Badge Name: Name For File: Badge Name (S/O): Organization Affiliation: Mailing Name: Mailing Address: City/State/Zip Code: Phone (day): Phone (evening): Name to use for calling:
Paying By Enclosed Check? YesNo(Make Checks Payable To IFGE Convention)
Paying By Credit Card? Yes NoType Visa MasterCard American Express Discover
Number Exp. Date
Name On Card
You may print this form out and mail it to: IFGE Convention c/o CIOE Enterprises, PO Box 61, Easton, PA. 18044-0061. You may also email the details of the form (once completed, it can be cut and pasted to an email) to skristinej@aol.com,fax it to 610-759-0223, or call 610-759-2347 (evenings)