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