IMACC INSTITUTIONAL MEMBERSHIP FORM (98-99)

Invoice 199899		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