Register online at www.aami.org/ac or by phone at 1-800-373-3174

Full name ________________________________________________

Nickname for badge _______________________________________

Title/Department __________________________________________

Organization ______________________________________________

Address __________________________________________________

City/State/Zip _____________________________________________

Country (if other than USA) _________________________________

Phone ___________________________________________________

Fax _____________________________________________________

E-mail ___________________________________________________

Special needs due to a disability: _____________________________

q I am a first-time AAMI Annual Conference & Expo attendee.

Registrant Profile1. I work for a (check one box only):

q Hospital (non-profit) q Hospital (for profit) q Manufacturer q Government Agency q College or University

2. Job Function (check one box only):

q Asset Manager q Biomedical Equipment Technician q Biomedical Engineer q Clinical Engineer q Biomed/CE Department Managerq Administration q CEO / President / Exec Director

3. I am currently involved, directly or indirectly, in annualmedical-device purchases of (check one box only):

q Less than $10,000q $10,001 – $50,000q $50,001 – $100,000q $100,001 – $150,000q $150,001 – $200,000

Registration Fees

Full-Conference Registration q AAMI Member ................................................ $750 $850

q Member of (check one organization): q ACCE q CABMET q HIMSS q JSMI ..... $750 $850

q Nonmember 1 .................................................. $950 $1050

q U.S. Federal Government Employee 2 ................ $350 $350

q Full-Time Student (student ID required) 3 .......... $30 $30

Team Rates (per person):

q AAMI Member in team of five or more 4 ........... $638 $723

q Nonmember in team of five or more 4 .............. $808 $893

One-Day Registration

q AAMI Member ................................................ $400 $400

q Member of (check one organization): q ACCE q CABMET q HIMSS q JSMI ...... $400 $400

q Nonmember ..................................................... $500 $500

q Indicate date of your registration: q Sat, June 6 q Sun, June 7 q Mon, June 8

Expo-Only Registration

q Expo Plus Registrant Includes Expo Hall and Career Center for all 3 days, plus Keynote, and General Session ....... $30 $50

q Expo-Only One-Day Registrant Includes Expo Hall only for one of the following days (check one): q Sun, June 7 q Mon, June 8 .................... Free Free

Payment Method Total Amount Due 5 $________

q Check is enclosed, made payable to AAMI.

Check must be in U.S. funds drawn on a U.S. bank.

Charge my: q VISA q MasterCard q AMEX

Card # ___________________________________________________

Exp. Date ________________________________________________

Signature ________________________________________________

Fax: 240-396-5781

Mail this form to: AAMI 2014 Registrar PO Box 0211 Annapolis Junction, MD 20701-0211 Phone: 800-373-3174

ACEW

q Dialysis Center q Independent Service Organization q Consultant q Other ______________________

q Consultant q Imaging Equipment Specialist q Information Systems / IT Specialistq Student q Physician / Surgeon q Quality Assurance q Other ______________________

q $200,001 – $500,000q $500,001 – 1,000,000q $1,000,001 – $2,000,000q Over $2,000,000

Register by February 27 and Save!

C O N F E R E N C E R E G I S T R AT I O N

1) Nonmember Registrants in the U.S. who pay the full-conference nonmember rate of $950 or $1050 and have not been AAMI members for the past 12 months will receive a complimentary one-year AAMI membership.

2) Government Employee registrants must provide a valid U.S. federal government employee ID upon arrival at the AAMI 2015 registration desk.

3) Full-Time Student registrants will be required to present their valid student ID upon arrival at the AAMI 2015 registration desk.

4) Team rates apply when five or more full-conference paid registrations (excluding students). To be eligible to receive this discount all individuals must be employees of the same company and at the same address.

5) Requests for refunds must be received by Friday, April 17, 2015, and are subject to a $75 administrative fee. No refunds will be issued for requests received after this date. Refunds will not be issued for “no-shows.”

ByFeb.27

AfterFeb.27