credit_card_registration

ONLINE REGISTRATION - WILL BE CLOSED 6:00 PM EDT WEDNESDAY MAY 21

(to allow us to process all the information given next Monday is a holiday)

Registration will be on a first come, first serve basis. included with the registration fee is attendance to all the functions, Reception on May 28, Lunch and Dinner on May 29, coffee breaks throughout, and a copy of the proceedings.

Individuals and Displayers - Early Bird Discount of $100 for registration on or before April 25, 2008.

Cancellation - full refund before April 28, 2008; after that NO REFUND.

INDIVIDUAL registration will be $450.00 (USD) after 04/25/08; $350 on or before 04/25/08.

Student registration is $100.00.

DISPLAYER REGISTRATION - $950.00 (USD) after 04/25/08; $850 on or before 04/25/08. For an 8x10 space suitable for large Skyline type display frame or table top.

On Line Registration Form (For Individual, Displayer, Student Registration)

Individual Registrant     DISPLAYER Student

REGISTRANT INFO (Individuals, Displayers, Students):

FirstMI Last Title (optional)

If you are registering for someone else, AND ARE NOT ATTENDING please list the ATTENDEE (s) below:

FirstMI Last Title (optional)

If you are registering for yourself AND someone else, you must EACH register separately.

Company

Address1

Address2

City        State Zip Code ZIP NEEDS TO MATCH BILLING ZIP CODE

Country

Phone      FAX

EMAIL      and/or

Displayers ONLY may bring additional persons (to staff the booth) for an additional fee of $150.00. This does not apply to multiple individual registrants coming from the same company.

Number of Person's Attending

FirstMI Last Title (optional)

FirstMI Last Title (optional)

        WEBSITE (Displayers Only)

        Booth Preference 1st 2nd 3rd 4th

Credit Card Information (we take Visa, MasterCard, & American Express)

4 Characters

Visa & MC & AMX

4 Characters Visa & MC

6 Characters AMX

4 Characters Visa & MC

5 Characters AMX

4 Characters Visa & MC

AMX - blank

The CVV is a three-digit security code that is printed on the back of cards. The number appears in reverse italic at the top of the signature panel at the end (see sample). This program helps validate that a genuine card is being used during a transaction.

TYPE EXPIRATION

AFTER SUBMITTING THIS FORM, A CONFIRMATION PAGE SHOULD APPEAR; HOWEVER THIS IS ONLY FOR REGISTRATION, YOUR CREDIT CARD WILL BE PROCESSED AND A RECEIPT MAILED TO YOU.

1099 The Central PA Section of ASCE's Taxpayer Identification Number is 23-7377736