International Telework Association & Council

CONFERENCE REGISTRATION FORM

Lessons from the Past Empowering the Future
September 4 & 5, 2003
Radison Plaza Lord Baltimore
Baltimore, Maryland USA
Conference Program

From August 8th to August 25th the ITAC corporate/agency member registration fee is $395 and the individual member and non-member fee is $495. For members of ITAC association partners, SHRM, MWWLC and ACT, the fee is $445. After August 25th the fee for members is $455, for association partner members is $505, and for individual members and non-members pay $555.

* = Indicates that the information is required.

*Full Name:

Company:

*Email Address:

*Street Address 1:

Street Address 2:

*City:

*State/Province:

*Zip/Postal Code:

Country:

*Phone:

Fax:

*Membership Status:

(Select one of the following categories)
	I am employee of an ITAC Corporate, Organizational, or Agency Member
	I am an ITAC Individual Member
	I am not an ITAC Member
	I am a member of the Society Human Resource Management (SHRM)
	I am a member of the Metro Washington Work/Life Coalition (MWWLC)
	I am a member of the Association for Commuter Transportation (ACT)

You may register more than one attendee and be billed for multiple registration fees. Please provide the names of each attendee and their email address (including yourself if you are attending)

*Attendee(s) and
Email Address(es):

*Billing Options:

	Pay Online by credit card (Visa, MasterCard and American Express)
	Invoice me Billing Address (if different than the address listed above): :

There will be a 20% cancellation fee on registrations until August 25th, after that date only attendee substitutions will be accepted.