IMACC INSTITUTIONAL MEMBERSHIP FORM (97-98)
Invoice 199798 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