Name: __________________________ License No.: AC____________

Telephone: ________________      email: ______________________________________

Mailing Address:__________________________________________________________

Seminar Fee	Pre-registration	On-site
AACMA Member or Other Association Member of this Conference	$30 (with 2018 membership card)	$30 (with valid 2018 membership card)
Student	$30 (with valid ID)	$30 (with valid ID)
Non—Member	$180	$200

(1) Pre-registration deadline is September 1st, 2018，

(2) Refund Policy: 80% prior to September 1st, 2018， none thereafter.

(3) Please make your check payable to AACMA.

(4) If you have not paid your 2018membership fee ($120) and PAC donation ($80), please pay them ASAP, or you can bring your checks (you must bring two checks to pay each separately) at the class to pay them on site. Please write your name and license number on your check.

(5) We will provide handouts prior to the lecture and issue CE certificate after the lecture.

AACMA email : aacmaus@gmail.com     Contact Tel:415-981-8384

Sent form and checks: 777 Stockton St, Suite 105, San Francisco, CA 94108