Technology Transfer Workshop “Membrane Use in the Great Lakes Area” Oct 1-2 2008 Please fill in the information below, submit it, and someone will contact you regarding your registration.
Name:
Salutation: Mr. Mrs. Ms. Dr. First: Middle: Last: Suffix: Job Title:
Salutation:
Mr. Mrs. Ms. Dr.
First:
Middle:
Last:
Suffix:
Job Title:
Company:
Mailing Address:
City:
State:
Zip:
Phone:
( )
Cell Phone:
Fax:
E-mail:
* Required field
Website:
I will attend the following functions, which are included in the registration fee:
Welcome Reception in Exibit Hall
Tue. Sept. 30 - 5:00-6:30 p.m.
Yes
No
Member of: AMTA SEDA SCMA SWMOA IDA
Special Needs: Wheelchair Access Visually Impaired Hearing Impaired Vegetarian Meals Other
Registration and Payment must be received by:
Sept. 9th
On/After Sept. 10
Members/Affiliate (must be listed above)
$250
$350
Non-Members
$450
Speaker/Full-Time Student/Retired
$150
Optional Items:
Sponsor: Major Sponsor: $1000 Luncheon: $750 Break: $500
I am planning on paying by:
Check Credit Card Invoice
If you are planning on paying by credit card, please fax your credit card information to 772-463-0860 or e-mail it to admin@amtaorg.com.
