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Four Ways to Register

Web: Complete the form below and click on the "Submit" button at the bottom of the screen.

Mail: 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

Phone: 508-533-9099

Fax: Complete and print the form, and fax a copy to: 508-507-3631
Please fill in the information below (all * fields must be completed)
*Name:
*Title:
*Company/Org:
*Address:
*City/State/Zip:
*Phone:
*E-mail:
How did you learn of this offer?
Have you attended previous IMPACT Forums?
Will you be staying at the Westfields Marriott?
Registration Fee Please Note: Payment must be received by NSI prior to
3/20/17 to qualify for the $50 three-day discount rate of $895
Three Day Registration: $945
Two Day Registration: $845
One Day Registration: $595
Pre-Conference JPAS Workshop This workshop is free for all three-day registrants
Yes, enroll me in the JPAS Transition to the new Defense Information System for Security (DISS) workshop on Sunday, April 23, 2:00 to 5:00 pm
No, I will not be participating in this workshop
PAYMENT
Charge To
VISA MasterCard Amex
Account No:
No spaces or dashes
Exp. Date:
Mo/Yr
Name on Card:
E-mail Receipt to:
Note: 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.
Invoice Me
At The Above Address At Accts. Payable Address Below
PO No:
Company/Org:
Attn:
Address:
City/State/Zip:
E-mail To:
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