Registration Form

AAMFT-CA Networking District: Inland Empire

Fill in the form below to sign up for a district meeting. Please make sure that your email address is correct and choose the appropriate options from the drop-down menus.

Attendee Information *required fields

Membership Number:

Name:*

Address:*

City:*

State:*

Zip:*

Phone:*

Fax:

email:*

Please select your Membership Status:

Receive Membership Information:

Single Event

Please select Student or Member, Non Member:

Upcoming Events

  • Friday, November 14, 2008
    12:00 noon to 3:00 p.m.
  • Location: California Baptist University
    San Bernardino Campus
    225 W. Hospitality Lane, Suite 108
    San Bernardino, CA 92408-3244

Credit Card Information

Name on Card:*

Credit Card Type:*

Card Number:*

Expiration:*

Please Note that if you receive an error when submitting this form, use your browser's "Back" button to return to this form.

Registrants not attending the meeting or failing to cancel their registration by Friday, two weeks prior to their session, will be invoiced for the full fee. There is a $20 fee for returned checks or denied charges to credit cards.