The Association for the Improvement of Minorities in the Internal Revenue Service 2015 Central Region Conference Registration Form

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2 The Association for the Improvement of Minorities in the Internal Revenue Service 2015 Central Region Conference Registration Form Central Region Reunion & Spring Conference May 1-2, 2015 Online registration also available at Hosted by the Cincinnati Service Center Chapter Registrant Information The Madison Event Center 700 Madison Ave Covington, KY Hotel Accommodations Hampton Inn Cincinnati-Riverfront 200 Crescent Ave Covington, KY Call to reserve your room at ; use Group Code: AIM Room Rate: $ Online Hotel Reservation - website: Book your group rate: Association for the Improvement of Minorities >> Name: Member: Y/N Chapter: ID#: Address: City/State: Zip Code: Personal Address: Business Phone: Home Phone/Cell: Permission to include your contact information in the Central Region Directory? Yes No Registration Options Full Registration (Includes Gala, Workshops, Luncheon, and Souvenir Book) Current / Retired or Former Members: Postmarked on/before April 15, $55.00 Postmarked after April 15, 2015 or ON-SITE...$70.00 Future Member:...$70.00 Event Registration (in lieu of full registration or additional tickets): Event Cost Number of Tickets Amount Reunion Gala $30.00 Workshops $30.00 Luncheon $30.00 Additional Items: Event Cost Description/Number Amount Conference T-Shirt (*additional $1for each X ) $10.00* Central Region Directory $10.00 Souvenir Book Patron $5.00 Souvenir Book Ad ¼ Page ½ Page Full Page $25 $50 $75 If you are purchasing an ad for the Central Region Souvenir Book, please send your advertisement to marketing@aimirs-cincy.org **CANCELLATIONS** On/before April 16, Subject to a 25%processing fee After April 16, "NO REFUND" Payment Check/Money Order or Cashier Check payable to: AIM-IRS Special Instructions: Mail Registration & Payment ("DO NOT SEND CASH") to: AIM-IRS Central Region Spring Conference Attn: Registration Committee P.O. Box 85 Covington, KY Full Registration Fee: Event Registration Amount Additional Item Amount: Total Payment Due For additional information, please contact Teresa Bellamy Registration Committee Chair (859)

3 Conference Schedule VENDOR Friday, May 1, :00 p.m. 8:00 p.m. Registration 1:00 p.m. 4:00 p.m. Regional Business Meeting 4:15 p.m. 5:15 p.m. Leadership Training 7:00 p.m. 11:00 p.m. Reunion Gala Saturday, May 2, :00 a.m. 10:00 a.m. Registration* 8:30 a.m. 9:00 a.m. Opening Session 9:00 a.m. 10:00 a.m. Workshop 1 10:15 a.m. 11:15 p.m. Workshop 2 11:30 a.m. 12:30 p.m. Workshop 3 1:00 p.m. 3:00 p.m. Luncheon & Closing *Registration is closed during Opening Session Times are subject to change

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5 Conference Shirt Order Form VENDOR Actual T-Shirt Design Please check the box next to the desired T-Shirt size(s) and indicate the quantity: Submit Order Form and Payment No Later Than April 15, 2015 MAIL PAYMENT TO: AIM-IRS 2015 Central Region Spring Conference ATTN: Registration Committee P.O. Box 85 Covington, KY Small X $10 = Medium X $10 = Large X $10 = X-Large X $11 = 2X-Large X $12 = 3X-Large X $12 = 4X-Large X $14 = Total Quantity of T-Shirts Ordered: Total Shipping & Handling (if applicable*) $ Total Amount Remitted for T-shirts: $ Name: Chapter: Address: Phone: T-Shirts only be purchased in advance of the conference, so please be sure to submit your payment when registering. Don t Miss Out! ALL T-SHIRT ORDERS MUST BE RECEIVED BY APRIL 15, *If you are unable to attend the conference but still would like a T-shirt, add $6 shipping & handling for one T-Shirt. For multiple T-Shirts, add $6 for the first and $3 for each additional T-Shirt.

6 Souvenir Book Advertisement Form VENDOR Greetings Members and Friends, The Cincinnati Service Center Chapter will host the 2015 Central Region Reunion & Spring Conference on May 1-2, One of our goals is to produce a Souvenir Book that will be included in each registration package. Placing an advertisement in the souvenir book will be one way of supporting the Central Region Spring Conference. AIM- IRS Chapters, businesses, and individuals may purchase advertisements in the various sizes shown in the order form below. The chapter that brings in the most ads will receive a full-page ad free. A minimum of $150, excluding its chapter s ad, must be secured in order to participate in the contest. The Cincinnati Service Center Chapter also challenges each chapter of the Central Region to place a full page advertisement in the Souvenir Book. All completed order & release forms, advertisements and payments must be received on or before April 15, Completed order forms and advertisements may be ed to the Marketing Committee at marketing@aimirs-cincy.org, color or black and white photos are welcome; however, they must be included in your ad. If you prefer to submit your advertisement on a disk/cd, the order form and full payment must also be included and mailed to: AIM-IRS 2015 Central Region Spring Conference ATTN: Marketing Committee P.O. Box 85 Covington, KY Make all checks, money orders, and/or cashier checks payable to AIM-IRS and mail to the address above by April 15, Electronic acknowledgements will be provided upon receipt of payment of the advertisement if an address is provided. If additional information is needed, please contact Savon Gibson (513) (c). _ AD FORM Name/Organization Contact Person Address City State Zip Phone: Home Work address: Please indicate selection: Full Page ($75) Half Page ($50) Quarter Page ($25) Inside back cover ($125) Back cover - Color ($150) Patron List ($5)

7 Souvenir Book Advertisement Release Form RELEASE By signing this release form, I authorize The Association for the Improvement of Minorities CSC Chapter to use the following personal/ business information: 1. My Business logo, images and/or information. I hereby grant The Association for the Improvement of Minorities CSC Chapter the right to use, publish and reproduce a copy of the information described in (1) for the purpose of the 2015 Central Region Conference Souvenir book. I hereby waive the right to receive any payment from The Association for the Improvement of Minorities CSC Chapter use of any material described above (1) for any of the purposes described by this release. I acknowledge that I have read the forgoing and I fully understand the contents. IN WITNESS WHEREOF, I have executed this release on this day of, Print Name: Signature: Address: City: State: Zip: Telephone Number: