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Counterfeit Electronic Components
Avoidance Workshop
August 14, 2007
Clarion Inn & Suites Conference Center
Austin, TX
Registration Information
Name _____________________________________________ Title_________________________________
Company ________________________________ Division _______________________________________
Address _____________________________________________________ M/S or Suite # _______________
City ____________________________________________ State/Prov _____ Postal Code ______________
Country _______________________ Phone ________________________Fax ________________________
Email __________________________________________________________________________________
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After August 3 |
| Registration Fee Payment |
$395 _________ |
add $50 _________ |
| 3 or more from same Company |
$350 each |
add $50 _________ |
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Total |
________________ |
Payment must accompany registration. Registrations without payment will not be processed.
Company checks must be made out to Components Technology Institute, Inc. and payable in US dollars
drawn on a US bank. Credit card payment requires cared number expiration date, and signature.
Only substitutions are accepted after registration is received. FAX THIS FORM TO: 256-539-8477
Payment Method: _____ AMEX _____ VISA _____ MC _____ Check
Card Number: _________________________________________ Exp. Date: _________________________
Name on Card: ___________________________________________________________________________
Signature ________________________________________________________________________________
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