AssetWorld 07

Online Registration Form

Personal Information - * fields are required
Title:
*First Name:
*Last Name:
Name on Badge:
*Email:
*Company/Organization:
*Job Title:
*Street Address:
*City:		*State/Province:
*ZIP/Postal Code:		Country:
*Telephone Number:	123-455-6789	Fax:	123-455-6789

Event Registration
	Individual Conference Registration Fee ($775.00 USD)
	Spouse/Guest Registration Fee ($115.00 per person)
	If applicable, please enter spouse/guest(s) names(s):

Dining
	Tuesday	Evening Reception
	Wednesday	Breakfast	Lunch
	Thursday	Breakfast	Lunch	Dinner
	Friday	Breakfast	Lunch

Payment Information - one field is required
	Check or Money Order (make payable to: MAXIMUS, Inc.) Mail Payments to: MAXIMUS, Inc. Asset Solution Division Attention: Mindy Edwards 1777 NE Loop 410, Suite #1250 San Antonio, TX 78217
	Bill to Purchase Order Number:
	If applicable, please enter billing address:
	Bill to Credit Card (MasterCard or Visa only) **Note: Upon completion of registration, after selecting Submit*, a credit card payment form will be generated. This form must be completed and returned to MAXIMUS to process payment.

Cancellation Policy: Once you have submitted a registration form, you have guaranteed your payment for the conference. If for some reason you cannot attend, MAXIMUS will provide a full refund, provided registration cancellation is received in writing prior to October 25, 2007. Written cancellations should be directed to Mindy Edwards and faxed to 210-301-0298 or email to mindyedwards@maximus.com.