On the Road with CETA
Saturday, July 24 , 2010
Baltimore MD
Tremont Plaza Hotel ▪ 222 St Paul Place ▪ Baltimore MD 21202
□ DOT Hazardous Material 9:00 am—1:00 pm
Register Before July 9, 2010 $45.00 Each CETA Member / $90.00 each Non Member
Register After July 9, 2010 $65.00 Each / CETA Member / $120.00 each Non Member
Register At Door $85.00 Each / CETA Member/$140.00 each Non Member
Register NOW and SAVE
Company Name: _____________________________________ Phone No:_____________________Fax No:_______________ Address: __________________________________________________________________________________________________ Mailing Address City State Zip __________________________________________________________________________________________________________ Shipping Address (If Different) City State Zip Attendee #1:(Please Print) Name: ________________________________________ Email: __________________________________ Title:____________ Last First Attendee #2:(Please Print) Name: __________________________________________ Email: __________________________________ Title: _________ Last First Attendee #3:(Please Print) Name: __________________________________________ Email: __________________________________ Title: __________ Last First Payment Type Visa Master Card American Express Amount Paying: $_______________ Card Number:_____________________________________Exp: _______________ CVC Code:_____________________ Name on Card: __________________________________ FAX Registration form to 704-635-7363 or email sherry@ceta.org
Signature: _____________________________________________________