Technical Training Associates

Workshop Registration:

Hands-On Electrical Wiring & Equipment Maintenance, Pumps, Motors, and Plumbing System Maintenance

June 21st and 22nd, 2010: Phoenix, Arizona

COMPANY NAME _________________________________________________

STREET ADDRESS _______________________________________________

CITY ________________________________STATE _______ ZIP___________

Phone ___________________________ FAX____________________________

ATTENDEES:

Name: ___________________________________________________________

Name: ___________________________________________________________

Name: ___________________________________________________________

Name: ___________________________________________________________

WORKSHOP FEE: $395 Per Person (Includes Take-Home Digital Meter)

Fees Are Payable In Advance

Check, Money Order, Visa or MasterCard Accepted.

Purchase orders accepted from Public Schools, Universities, Colleges and Government Agencies.

PO#________________ OR, CREDIT CARD INFORMATION:

___Visa      ___MasterCard    ___Discover   ___AMEX

CARD # ___________________________________________________________________

EXP. DATE ________________ SECURITY CODE ______________

SIGNATURE __________________________________________

To Register By Regular Mail, Send This Form With Payment Or PO# Information To:

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

Or, You May Use This Form To Register By Fax To 520-648-3334

Call 520-625-6847 to register by phone.