Life
Member 
Annual
Member Non-Members
You can download the form here or print this page.
INDIAN MEDICAL ASSOCIATION OF GREATER LOS ANGELES
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
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_______________________________