Technical Training Associates Workshop Registration Form

Hands-On Wiring & Equipment Maintenance

September 21st & 22nd, 2010: Mahnomen, MN

Company Or Agency _____________________________________

Street Address __________________________________________

City _____________________ State ________ Zip _____________

Phone ____________________ Fax _________________________

E-Mail _________________________________________________

ATTENDEES:

Name: _________________________________________________

Name: _________________________________________________

Name: _________________________________________________

Workshop Fee: $395.00 Per Person (Includes Take Home Digital Meter)

Check, Money Order, Visa or MasterCard Accepted. Purchase Orders Accepted From Public Schools, Universities, Colleges, and Government Agencies. PO# ___________________

CREDIT CARD INFORMATION:

____Visa   ____MasterCard   ____Discover   ____AMEX

CARD# ________________________________________________________EXP DATE______________

SECURITY CODE: _________________

Send This Form With Payment To:

Technical Training Associates

HC 70 Box 3172

Sahuarita, AZ 85629

Or Fax TO: (520) 648-3334

Please Send My Confirmation Via: ___Fax ___Mail ___E-mail