Spray Technology Seminar Registration Form

If you have any difficulty registering online, please print this form and fax it to (630) 260-7593

Please fill in the following contact information:
* Mandatory Fields

*First Name:

Initial:

*Last Name:

*City:

*State/Province:

*Zipcode/Postal Code:

Please choose from the following:

	EARLY REGISTRATION FEE (Sign up by 3/26/2012)	.................$1,300.00
	STANDARD REGISTRATION FEE (Sign up after 3/27/2012)	.................$1,500.00
	Discount Code:	.................- $ .00
	Your Registration Fee Total (Less Discount)	................. $ .00

Hotel Reservations will be made by Spraying Systems Co.

Hotel accommodations at Bloomingdale Residence Inn

I do not need hotel accommodations

Arrival Date:		mm/dd/yyyy
Departure Date:		mm/dd/yyyy

	Single Room Accommodations, Per Person	Register by 4/9/2012 and the room rate will be $99.99/night. After that, the room rate is based on the hotel's prevailing rates
	Double Room Accommodations

Non-Smoking

Smoking

Spraying Systems Co. has permission to use my credit card to reserve my hotel room.

Transportation

*Will you require transportation to Spraying Systems Co.?

Yes

Payment Method (Credit Card or Check) Sorry we are unable to accept P.O.'s

Credit Card

Charge my:

Name on Card:
Card Number:

Expiration Date:

Month

Year

Check

	Payment by Check payable to Spraying Systems Co.

* If paying by check, please complete the registration form to reserve your spot. Check may be mailed separately.
Payment policy: In order to confirm your place in our seminar, we require payment in full. Cancellation policy: If you are unable to attend, please send a colleague in your place. If no one from your company can attend, refunds will be granted as long as we receive your cancellation by 4/9/2012. Refunds are not available after that date.

HELP US PLAN

To help us customize the seminar to your needs, please provide some information about your interests, industry and application.

TYPICAL VOLUMES USED

High

Medium

Low

Specific topics of interest you'd like to see addressed during the seminar:

*May we share your name, title and company with other registrants 14 days prior to the seminar?
	Yes		No

*How did you learn about the seminar?
	Website
	Mailing
	Magazine
	Sales Rep
	Other - please specify :

Comments:

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