RegistRation FoRm

Registration Form
You may also register online at www.RIMS.org/RegisterNow
Boxes indicate maximum characters on the conference badge. This information will also be used to update your RIMS record.
Registration Deadlines EARLY BIRD
February 26
REGULAR
ON-SITE
February 27 – March 26 April 25 – 29
(On-site fees apply after March 26)
RIMS Corp. Member/Associate
Full Conference Pass
$850 $960 $1,100
Corporate 3rd Member
$600 $675 $775
One Day Pass
$400 $455 $500
Non-Member
Full Conference Pass
One Day Pass
$1,175 $475 $1,285 $525 $1,425
$575
ADDITIONAL FULL
CONFERENCE REGISTRATION
OPTIONS
Affiliate Member
$360
Retired Member
$360
Educational Member
$360
Student Member
$150
Student Non-Member
$200
Name
(Last) (First) (M)
Title
Company Name
Address
City
State/Province
Country
Zip/Postal Code
Phone:____________________________Fax:_ __________________________ E-mail:_ __________________________________
(include country code)
Emergency Contact Name:_ ________________________ Phone: _ __________________ Twitter username:_ ________________
The Full Conference Pass is all-inclusive. The One Day Pass entitles you to sessions, entrance to the Exhibit Hall and admittance to that day’s events.
One Day Pass Registrants for Monday may attend the Opening Reception, Thursday registrants may attend the Wednesday night event.
* Please check day(s) selected for one day registration:
Mon
Tues
Wed
Thurs [Multiple one day passes may be purchased.]
Guest passes are available for: Opening Reception ($65)
Wednesday Social ($65)
both events ($100)
I would like to participate in RIMS 2010 Community Service Day:
Credit Card Authorization
Credit Card:
Amex
Visa
MasterCard Card number:____________________________________ Expiration Date:____________
I have read and agree to RIMS Annual Conference & Exhibition Policies and Procedures.
Signature: _____________________________________ Print Name:_ ____________________________________ Date:_ _____________
v Is this your first RIMS Annual Conference & Exhibition?
Yes
No
v Years of risk management experience: 0-6
7-12
12+
v If you are disabled and need assistance with transportation or facilities, check this box and attach a written description of your needs:
v RIMS shares the attendee mailing list. Check appropriate box(es) to be excluded from: Exhibitor Correspondence Post Conference Correspondence
v To exclude demographic information from your conference badge, check this box:
v E-Mail
Addresses: RIMS does not share your e-mail address. However, we may on occasion allow relevant, third parties to communicate
with you, executed by a third party to retain your confidentiality. Check here to be included:
Payment
Online
Register with a credit card at www.RIMS.org/RegisterNow. RIMS accepts American Express,
Visa and MasterCard. Registrations completed online choosing check or bank transfer
payments will not be processed until payment is received. You will receive an e-mail
confirmation after completing the process.
Mail
If you are paying by credit card and unable to use the online system, mail the registration form
on page 29 to: Risk and Insurance Management Society, Inc., 1065 Avenue of the Americas, 13th
Floor, New York, NY 10018, Attn: Conference Registration; or fax your credit card payment to:
212-655-7429.
If you are paying by check or money order, make checks payable to: Risk and Insurance
Management Society, Inc. Corporate/personal/traveler’s checks or money orders must be
payable in U.S. funds drawn on a U.S. bank. Purchase orders are not an acceptable form of
payment.
For regular mail delivery:
Risk and Insurance Management Society, Inc.
P.O. Box 95000-2345
Philadelphia, PA 19195-2345
For express or overnight mail delivery:
Image Remit
205 North Center Drive
North Brunswick, NJ 08902
Attn: P.O. Box 95000-2345
Bank Transfer
Bank Transfers are payable only in U.S. dollars drawn from a U.S. bank. Transferred funds
must be sent to: TD Bank, 469 Seventh Avenue, New York, NY 10018, ABA #026013673, Swift
Code: CBNAUS33, Account Name: Risk and Insurance Management Society, Inc Operating
Account. Account Number: 7920319089. Registrant is responsible for all bank charges, including
a $30 RIMS processing fee, which must be added to the total amount transferred. The bank
order must include the registrant name(s) and company. Please enclose a copy of your bank
order with your registration form.
RIMS Federal Tax ID # 13-1860397
Reminder: Keep a photocopy of the registration form for your files.
Please note: Registrations not postmarked by their respective cut-off dates will be subject to additional
fees. Any registrations postmarked after March 26 will be treated as on-site registrations and subject to
on-site fees. Registrations received via mail will be processed within 10-15 business days. RIMS is not
responsible for delayed mail or incorrectly addressed correspondence.