Semiconductor Technology Registration Form
May 23 - 27, 2011
San Jose Airport Clarion Hotel
| Last Name | First Name |
| Job Title |
| Company |
| Mail Address | Mail Stop |
| City | State/Providence | Postal Code | Country |
| [ ] Registration Fee [ ] Registration fee discount before May 13 [ ] Group Discount - 10% ($250), 3 or more at the same time * * Send Registration info for each |
$2500.00 ___________ $2100.00 ___________ ___________ Total ____________ |
The Seminar is definite
BOOK ORDER ONLY
| # Copies | U.S. Dollars | Sub-Total | |
| __________ |
Semiconductor Technology Handbook |
$400.00 |
___________ |
| [ ] Surface Shipment - U.S. [ ] Air Shipment - U.S. & Canada [ ] Air Shipment - Outside U.S. * Or provide FedEx Acct. No. ___________________________ |
$ 12.00 $ 40.00 $ 85.00 Total |
___________ ___________ ___________ ___________ |
PAYMENT TERMS:
Prepayment is required on Handbooks. Payment must be made by credit card, check, or bank transfer to the account of Component Technology Institute. Please contact CTI for transfer information. All checks and transfers must be free of bank charges.
Payment by [ ] Check [ ] Bank Transfer [ ] American Express [ ] MasterCard [ ] Visa
Account No.: ________________________________________________ Expiration:__________
Cardholder’s Signature: ___________________________________________________________
Print Cardholder’s Name: _________________________________________________________