Registration Form

November 14 - 15, 2001
Dallas Market Center, Dallas, TX

Registration Form

The amount we will charge to your credit card is: (circle preference)
FULL PASS (11/14 -11/15) PRICE: $1195.00
DAY ONE ONLY (11/14) PRICE: $795.00
DAY TWO ONLY (11/15) PRICE: $795.00

Please complete the form below. After typing information,
print this form and mail or fax with payment to the address below.

YOUR INFORMATION

First Name:

Last Name:

Title:

Company Name:

Street Address:

City:

State or Prov.:

Zip/Postal Code:

Country:

E-mail Address:

Telephone:

Fax:

PAYMENT INFORMATION
Credit Card Holder's Name:
*Credit Card Type:
Credit Card Number:
Month card expires:
Year card expires:
Cancellations and Substitutions If you must cancel for any reason, we must receive written notice of cancellation by October 14, 2001. Your registration will be refunded less a $100.00 processing fee. Cancellations after October 14, 2001 are non-refundable. You may transfer your registration to another person at any time by providing written authorization.
How did you hear about us?:
If other:

Mail your completed registration form with payment to (checks payable to INTM Media Group):

INTM Media Group
Att: Search Engine Strategies Fall 2001
Church Street Station
P.O. Box 6414
New York, NY 10249-6414

You may also fax it WITH CREDIT CARD PAYMENT to (203) 286-1010 - ATT: Allison Alessio.

Credit Cards Only: Fax:(203) 655-9582

NOTE: REGISTRATION FORM AND PAYMENT MUST BE RECEIVED TOGETHER TO BE PROCESSED.