Online Payments Form For advertisements, please use the Advertising Payments Form instead. School/Company Name* Enter N/A if does not applyName* First Name Last Name Email* Phone*This is a payment for:* Conference fees Consultant training deposit and/or balance due Recognition/consultation fees AMI/USA memberships Other Conference fees* Enter the amount to chargeWho is the conference payment for?* Consultant training fees* Enter the amount to chargeName of Trainee?* Application fee $80 if not already paidRecognition status fees Enter the amount to chargeConsultation fees Enter the amount to chargeAMI/USA Memberships Price: $99.00 Quantity: Enter # of membershipsOther fees* Enter the amount to chargePlease describe what this payment is for:* Additional Information for AMI/USATotal $0.00 PaymentCredit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ