Name (please print or type) ____________________________________________________________  
      
      
ASIS member no. ___________
      
      
Affliation (for name badge) ___________________________________________________________________
      
      
Email: ____________________________________________
      
      
Check one:
___ ASIS Member:  $30.00
___ Student/Retiree/Between jobs:  $20.00
___ Spouse, or Significant Other of ASIS members:  $20.00


___ Please check here if you prefer a vegetarian meal 

      
Make out check to "NEASIS."     

registrations MUST be received by April 3rd         

Please print this form and mail to:

Joanne Ren / Bose Corporate Library / MS 8 /The Mountain / Framingham, MA 01701

(please copy form for additional registrations)