Registration

Registration includes meeting, continental breakfast, lunch and breaks
       $70 for early registration. Must be postmarked by 10/15/2005
       $40 for students with proof of qualified enrollment
       $85 for on-site registration
Note: For full refund you must cancel by 10/15/2005. There will be a $25.00 administration fee for cancellations requested after 10/15/2005.

Instructions
  1. Print this page and complete the form
  2. Make check payable to the SWC-Technologist Section
  3. Mail to: Kim Petrillose
                    4632 Sheffield Lane
                    Corpus Christi, TX 78411

Please Print

Name: ___________________________________________ Professional Initials/Degree: __________

Company:_____________________________________ Department:_______________________________

Address:_______________________________________________________________________________

City:_________________________________________ State:_____________ Zip:____________________

Phone:_________________________________ Email:__________________________________________