . . . . . . . . . . Grand Total Registration Fee


Pay by Check -

Make check payable to: IAFC Fire Museum Network

Pay by Credit card -

Name on the credit card:

American Express - card # Expiration
. . . .. . Discover - card # Expiration
. . . Master Card - card # Expiration
. . . .. . .. VISA - card # Expiration


THE SEPERATE HOTEL RESERVATION FORM FOR EACH ATTENDEE
MUST ACCOMPANY THIS REGISTRATION

Mail or fax BOTH this Fire Museum Seminar Registration form,
and the Hotel Reservation Form, along with your payment to:

Expo Exchange
108 Wilmot Road, Suite 400,
Deerfield, IL 60015

1-800-424-5249 (phone)
847-940-2386 (fax)

A $25 CANCELLATION FEE WILL APPLY AFTER AUGUST 10, 2002


NO e-mail reservations are being accepted - fill this form out, print it using the "PRINT" command on your web browser, and mail it in with your payment.

Click here for the - Housing Reservations Form

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