Fees and Fax-Mail Form

Registration Form: Santa Fe Conference - Nov. 3-5, 2017 

Mail/fax/e-mail this form to ICSA, PO Box 2265, Bonita Springs, FL 34133, USA. Fax: 1-305-393-8193. Phone: 1-239-514-3081. Email: mail@icsamail.com.

If this form does not display properly, use the PDF version.   
Prefer Online Registration


No. People

Item

Fee (Util September 15, 2017) - USD

Fee (After September 15, 2017) - USD

Calculate Amount Due

 

ICSA Member 3-day fee per person  (member and immediate family)

$150

$200

$

 

Nonmember 3-day fee per person (includes ICSA Web membership; family of nonmember registrant may take member rate)

$200

$250

$

 

One-Day fee per person—members or nonmembers—check day:

Friday  [     ]         Saturday [     ]          Sunday [     ]

$100

$125

$

 

Full-Time Student Registration

$50

$75

$

 

Contribution

$

 

Total Amount

$

 

Payment Method: _____Check (US Funds drawn on US bank or money order)        ___Visa   ___ MasterCard

Number:                                                                                                                                                      Exp. Date:               Security Code:

 

Name(s):

 

Address:

 

City/State/Zip/Country:

 

Phone(s)/Fax:

 

Email(s) (Important!):


If financial need (e.g., unemployed, disability) prevents you from attending the conference, contact ICSA.