Conference Registration Form
SEND FORM TO: +1 256-539-8477
CMSE 2011
Registration Information (please type or print clearly)
Name _____________________________________________________________________________________________
Title ________________________________ Company _______________________________________________________
Division ____________________________________________________________________________________________
Address _____________________________________________________________ M/S or Suite # ____________________
City ______________________________________________ State/Prov __________ Postal Code _____________________
Country ____________________________________________________________________________________________
Phone _________________________________ Fax _________________________________________________________
E-mail ______________________________________________________________________________________________
Registration Fees
Advance After Jan. 10th
Seminar1 or 2 (Monday, Feb. 7) *1, *3 $450 ____ $550 ____
Conference Technical Sessions & Tutorial *2, 4* $595 ____ $725 ____
Seminar, all Technical Sessions & Tutorial *2, 3*, 4* $845 ____ $975 ____
Workshop (Thursday, Feb. 10) *1 $300 ____ $350 ____
Speakers and Session Chairmen $450 ____ $595 ____
Exhibition Visitor Only (Feb. 8 - 9) $0 ____ $50 ____
Fees not refundable after Jan. 10. Total __________ ___________
*1 Groups of 3 or more, from the same company and registering at the same time for same Seminar get $50 each discount.
*2 Includes Conference Notes CD, applicable Seminar and Tutorial notes, continental breakfast, breaks, lunches, and reception.
*3 Please check Seminar 1 _____ or Seminar 2 _____ attending on Monday, Feb. 7
*4 Please check for Tutorial _____ attendance on Thursday, Feb. 10 (must identify when registering)
Payment
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 card number, expiration date, and signature.
No registration cancellation after Jan. 10, 2011, substitutions can be made at any time. Cancellations before Jan. 10 will be charged $100.
Payment Method: O AMEX O VISA O MC O Check For Info Call: 256-536-1304
Card Number _____________________________________________________________ Exp. Date __________________
Name on Card _______________________________________________
Signature __________________________________________________________________________________________
Components Technology Institute, Inc.
904 Bob Wallace Avenue / Suite 117
Huntsville, AL 35801
www.cti-us.com
