Name _____________________________________ Company_____________________________________

Phone_____________________________________ FAX_________________________________________

Guest_____________________________________ Company_____________________________________

___ HSMAI Members                                       $30.00 each
    and members of the Arizona Meeting Industry Alliance           
	("early bird" fee for payment before 5:00 p.m. on 10/18/11)*
	
___ Members after deadline                              $40.00 each

___ Non-Members                                         $40.00 each

___ HSMAI Student Members                               Complimentary

___ I am on the 2011 pre-paid meeting plan

___ I would like to pre-purchase a raffle package for $10.00
___ I would like to pre-purchase a raffle package for $20.00

(Reminder: Non-members can attend up to two meetings prior to joining)

___ I would like to pay for a student to attend at $20.00.

Special dietary needs: ________________________________________________________________

_______ # of attendees       Total amount due $_______

____Payment by Check   ____Payment at Door   ____Card (Mastercard, AmEx or Visa)

Card #_____________________________________ Exp _______________________

Authorized Signature___________________________________________________