1. Register online at www.aami.org/ac
or by phone at 1-800-373-3174
Full name_________________________________________________
Nickname for badge________________________________________
Title/Department___________________________________________
Organization_______________________________________________
Address___________________________________________________
City/State/Zip______________________________________________
Country (if other than USA)__________________________________
Phone ____________________________________________________
Fax ______________________________________________________
E-mail____________________________________________________
Special needs due to a disability:______________________________
q I am a first-time AAMI Annual Conference & Expo attendee.
Registrant Profile
1. I work for a (check one box only):
q Hospital (non-profit)
q Hospital (for profit)
q Manufacturer
q Government Agency
q College or University
2. Job Function (check one box only):
q Asset Manager
q Biomedical Equipment Technician
q Biomedical Engineer
q Clinical Engineer
q Biomed/CE Department Manager
q Administration
q CEO / President / Exec Director
3. I am currently involved, directly or indirectly, in annual
medical-device purchases of (check one box only):
q Less than $10,000
q $10,001 – $50,000
q $50,001 – $100,000
q $100,001 – $150,000
q $150,001 – $200,000
Registration Fees
Full-Conference Registration
q AAMI Member ................................................. $750 $850
q Member of (check one organization):
q ACCE q CABMET q HIMSS q JSMI...... $750 $850
q Nonmember 1
................................................... $950 $1050
q U.S. Federal Government Employee 2
................. $350 $350
q Full-Time Student (student ID required) 3
........... $30 $30
Team Rates (per person):
q AAMI Member in team of five or more 4
........... $638 $723
q Nonmember in team of five or more 4
............... $808 $893
One-Day Registration
q AAMI Member ................................................. $400 $400
q Member of (check one organization):
q ACCE q CABMET q HIMSS q JSMI....... $400 $400
q Nonmember...................................................... $500 $500
q Indicate date of your registration:
q Sat, June 6 q Sun, June 7 q Mon, June 8
Expo-Only Registration
q Expo Plus Registrant
Includes Expo Hall and Career Center for all
3 days, plus Keynote, and General Session........ $30 $50
q Expo-Only One-Day Registrant
Includes Expo Hall only for one of the
following days (check one):
q Sun, June 7 q Mon, June 8..................... Free Free
Payment Method
Total Amount Due 5
$________
q Check is enclosed, made payable to AAMI.
Check must be in U.S. funds drawn on a U.S. bank.
Charge my: q VISA q MasterCard q AMEX
Card #____________________________________________________
Exp. Date_________________________________________________
Signature _________________________________________________
Fax: 240-396-5781
Mail this form to:
AAMI 2014 Registrar
PO Box 0211
Annapolis Junction, MD 20701-0211
Phone: 800-373-3174
ACEW
q Dialysis Center
q Independent Service Organization
q Consultant
q Other ______________________
q Consultant
q Imaging Equipment Specialist
q Information Systems / IT Specialist
q Student
q Physician / Surgeon
q Quality Assurance
q Other ______________________
q $200,001 – $500,000
q $500,001 – 1,000,000
q $1,000,001 – $2,000,000
q Over $2,000,000
Register by February 27 and Save!
C O N F E R E N C E R E G I S T R AT I O N
1) Nonmember Registrants in the U.S. who pay the full-conference nonmember
rate of $950 or $1050 and have not been AAMI members for the past 12 months
will receive a complimentary one-year AAMI membership.
2) Government Employee registrants must provide a valid U.S. federal government
employee ID upon arrival at the AAMI 2015 registration desk.
3) Full-Time Student registrants will be required to present their valid student ID
upon arrival at the AAMI 2015 registration desk.
4) Team rates apply when five or more full-conference paid registrations (excluding
students). To be eligible to receive this discount all individuals must be employees
of the same company and at the same address.
5) Requests for refunds must be received by Friday, April 17, 2015, and are
subject to a $75 administrative fee. No refunds will be issued for requests
received after this date. Refunds will not be issued for “no-shows.”
By
Feb.27
After
Feb.27
