2020 CCSNMMI Annual Meeting Reimbursement Questionnaire

If you registered and paid to attend the 2020 CCSNMMI Annual Meeting in Milwaukee, please complete the questionnaire below.

Question Title

* 1. Did you register and pay to attend the 2020 CCSNMMI Annual Meeting?

Yes

No

Question Title

* 2. Please indicate if you would prefer to receive a refund of your 2020 Annual Meeting registration fees or have them rolled forward to cover your 2021 CCSNMMI Annual Meeting registration, March 20-21, 2021 in Oak Brook, IL?

Please refund my registration fees.

Please roll my registration fees forward to 2021.

Question Title

* 3. If you indicated that you would like to receive a refund, please complete the information below with where to send your refund check. Rolling your registration over? Please only give us your first and last name below.

Name

Organization/Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Whom should the check be made payable to:

Email Address

Phone Number

Question Title

* 4. Questions or Comments?