International Telecommunication Professionals Exchange


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	2007 Conference Registration

June 3rd - 6th
Palms Casino Resort, Las Vegas

Please provide the following registration information:

Prefix
First Name
Last Name
Title
Organization
Address
City
State/Province
Zip/Postal Code
Country
Telephone
Fax
E-mail
Special Needs

If you have special needs that require assistance, please indicate above or email businessoffice@itpx.org

I will be attending:                          FULL CONFERENCE
                                               Full Conference             Daily Rate:
End User Member                   $720                            $250

Educational Member               $720                              $250

Associate Member                  $720                               $250

Industry Professional             $920                              $300

Trade Show Only             $50
 
If selecting a DAILY RATE, please indicate day(s)
Monday
Tuesday
Wednesday

* Early bird registration ends March 8th 2007

Spouse/Companion/Adult Guest   $200
Spouse/Guest First Name   

Spouse/Guest Last Name     

IMPORTANT INFORMATION
CANCELLATION AND REFUND POLICY
Advanced Registration can be cancelled and refund made only if WRITTEN notice
is postmaked prior to midnight on March 8 2007. Facsimile (Fax) transmitted 
cancellations  must carry a transmittal time prior to midnight March 8 2007 
to receive a full refund. 
Participants who register after March 8 2007 are responsible for full registration payment. 
No full or partial cancellations after March 8 2007.

IMPORTANT NOTE: Name badges and tickets are issued to individual
registrants. ITPX does not permit the exchange of name badges
or tickets from one individual to another. Each individual
attending the conference must be registered for the event.

Payment Method (US Funds)

Check enclosed, payable to ITPX and mailed to:
ITPX c/o PO Box 29332 Brooklyn Center, MN 55429
MasterCard
Visa Card
(Sorry, American Express not available)

Card Number
Expiration Date
Cardholder Name (as it appears on your billing statement)
Address (as it appears on your billing statement)
City (as it appears on your billing statement)
State/Province (as it appears on your billing statement)
Zip/Postal Code (as it appears on your billing statement)

Please complete the following information: Service Provider(s):
AT&T (SBC)
Bell Canada
Bell South
QWest (US West)
Telus
Verizon (Bell Atlantic/GTS)
Other (Please specify)

                                 
  The International Telecommunication Professionals Exchange (ITPX) has permission to release my name and the above information (excluding payment information) to companies in the telecommunications field.