Seminar Registration

Gogolin & Associates

Seminar Registration

Registration Form for the 24th Coating & Drying Technology Seminar

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

Edgar B. Gutoff
Consulting Chemical Engineer
194 Clark Rd., Brookline, MA 02445-5848
U.S.A

Fax to 617-734-7081, 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 (Check the seminar you'll be attending and circle the price.):

by April 26*

by May 3**

_____ Coating & Drying

$1695

$1795

_____ 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 #: ________________________

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 26, 2010. No refunds will be made after that date, but the registration may be transferred to the following seminar(s).
** Full payment or a purchase order must be received by the start of the seminars on May 3, 2010.

Seminar Outline