Fax Registration Form:

If you do not wish to send your credit card information over the Internet, 
please print out this form and fax it to us at (541) 346-3545, 
or call us at (800) 280-6218 or (541) 346-3537.

Please complete the registration information below: 

Which conference do you plan to attend?	__________________________________

If applicable, do you plan to attend the pre and/or the post conference workshops? 

If yes, which one(s):	___________________________________


If applicable, please enter your 5-digit priority code:   _____

First Name:	_______________________________

Last Name:	_______________________________

Company Name:	_______________________________

Title:		_______________________________

Email:		_______________________________

Address 1:	_______________________________

Address 2:	_______________________________

City:		_______________________________

State:		_______________________________

Zip:		_______________________________

Country:	_______________________________

Postal Code:	_______________________________

Phone:		_______________________________

Fax:		_______________________________

Payment:

Spaces cannot be held until payment is received in 

the form of check, credit card or money order. 

Invoices are available for a $25 processing fee.

Total amount:	_______________________________

Names on Card:	_______________________________

Card #:		_______________________________

Expiration:	_______________________________

Thank you for your order. You will receive an email confirmation within 24 hours
confirming that your order has been processed.