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IINDIVIDUAL ATTENDEE REGISTRATION FORM2009 GORHAM PMA PARTS/DER REPAIRS CONFERENCE

R e g i s t r a n t s N a m e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ P o s i t i o n / Address: T i t l e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C o m p a n y / O r g a n i z a t i o n : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Telephone: E-Mail:

______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ _________________________ FAX: ______________________ ______________________________________________________

  • *

    FOR MULTIPLE REGISTRATION , PLEASE USE SEPARATE REGISTRATION FORMS FOR ADDITIONAL REGISTRANTSCONTACT INFORMATION*

** FOR INFORMATION ON EXHIBITOR PRICING & SPECIFICATION , SEE THE CONFERENCE WEBSITE **

REGISTRATION FEES

___ ___

___

1st & and 2nd Registrant Fee:

US$ 1295.00 (each):

3rd & following Registrant Fee: US$ 1095.00 (each):

Alumni Registrant Fee:

US$

995.00 (each):

$ $

_________________ _________________

$

_________________

___ ___ ___ Airline/Civil Air Authority Registrant Fee: SAVE $100 … Attend Both Workshops for US$290 (each individual registrant): Optional Pre-Conference Workshop (I) Registrant Fee: US$ 195.00 (each): Optional Pre-Conference Workshop (II) Registrant Fee: US$ 195.00 (each): FREE $ $ $

________ ________ ________

Total: US$

___________

___ ___ __

PAYMENT OPTIONS Check Enclosed (drawn on a US Bank and made payable to Gorham Technical Associates, Inc.)

Bank Wire Transfer (please contact us for bank details); Bill My Credit Card (circle appropriate card type):

___

Invoice My Organization (Purchase Order is required)

American Express

Discover

MasterCard

Visa

Card Number Name on Card

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiration Date Signature ______________________________ __________________________________

** If you are paying by credit card, please provide the credit card billing address, if it is different from your contact address: Credit Card Billing Address:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

__________________________________________ TO REGISTER FOR THE CONFERENCE, OR FOR MORE INFORMATIONCONTACT:

Gorham Technical Associates, Inc. P.O. Box 535 Scarborough, ME 04070-0535 USA

Telephone: 207-883-6091/207-632-2243 Fax: 207-883-2139 E-mail: pma-2009@gorham-tech.com

Conference Website: www.gorham-tech.com

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