IRMMW-THz 2008

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Main Menu

[FMP-field:id_number]
[FMP-field:salutation] [FMP-field:first_name] [FMP-field:mi] [FMP-field:last_name]
Email: [FMP-field:email]
Registration Date: [FMP-field:creation_date] [FMP-field:creation_time][FMP-if:field:email_reg_confirm_date .gt. 0]
Email Confirmation of Payment Sent: [FMP-field:email_reg_confirm_date]
[/FMP-if]

[FMP-if:field:configuration .gt. 0]Configuration Requested by Exhibitor: [FMP-field:configuration]

[/FMP-if]Erich's Notes:
[FMP-field:exh_comm]

Paid? Amount: $

[FMP-if:field:paid .eq. no] no
check
credit card
fee waived
bank transfer[FMP-else][FMP-if:field:paid .eq. check] no
check
credit card
fee waived
bank transfer [FMP-else][FMP-if:field:paid .eq. cc] no
check
credit card
fee waived
bank transfer [FMP-else][FMP-if:field:paid .eq. waived] no
check
credit card
fee waived
bank transfer [FMP-else][FMP-if:field:paid .eq. iccai] no
check
credit card
fee waived
bank transfer [/FMP-if][/FMP-if][/FMP-if][/FMP-if][/FMP-if]

Remove from active database?[FMP-if:field:flag .eq. 0]

yes
no [FMP-else]
yes
no [/FMP-if]

Payment Comments
[FMP-field:comments]

Salutation:

First Name:

Preferred First Name:

Last Name:

Affiliation:

[FMP-field:salutation] [FMP-field:first_name] [FMP-field:mi] [FMP-field:last_name]
[FMP-field:affiliation]
[FMP-field:dept]
[FMP-field:address,break]
[FMP-field:city], [FMP-field:state] [FMP-field:zip] [FMP-field:country]

Phone: [FMP-field:phone]
Cell Phone: [FMP-field:cell_phone]
Fax: [FMP-field:fax]

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