IMASC TAX ID No. 330044199
Non-profit Organization - 501(c)6
Earlier Registration ensure priority seating
By Check: Please print, fill and mail this form along with your check payable to
IMASC to : IMASC, Jayanti Patel, M.D., P.O.Box 18867. Anaheim, CA 92817-8867
OR e-mail at firstname.lastname@example.org
Online: *Payment option by PayPal.