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
Sauk Valley Community College 173 IL Route # 2 Dixon, IL 61201 |
| Institutional Members receive one complimentary registration at the IMACC annual meeting. |
| Institution Name
Address
|
| President Vice President (Academics) |
| Contact Person Title Phone |