You may want to print this page for your records. 

If any of this information is incorrect, please send email to seminar@imanationscapital.org

OR print this sheet, write in the corrections and FAX to 888 476-0665

Name
If applicable CMA CFM CPA CCM CPCM PMP
Title
Company
Street
City, State Zip+4
Telephone
Email
Payment Amount
Payment Method
Comments (optional)
To pay by Credit Card or Debit from your bank account click the button to the right  ==>> (A PayPal account is not required to make payment.) Problems?  Your credit card provider might have blocked the payment. Call them to request they unblock the transaction.	Payment is for - enter name(s)
If paying by check, make payable in US funds to the "IMA" and mail to:	IMA Nation's Capital Chapter 13112 Memory Lane, Fairfax, VA 22033

Revised: 10/18/11