CHIMA Annual Meeting Refund

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* 1. Meeting registrant's first and last name.  If your facility paid for more than one registrant with the same payment method (check or credit card), please list all registrant names below.  If you are a registered exhibitor, enter the name of the registered company.

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* 2. Meeting registrant's phone number.  If your facility paid for more than one registrant with the same payment method (check or credit card), please list all registrant phone numbers below. If you are a registered exhibitor, enter the company representative phone number.

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* 3. Meeting registrant's email address.  If your facility paid for more than one registrant with the same payment method (check or credit card), please list all registrant email addresses below. If you are a registered exhibitor, enter the company representative email address.

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* 4. Who should the check be made payable to?

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* 5. What address should the check be mailed to?

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* 6. Additional Comments/Questions?

0 of 6 answered
 

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