ISACA

ISACA New York Metropolitan Chapter

2004-2005 Chapter Year

July 1, 2004 - June 30, 2005

GENERIC REGISTRATION FORM AND INVOICE

(revised 09/17/2004)

Please print, complete, and mail this form

Registrant:

ISACA Member Number: or, __Non-Member

Organization:

Address:

City: State: ZIP:

Phone: Fax:

e-Mail Address:

Event Date:

Event Name:

Member Cost . . . . . $450 payment method: __Check, or Subscription Ticket #_________

Non-Member Cost . $550 Checks Only Please! We do not currently accept Credit Cards

If the event includes a meal, please

note any special dietary requirements:

This form can be used to reserve your attendance at any 2004-2005 Chapter Year event.
Member pricing is for the sole benefit of current ISACA members in good standing.
If a non-member registers with member pricing, they must pay the difference between member and
non-member pricing prior to attending the event.

Please make your check payable to:

(Your cancelled check will be your receipt)

ISACA New York Metropolitan Chapter, Inc.

Mail this form and your check to:

ISACA NY Metro
G.P.O. Box 1279
New York, NY 10116-1279

For questions, please contact:

David Kipin at 212-230-9112 / David.Kipin@isacany.org