MAILCOM Registration

DELEGATE INFORMATION


First Name
Last Name
Title
Badge Name
Company
Address
City
State		Zip
Email
Phone		Fax

Additional Name
Email
Title
Badge Name


Additional Name
Email
Title
Badge Name

CONFERENCE ENROLLMENT

For the days registered, each option includes entry to all seminars, keynotes, exhibition hall, meals and receptions; and, supporting documentation.
Please select the appropriate box :

Full Conference Enrollment
Regular Full Rate (After 2/9/17)	$995.00	$

Group Rate Full Conference
Group Rate (2 + from same co.)	$865.00	$
Large Group Rate (2-4 + from same co.)	$845.00	$
Extra Large Group Rate (4 + from same co.)	$795.00	$
Two & One Day Enrollments
Two-Day: Monday - Tuesday	$795.00	$
Two-Day: Tuesday - Wednesday	$795.00	$
One-Day: Monday Only	$395.00	$
One-Day: Tueaday Only	$495.00	$
One-Day: Wednesday Only	$395.00	$

Total $

PAYMENT INFORMATION

Select Billing Method

Name on credit card
P.O.or Credit Card #
Expiration Date
Bank Security Code

Attach Government PO or Military Training Form if paying by this method.

CHECK APPLICABLE BOXES

special dietary needs physical disability which requires assistance:

If you require special assistance you must register by 3/10/17 so that appropriate services can be scheduled.

REGISTRATION INSTRUCTIONS

Print and complete this form, include payment information and press the button or mail/fax to:

MAIL:
Registration Dept.
MAILCOM 2017
P.O. Box 451
Brigantine, NJ
08203-0451

FAX:
1-609-264-0121

Upon receipt of your paid registration, we will send you a confirmation. If you do not receive confirmation within 30 days of the show, call 1-609-264-0120.

Cancellation: If you must cancel, notify the Registration Dept. in writing by 3/10/17 for a refund. After this date, only conference credit will be issued.