Technical Training Associates Workshop Registration Form

Hands-On Pumps & Motors, December 10th & 11th, 2007, Phoenix, AZ

COMPANY NAME _________________________________________________

STREET ADDRESS _______________________________________________

CITY ________________________________STATE _______ ZIP___________

Phone ___________________________ FAX____________________________

ATTENDEES:

Name: ___________________________________________________________

Name: ___________________________________________________________

Name: ___________________________________________________________

WORKSHOP FEE: $295 Per Person (Includes Take-Home Workbook,)

Fees Are Payable In Advance

Check, Money Order, Visa or MasterCard Accepted. Purchase orders accepted from Public Schools, Universities, Colleges and Government Agencies.

CREDIT CARD INFORMATION: ___ Visa      ____MasterCard

CARD # ___________________________________EXP. DATE ________

SIGNATURE __________________________________________

Send This Form With Payment To:

Technical Training Associates, HC 70 BOX 3172, Sahuarita, AZ 85629

Fax to 520-648-3334

Call 520-625-6847 to register by phone.