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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"> 
              Full Name: </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Full Name" type="text" id="Full Name" size="40">
              </span></b></td>
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            <td align="right" nowrap><span style='text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Nickname</font></span><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Nickname" type="text" id="Nickname" size="40">
              </span></b></td>
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            <td align="right" nowrap><span style='text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Title</font></span><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Title" type="text" id="Title" size="40">
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            <td align="right" nowrap><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Company: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Company" type="text" id="Company" size="40">
              </span></b></td>
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            <td align="right" nowrap><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Address: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Address" type="text" id="Address" size="50">
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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
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              </span></td>
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text-decoration:none;text-underline:none'> 
              <input name="City" type="text" id="City" size="20">
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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
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              </span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="State" type="text" id="State" size="20">
              </span></b></td>
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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Zip: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Zip" type="text" id="Zip" size="20">
              </span></b></td>
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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Phone: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Phone" type="text" id="Phone" size="25">
              </span></b></td>
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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">Fax: 
              </font> </span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="Fax" type="text" id="Fax" size="20">
              </span></b></td>
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            <td align="right"><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">E-mail: 
              </font></span></td>
            <td><b><span style='font-size:10.0pt;font-family:Weiss;
text-decoration:none;text-underline:none'> 
              <input name="email" type="text" id="email" size="20">
              </span></b></td>
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            <td><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"><span class="arial10"> 
              <input name="price" type="radio" id="price" value="$795">
              </span><strong>No registration fee benefit of membership</strong></font></td>
            <td><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"><span class="arial10"> 
              <input name="price" type="radio" id="price" value="$1250">
              </span> $295 Non-member firm representative</font></td>
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            <td colspan="2"><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"> 
              Payment: </font></td>
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            <td colspan="2"><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"> 
              <input name="Payment" type="radio" id="creditCard" value="Check">
              Check payable to AMCF in US funds drawn on a US Bank</font></td>
          </tr>
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            <td colspan="2"><span class="arial10"><font face="Weiss, Arial, Helvetica, sans-serif" size="2"> 
              <input name="Payment" type="radio" id="creditCard" value="AMEX">
              AMEX &nbsp;&nbsp; 
              <input name="Payment" type="radio" id="creditCard" value="Diners Club">
              </font></span><font face="Weiss, Arial, Helvetica, sans-serif" size="2"><span class="arial10"><font face="Weiss, Arial, Helvetica, sans-serif" size="2">Diners 
              Club&nbsp;&nbsp; 
              <input name="Payment" type="radio" id="creditCard" value="Mastercard">
              MasterCard </font></span></font> <span class="arial10"><font face="Weiss, Arial, Helvetica, sans-serif" size="2">&nbsp;&nbsp; 
              <input name="Payment" type="radio" id="creditCard" value="Visa">
              Visa</font></span></td>
          </tr>
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            <td align="right"><span class="arial10"><font face="Weiss, Arial, Helvetica, sans-serif" size="2">Account 
              Number: </font></span></td>
            <td> <font face="Weiss, Arial, Helvetica, sans-serif" size="2"> 
              <input name="accountNumber" type="text" id="accountNumber" size="40">
              </font></td>
          </tr>
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            <td align="right"><span class="arial10"><font face="Weiss, Arial, Helvetica, sans-serif" size="2">Exp 
              Date: </font></span></td>
            <td> <font face="Weiss, Arial, Helvetica, sans-serif" size="2"> 
              <select name="expMonth" id="expMonth">
                <option value="01">01</option>
                <option value="02">02</option>
                <option value="03">03</option>
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
                <option value="09">09</option>
                <option value="10">10</option>
                <option value="11">11</option>
                <option value="12">12</option>
              </select>
              / 
              <select name="expYear" id="expYear">
                <option value="04">04</option>
                <option value="05">05</option>
                <option value="06">06</option>
                <option value="07">07</option>
                <option value="08">08</option>
              </select>
              </font></td>
          </tr>
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            <td colspan="2"><span class="arial10"><br>
              <font face="Weiss, Arial, Helvetica, sans-serif" size="2">Signature:</font><font size="2">__________________________________________________________________________<br>
              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<font size="1">&nbsp;<b><font face="Weiss, Verdana Arial, Helvetica, sans-serif">Signature 
              is required to processing</font></b></font></font></span></td>
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                  <td><p><font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"><strong>Cancellations/Substitutions &#8211; Policy: </strong>Cancellations
                        received by <strong>March
                          21, 2005</strong> will be subject to a $75 administrative
                          fee. <strong>No
                          refunds for cancellations will be made after March
                          21, 2005.</strong> Those who register, but do not
                          attend, are not eligible for a refund. Your registration
                          may be transferred to another member of your organization.<br>
                      </font></p></td>
                </tr>
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                  <td><p><span class="arial10"><font face="Weiss, Arial, Helvetica, sans-serif" size="2"> 
                      <input name="AMCF_Info_Packet" type="checkbox" id="AMCF_Info_Packet" value="YES">
                      </font></span> <font size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif">I 
                      am (we are) interested in AMCF membership &#8211; please 
                      send an information packet.</font><br>
                    </p></td>
                </tr>
                <tr> 
                  <td align="center"><font color="#336867" size="2" face="Weiss, Verdana Arial, Helvetica, sans-serif"><strong>AMCF 
                    &#8211; 380 Lexington Avenue, Suite 1700, New York, NY 
                    10168 <br>
                    212.551.7887&nbsp;&nbsp;&nbsp; Fax: 212.551.7934 &nbsp;&nbsp;Visit 
                    our web: <a href="http://www.amcf.org" target="_blank">www.amcf.org</a></strong></font></td>
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