- Food Marketing Institute

January • 24 - 27
Fontainebleau Miami Beach • Miami Beach • FL
fmi.org/mw2015
15
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Associate/Private Brands Member Registration FORM
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NICKNAME/badge name m MR. m MRS. m MS.
FIRST NAME
LAST NAME
Please complete this information as
you would like it to appear in the
directory, by the deadline of
December 18, 2014.
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3 Easy Ways to Register
DIRECTORY INFORMATION
TITLE
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ONLINE:
www.fmi.org/mw2015
(Associate/Private Brands Members Only)
COMPANY NAME
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MAILING ADDRESS
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CITY
STATE/PROVINCE
ZIP/POSTAL CODE
COUNTRY
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DIRECT BUSINESS PHONE (include country & city/area codes)
COMPANY LEVEL PHONE (include country & city/area codes)
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EMAIL (required for confirmation)
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NON-INDUSTRY GUEST — Companion/SpOUSE (social events only, no fee)
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EMERGENCY CONTACT
Phone
Confirm to (if different from attendee):
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Name
____________________________________________________________________________________________________
EmailPhone
Program Participation
FAX:202.220.0830
MAIL:
Food Marketing Institute
P.O. Box 758870
Lockbox 758870
Baltimore, MD 21275-8870
Ref. # on check: 3600-017-0826
Registration questions? Contact Customer Service
at dstewart@fmi.org or 202.220.0828.
Hotel Information
Fontainebleau Miami Beach
4441 Collins Avenue
Miami Beach, Florida 33140
Once registered, each registrant will receive a Registration
Confirmation email from meetings@fmi.org containing a unique
code to secure housing. Hotel reservations must be made directly
with the hotel by Monday, December 18, 2014.
REGISTRATION CANCELLATION POLICY
m I plan to participate in FMI's Food Industry Golf Tournament, Sunday, January 25th (separate registration required)
Please notify registrar in writing by email to dstewart@fmi.org.
A refund, minus a $75 processing fee, is granted when a
cancellation is received prior to December 18, 2014.
No refund is granted if notification is received after
December 18, 2014, however the registration can
be transferred to another company employee.
m My company plans to participate in the Strategic Executive Exchanges (SEEs) as a Supplier.
(complete the SEE Commitment Form if participating)
MIDWINTER SPECIAL EVENTS
m I’m interested in supporting the FMI Foundation Industry Leadership Dinner. (seperate registraion required)
Golf:
Separate registration is required
Spouse Luncheon:
Separate registration is required
Please check all that apply.
m I am a first-time attendee
m I plan to attend the breakfast and business session on Tuesday, January 27th.
m I plan to attend FMI Foundation Gala and Industry Awards Dinner, Saturday, January 24th, 6-9pm
REGISTRATION PAYMENT
PAYMENT: Registration CANNOT be processed without payment. TOTAL TO BE CHARGED FOR REGISTRATION: $3,995.00 (spouse/non-industry guest, included in fee)
ENCLOSED IS MY: m Check (payable to FMI in USD drawn on a U.S. bank) Reference #: 3600-017-0826
m Credit card information (complete below) m AMEX m MasterCard m VISA
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CARD NUMBER
EXPIRATION DATE
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CARDHOLDER NAME (please print)
____________________________________________________________________________________________________
SIGNATURE (Required for ALL credit card payments)
MAIL:
Food Marketing Institute
P.O. Box 758870, Lockbox 758870
Baltimore, MD 21275-8870
Ref. # on check: 3600-017-0826
FAX:202.220.0830
EMAIL:dstewart@fmi.org
online: www.fmi.org/mw2015
It is FMI’s policy to comply with the Americans with Disabilities Act.
Please check m if you require ADA assistance and specify the assistance you require here:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Please submit your request at least two (2) weeks prior to event date so that we can work with you to ensure full accessibility. We can guarantee services only to those who register and notify us at least two (2) weeks prior to the event date.
FMI Foundation Gala & Industry Awards Dinner
Are you interested in attending the FMI Foundation Gala and
Industry Awards Dinner on Saturday, January 24, 2015.
Please indicate your interest by checking “Yes” below.
Indicating your interest DOES NOT register you to attend
the dinner. FMI Foundation staff will contact you directly with
additional details and confirm your participation.
m Yes m No
For more information on Midwinter
Special Events, please visit our website:
www.fmi.org/mw2015
REGISTRATION DEADLINE
FOR DIRECTORY:
DECEMBER 18, 2014
WEB