Print and complete this form.
Fax or Mail to the Conference Administrative Office at the 
Annual Workshop on SIMS. Contact information below.

NOTE:  Online payment is not available this year.  Pay with 
credit card or check by mail or fax.

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Annual Workshop on SIMS
Mail or Fax Payment Form
-If you registered online,
use this form to mail or fax your payment.
-If not registered online,
use the PDF Registration Form to register and make payment.

Check Enclosed, Nr. ________ Amount ______

Charge This Card 
___ VISA ___ MasterCard
Account Number
_____________________________________
3 Digit Security  Code (on reverse of card)
  
We can not process your transaction without this code.
________________________________
Expiration Date
_____________________________________
Name on Account
_____________________________________
Billing Address (Street, City, State, Zip)
_____________________________________

Total Charge Amount $___________________

Authorized Signature 
_____________________________________
Date
_____________________________________

Payment is for (Names)
_____________________________________

_____________________________________

_____________________________________

_____________________________________


Please make all checks payable to: 
Annual Workshop on SIMS (US Currency Only)
Mail or Fax to:
Annual Workshop on SIMS
P.O. Box 1480
Edgewater, MD 21037-7480
Telephone: 1-888-396-8620
Facsimile: (410)451-7373

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