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INDUSTRY EVENTS | Technical Short Courses

Additives Short Course
REGISTRATION FORM

Meeting Dates: November 4 – 5, 2009
All fields denoted by an * are required.

*Full Name

*Title

*Company

*Address Line 1

Address Line 2

*City

*State/Province

Country

*Zip/Postal Code

*Phone

*Fax

*E-Mail


(type "none" if you do not have an email address)

*Registration Fee:

Note: In order to access the member rate, you must login. If you do not have your member login and password, please contact Malinda Armstrong at malinda.armstrong@ascouncil.org.
$675 (ASC Member/End-User) $1050 (Non-Member)

TOTAL$

Payment
All payments must be made in U.S. dollars drawn on an U.S. bank.
*Payment (check method): VISA       Mastercard       AMEX
*Credit card number:(Input Credit Card Number with no dashes)
*Expiration date:       (MM/YYYY)
 
 
*My company's business: (Please select the most appropriate box)
Manufacturer/marketer of adhesive and/or sealant product (includes Distributors)
Supplier of raw materials, equipment, or other services to the adhesive and/or sealant industry
End User of adhesives/sealants
Academia
Trade press
Government agency
Trade association
Other - please specify:

Deadline to register:  October 23, 2009.
You may register ONSITE after this date.
Cancellation Policy: All cancellations must be received in writing no later than October 23, 2009 . Note: a 20% processing fee will be assessed on cancellations.NO REFUNDS AFTER October 23, 2009.

This form may be photocopied. Mail or fax this Registration Form no later than October 23, 2009 to The Adhesive and Sealant Council, 7101 Wisconsin Avenue, Bethesda, MD 20814; Fax: (301) 986-9795. For questions call (301) 986-9700, x106.

Liability Disclaimer: The Adhesive and Sealant Council (ASC) claims no liability for the acts of any participants at this meeting, nor for the safety of any person participating in, or in transit to or from this event. ASC reserves the right to cancel any function without penalty. The total amount of any liability of ASC, in the event of cancellation, will be limited to a refund of the registration fee.

Press the "Submit" button to send your request.
PLEASE CLICK SUBMIT ONCE
(Print this page for your records.)
 



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