Source sampling & CEMS Workshop Registration Form

 
Name:
Title:
Company:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Extension:
Fax:
E-mail:
 Can we Notify you by Email of Courses or Bulletins of interest?
 I am registering for the August 11-15, 2008 workshop
 I am registering as a Workshop Participant ($1,299.00) Vendor ($400.00)

Payment by check or credit card must be received in our office within two weeks of receipt of this registration form to hold a seat.

 

Please return the completed registration form with deposit to: Attn. Workshop Registrar Walter Smith & Associates, Inc. 6225 Splitrock Trail, Apex, NC 27539 Phone/FAX (919) 772-7843

or Mail to: walt@waltersmith.com

 

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