Seminar Registration

Registration Form for the 28th Coating & Drying Technology Seminar

To register, please print the form, complete it, and mail it to:

Edgar B. Gutoff
Consulting Chemical Engineer
135 Pleasant St., Unit 308, Brookline, MA 02446-7186 U.S.A

Fax to 617-879-9998, or E-mail to ebgutof@coe.neu.edu

[For security reasons please do not send credit card numbers by E-mail or in an attachment to E-mail. Use regular mail, Fax, or phone.]

Name: _________________

Title: ____________________________

Company Name:_____________________________

Phone:______________________

Fax: ___________________

E-Mail: ______________________________

Company Address:_______________________________________________________

City, State, and ZIP:_________________________________________________________

Country, if outside of the US:________________________________________________

Registration fee (Please circle the fee that applies)

Early by April 9*

Normal by May 7**

$1795

$1895

_____ I'm registering two or more people, for the same seminar, from my firm and would like to take advantage of the 20% discount for the second and any additional persons.

Total $ ___________

Total $ ___________

_____ Company purchase order(payable to Edgar B. Gutoff)

P.O. No.____________

_____ Check enclosed (payable to Edgar B. Gutoff)

_____ Charge my credit card

___American Express

___Mastercard

___Visa

Credit card #: ________________________
[For security reasons please do not send credit card numbers by E-mail or in an attachment to E-mail. Use regular mail, Fax, or phone.]

Exp. Date: ___________

Name on Card:________________________

Signature:__________________________

Date: ________________

Address, if different: _______________________________________________________________
Checks and purchase orders should be made out to Edgar B. Gutoff.

* The early registration payment must be received by April 9, 2012. Full refunds will be made to April 9, half refunds to April 23, No refunds will be made after that date, but the registration may be transferred to the next seminar if one will be held. Substitutions may be made at anytime. ** Full payment or a purchase order must be received by the start of the seminars on May 7, 2012.

Seminar Outline