INDIAN MEDICAL ASSOCIATION OF GREATER LOS ANGELES
www.imala.net
Annual Convention
November 21-23, 2008
Sheraton Park Hotel @ the Anaheim Resort, 1855 S Harbor Blvd, Anaheim, CA 92802
(866) 716-8130
REGISTRATION FORM
For life-members, current annual members and one Guest, there is a deposit fee of $ 50 per person (refundable upon attendance) if paid before November 8, 2008. 
 After November 8, 2008, life-members and current annual members and one guest pay $ 100 per person at the door.  
For physician non-members, guests of members , and Business Community there is flat fee of $ 150 per person. 
This includes CME, breakfast, lunch and Dinner Gala There is NO additional charge for individual events. 
For Tables, please contact info@imala.net 310-786-7100 Fax 310-472-4459
For medical students, residents and fellows and spouses, there is a deposit fee of $50.00 per person (refundable upon attendance) if registered before November 8, 2008.  After November 8, 2008, medical students, residents and fellows and their spouses pay $50 at the door.

REGISTRATION DEADLINE: Registration Form and check must be received by 11/8/08
 Life Member    Annual Member     Non-Members 
  	 Students, Residents, Fellows (Proof required)
Member Ship Dues:
Life  $750   Annual  $100 
Students Residents and Fellows $0
Enclosed with Registration ________

Name: _____________________
Spouse/Guest Name______________________
Specialty_____________________
Address:______________________________________________________________________
Phone:_______________E-mail:________________Fax: ______________

Please copy, print, fill and mail this form along with your check to: 
IMA of Greater Los Angeles, 
912 Teakwood Rd, Los Angeles, CA 90049.
NON-PROFIT TIN: 95-4393229
The membership form is also available at www.imala.net
For more information, call 310-786-7100.
 METHOD OF PAYMENT
 Check payable to IMA of Greater Los Angeles
VISA	MasterCard		American Express
Credit Card #:_______________________________ Amount________ 
Expiration Date:____________ Security code_______
Billing address ______________________________
______________________________

Signature_______________________________