Four Ways to Register
Complete the form below and click on the "Submit" button at the bottom of the screen.
Complete and print the form, and send it along with your registration fee or billing
instructions to: National Security Institute, 165 Main Street, Suite 215, Medway, MA 02053
Complete and print the form, and fax a copy to: 508-507-3631
Please fill in the information below (all
fields must be completed)
How did you learn of this offer?
Browsing the Web
Have you attended previous IMPACT Forums?
Will you be staying at the Westfields Marriott?
No - Local Commuter
No - Another Hotel
Payment must be received by 3/1/19 to qualify for the $50 three-day discount rate of $945
Three Day Registration:
Two Day Registration:
One Day Registration:
Pre-Conference DISS Workshop
This workshop is free for all three-day registrants
Defense Information System for Security (DISS) workshop on Sunday, April 14, 2:00 to 5:00 pm
I will not be participating in this workshop
No spaces or dashes
Name on Card:
E-mail Receipt to:
In an effort to keep costs down, we don't use an automated credit card service. We batch process them every few days. We'll e-mail you a receipt as soon as your card is processed.
At The Above Address
At Accts. Payable Address Below
By Check Payable To
National Security Institute
165 Main Street, Suite 215
Medway, MA 02053
Please print & include a copy of this form with your payment