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30th ANNUAL CONVENTION 2009
Friday Oct 30th, Saturday Oct 31st & Sunday November Nov 1st 2009
Sheraton Park Hotel at the Anaheim Resort
1855 South Harbor Boulevard · Anaheim, California 92802
Member Registration Early bird  $50 per person (after October 10, 2009 $75 per person)
Registration at the door $100 pp based on availability

Special reduced fee for MSRF members: $25 per person (after Oct 10, 2009 $50 per person)
REGISTRATION DEADLINE: Registration Form and check for Early Bird Registration must be received by 10/10/09

NON-MEMBERS: (charges are per person including children of “members”)
Add $ 25 per event for registrations received after Oct 10th, 2009

  Life Member     Annual Member      MSRF Member    Non-member
Name: ___________________________________________________________________________

Address: __________________________________________________________________________

Phone:______________  E-mail:____________________________________  Fax: ______________

ANNUAL MEMBERSHIP RENEWAL for 2009 --- $75 (Regularly - $125)
ANNUAL MEMBERSHIP RENEWAL for 2009 & 2010 --- $175 ( Regularly - $250)
Individual Life Membership --- $900 (Regularly - $1000)
Joint Physician Couple Life Membership --- $1400 (Regularly - $1500)
MSRF Free with ID

Please print, fill and mail this form along with your check payable to IMASC to:
11100 Warner Avenue #252, Fountain Valley, CA 92708
OR pay by Credit Card Online at www.imasc.org