IMACC INSTITUTIONAL MEMBERSHIP FORM (97-98)
Invoice 199697 Amount Due $115.00
IMACC Tax ID # 371127733 Amount of Remittance
Date
Signature Title
Make Check Payable to: IMACC Mail to: IMACC
Institutional Members receive one complimentary registration at the IMACC annual meeting. c/o Dave Clydesdale

Sauk Valley Community College 173 IL Route # 2

Dixon, IL 61201

Institution Name Address
President Vice President (Academics)
Contact Person Title Phone