ATIA 2009 Chicago Conference 
Pre-Conference:  October 28, 2009 
Conference:  October 29 – 31, 2009 
Renaissance Schaumburg Hotel & Convention Center
Schaumburg (Chicago), Illinois, USA

GROUP DISCOUNT REGISTRATION FORM
Group Discount Contact Information 

NOTE: The ATIA 2009 Group Discount contact is responsible for full payment of each individual and distribution of the order number.  When payment is received, a group order number will be e-mailed to the contact.  Each partner can register
individually for the conference using their order number.  ATIA does not require the names of these individuals at this time.

First Name: ______________________________________	 

Last Name: _____________________________________________________

Position/Title:_____________________________________   

Organization:____________________________________________________

Preferred Mailing Address: ________________________________________________________________________

City: ________________________________ State/Province: ___________ 

Zip/Postal Code: ____________Country:___________________ 

Phone: ___________________________________________ 

Fax: ___________________________________

E-mail: ________________________________
	
Group Discount Information 

Individual rate: $350 (per person).  A minimum of five (5) persons is required to take advantage of this program. 

Total Cost
Number of attendees in your group ____________ x $350 = $_____________

Total Fees Due $_________________

Payment Information: All Group Discount attendees must be paid in full by September 18, 2009 in order to qualify.  

__ Check (payable to ATIA)
__ AMEX	    
__ Visa	
__ MasterCard	

Credit Card # ____________________________________________ 

Exp. Date_________________

Name on card (please print) __________________________________________________________

Signature: _______________________________________________________________________

Fax to: (312) 673-6939 or 

Mail to: ATIA Headquarters, 1325 Paysphere Circle, Chicago, IL 60674.

No refunds will be granted to persons participating in the ATIA 2009 Group Discount Program. The ATIA 2009 Group Discount Program is subject to availability.  ATIA reserves the right to deny any Group Discount registration.  


This Word document version of the Group Discount Program Registration Form must contain the same information as in the PDF version. Any alterations other than data requested will make this registration void.