DAMA NJ 2008 DAMA Day Registration Form
Registration is by POSTAL MAIL or FAX Only. Email and phone registrations are not available.
Please print off the this registration form, complete required information for attendee and
Mail check payments to: DAMA NJ P.O. Box 7014 Watchung, NJ 07069-0799
Or Fax credit card information to: fax # 813-990-1084
Name: ________________________________________________________________ Title: ________________________________________________________________ Company: ________________________________________________________________ Address: ________________________________________________________________ City/State/Zip: ________________________________________________________________ Business Phone: ________________________________________________________________ E-Mail: ________________________________________________________________
Are you currently a member of DAMA-NJ: YES [ ] No [ ]
You may use this form to register multiple members from the same Corporate or Enterprise Membership ...
(if paying with the same check or with one credit card).
Please include for each member the Name, Title, Bus. Phone Number, and Email Address for each:______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Payment Amount:
[___] $ 75.00 DAMA NJ member rate, if paid before June 1st.
[___] $ 150.00 DAMA NJ member rate, if paid June 1st or after.
[___] $125.00 Non-member rate, if paid before June 1st.
[___] $200.00 Non-member rate, if paid June 1st or after.
Note to non-members, your 2008 DAMA Day registration fee includes a 1-year individual membership to DAMA NJ.
Payment includes lunch and AM/PM breaks.
No refunds - substitutions are allowed.
Payment Method: CHECK [ ], AMEX [ ], DINERS CLUB [ ], Master Card [ ], Visa [ ].
Name of credit card holder:
___________________________________________________________
Is credit card billing address the same as listed above? YES [ ] No [ ]
If NO - please include the credit card billing address, city, state, zip:
____________________________________________________________________________
Card Number:
__________________________________________________________
Expiration Date:
_____________________
Signature of Cardholder:
__________________________________________________________
CHARGES WILL NOT BE ACCEPTED WITHOUT SIGNATURES!!!!
[DAMA NJ Tax ID #22-3244193]
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