Archives Registration Form

First Name: *

Last Name: *

Position Title: *

Email Address: *

Institution Name: *

OCLC Symbol:

Are you an Amigos member?: *

Yes

No

Address 1: *

Address 2:

City: *

State: *

TX, AR, KS, etc...

Zip Code: *

12345-6789

Telephone: *

123-456-7890 x1234

Fax:

123-456-7890

Access will be available for 3 months.

Entire conference for Amigos members: $120
Entire conference for non-members: $140

View conference and session descriptions. (opens in a new window/tab)

Payment Method: *

Deduct fee from Amigos Deposit Account (members only)

Bill Institution

Pre-pay by check

Credit Card (Visa, MasterCard or Discover)

For security purposes, Amigos does not currently accept credit card numbers on this form. Please fax us your account information, including type (Visa, MC or Discover), expiration date, and signature. Access to the course will be provided after payment is received. Please send checks to: Amigos Training Registration 14400 Midway Road Dallas, TX 75244-3509 Please be sure you have authority from your institution to purchase Amigos training via this Internet form.

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