IMACC INSTITUTIONAL MEMBERSHIP FORM (96-97)
Invoice 199697 Amount Due $115.00
IMACC Tax ID # 371127733 Amount of Remittance
Date
Signature Title
Make Check Payable to: IMACC Mail to: IMACC
c/o Dave Clydesdale Institutional Members receive one Sauk Valley Community College complimentary registration at the 173 IL Route # 2
IMACC annual meeting. Dixon, IL 61201
Institution Name Address
President Vice President (Academics)
Contact Person Title Phone