ITMI Symposium & Reunion Registration Albuquerque, New Mexico ~ January 27 – 31, 2013 Early Bird Registration by October 31, 2012 Personal DataName (as it will appear on your badge)*VegetarianGluten FreeCompany (Tour Operators Only)Address*Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryPhone*Email*Hotel AccommodationsHotel accommodations must be booked thru ITMI. A credit card is required to guarantee reservation. You will be responsible to confirm your reservation directly with the Embassy Suites Albuquerque, at least 10 days prior to arrival. No shows will be charged 1 room night.The following information is for ITMI use to coordinate Symposium rooms. Please read carefully: If you are requesting ITMI to assign a share partner for you, there is no guarantee that your roommate will share the exact number of room nights as you. There may be a night or nights that you will be paying the single rate.Accommodations*Yes, I require accommodationsNo, I do not require accommodationsSmoking preference*SmokerNon-smokerRoom Options*SHARE-TWIN ROOM at $64.50 per person per night, plus room taxSINGLE ROOM at $129 per night, plus room taxSNORER? If you are a snorer, please be advised to request a single room.Requested share partnerEnter the name of your requested share partner if you have one, otherwise leave this field blank and we will assign one for you.I understand that I am responsible for all hotel charges which are to be paid directly to the hotel upon check-out. The special rates apply only to the dates below. I will be reserving the following nights:Fri 1/25Sat 1/26Sun 1/27Mon 1/28Tues 1/29Wed 1/30Thur 1/31Complimentary Sightseeing FAM ToursSee Symposium brochure for descriptions.Pre-Symposium–Sun, Jan. 27, 2013*Tour A: "Meet Albuquerque" Tour(9am – 5pm)Tour B: "Albuquerque & Sandia Peak Tram" Tour(1pm – 5:30pm)No Pre-Symposium TourPost-Symposium–Thur, Jan. 31, 2013*Tour C: "Santa Fe & the Turquoise Trail" Tour(9am – 5pm)Tour D: "Albuquerque Hispanic Cultural" Tour(9am – 1pm)No Post-Symposium TourSymposium Registration*Tour Director $445Tour Operator $445Please pick the appropriate option to continue.Add MarketplaceSpouse/Partner/GuestYes, I will have a Spouse/Partner or GuestSpouse/Partner/Guest NameVegetarianGluten FreeWill you be bringing additional Associates?*YesNoHow many additional Associates?1 Additional associate $4452 Additional associates $8903 Additional associates $1335Maximum 3Additional Associate 1 NameAdditional Associate 2 NameAdditional Associate 3 NameLate Fee(after October 31, 2012 deadline)Would you like to pay online now or pay by check?*Pay online nowPay by checkTotal$0.00Cancellation Policy Full refund if canceled prior to November 14, 2012. 50% refund if canceled prior to December 1, 2012. No refund after December 1, 2012.Check by mail instructions.If paying by check follow these steps: 1. Note total due above. 2. Click Submit to send us your registration information. 3. Mail your check made payable to ITMI to: ITMI 625 Market Street, Suite 810 San Francisco, CA 94105CommentsThis field is for validation purposes and should be left unchanged. Please e-mail questions to travel@itmisf.com and refer to “ITMI Symposium” Don’t forget to keep a copy for your records!