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.
----------------------------
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
----------------------------
Return to SIMS Workshop home | Return to Annual Workshop Meeting