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Not for profit Registration
Not for profit Registration
AMI Team
2023-04-03T20:10:48+00:00
Name
*
First
Last
Preferred name for nametag
Organization
Title/Position
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email Address
*
Mobile Phone
Will you be staying at the meeting hotel?
Yes, count me for a room in the room block (call or follow the link above to reserve your room by March 24th)
No, I will not be staying at the meeting hotel
Unsure at this time
Do you plan to attend the pre-meeting workshop. (Plan to arrive at hotel by NOON Tuesday)
Yes
No
Request a Beg, Brag, What If session.
No thanks, maybe next time
Beg
Brag
What If
Please indicate your BBWI below (You will receive an Information Form to complete closer to the meeting date.)
BBWI Title and Description
Do you have any dietary restrictions?
Yes
No
If so, please describe.
*
Do you have any mobility issues or special requests?
Yes
No
If so, please describe.
*
What is the primary reason for attending this AMI meeting?
Registration Options (If you have held funds ONLY select "apply meeting fees")
*
Meeting Fee (includes Celebratory Dinner on Wednesday night) - $1095.00
Wednesday Celebratory Dinner Ticket (if you don’t plan to attend the full meeting, but would like to join us for the celebratory dinner) - $150.00
Please apply my meeting fees held with AMI since the 40th celebration/April 2020 was canceled due to COVID
Please note that your dinner is included in your meeting fee.
Additional Activities (If you have held funds ONLY select "apply meeting fees")
Lowes Pre-Workshop on Tuesday, 1-4pm
Please apply my pre-workshop fees held with AMI since the 40th celebration/April 2020 was canceled due to COVID
Next Gen Innovator Scholarship
$100.00
$250.00
$500.00
$750.00
$1000.00
$1250.00
$1500.00
Donate my meeting fees held with AMI since the 40th celebration/April 2020 was canceled due to COVID
Donate my pre-workshop fees held with AMI since the 40th celebration/April 2020 was canceled due to COVID
Optional: This Scholarship Donation will go toward the attendance of a Next Gen Innovator at an AMI Gathering. Any amount is appreciated.
Total
$0.00
Credit Card
Card Details
Cardholder Name
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