WAM 2004 Credit Card Form

WAM Alaska 2004

Conference Registration - Credit Card Form

Directions: To pay by credit card:

1. Complete the electronic form below and PRINT A COPY. Your information will not be sent to the WEB because we cannot assure a secure route for your data.

2. FAX the completed form to Frank Jeffries at (907) 245-3420

3. Or mail the form to: Professor Frank Jeffries, College of Business and Public Policy, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, AK 99508

4. For more information contact Frank Jeffries at (907) 786-4162 or afflj@cbpp.uaa.alaska.edu .

Credit Card Order / Information Form
Western Academy of Management Conference, Anchorage, Alaska March 31-April 4, 2004	Review your information carefully before you submit. Card payment will be rejected if incomplete or incorrect. All input fields must be entered.
NAME OF PERSON REGISTERING
EMAIL ADDRESS OF PERSON REGISTERING
CARD TYPE
CARD NUMBER
EXPIRATION (MONTH / YEAR)	/
DOLLAR AMOUNT TO BE PUT ON CREDIT CARD
NAME ON CREDIT CARD
ADDRESS OF CARDHOLDER
CITY OF CARDHOLDER
STATE/PROVINCE OF CARDHOLDER
COUNTRY OF CARDHOLDER
ZIP CODE OF CARDHOLDER
PHONE NUMBER OF CARDHOLDER
OPTIONAL COMMENTS

WAM Alaska 2004 Conference Registration - Credit Card Form

Credit Card Order / Information Form

Review your information carefully before you submit. Card payment will be rejected if incomplete or incorrect. All input fields must be entered.

WAM Alaska 2004

Conference Registration - Credit Card Form

Review your information carefully before you submit.
Card payment will be rejected if incomplete or incorrect.
All input fields must be entered.