I S M P R O G R A M R…

                                                 I S M P R O G R A M R E G I S T R AT I O N F O R M
                                                                          NOT       FOR USE WITH         ONLINE PROGRAMS

  INTERNET:                        FA X :                               MAIL:                            PHONE:
  Complete and submit your         Complete the order form and fax      Complete the order form and      Note the item number(s) you
  order form via the Internet at   (24 hours) with your credit card     mail with your check or credit   wish to order, have your credit card
  www.ism.ws. Select Products &    information to 480/752-2299.         card information to ISM, P.O.    ready, and call 800/888-6276 or
  Study Materials.                                                      Box 22160, Tempe, AZ             480/752-6276, extension 401,
                                                                        85285-2160 USA.                  to place your order.




Program Number _________________ Program Date ___________________________________________________
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Program Title_________________________________________________________________________________________

 ISM Member  Nonmember                                ISM ID # (if known) ____________________________________________
I am a C.P.M.:  Yes  No                I am an A.P.P.:  Yes  No

 Dr.  Mr.  Mrs.  Ms.  Miss

First Name ____________________________ MI _____ Last Name __________________________________________

Title _________________________________ Organization Name ____________________________________________

MAILING ADDRESS:  HOME  BUSINESS
______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

City _________________________________ State ________ ZIP Code _______________________________________

Country ___________________________________ Postal Code ______________________________________________

(______) _____________________ (______) _____________________ _______________________________________
Daytime Phone Number*          Fax Number*                    E-Mail Address
*For international phone numbers, please include country and city codes.

METHOD OF PAYMENT: (U.S. Funds Only)                      Prices are subject to change

 Personal  Organization check is enclosed for $ _____ Org. Name __________________________________

Credit/Procurement Card Charge:  VISA  MasterCard  American Express  Diners Club

Charge Card # __________________________________________________
                                                               ________ Expiration Date _____/______

Amount to be Charged $ ________ Cardholder Signature _____________________________________________

 Please check here if you have any special needs that we can address to make your participation more
enjoyable and informative (this includes any dietary or physical requirements).