Name (Last, First, MI)
Title
Employer
Employers Address
City, State, Zip
Phone	- -    Phone  - -    Fax  - -    Cell
Mailing Address (if different from work)
City, State, Zip
eMail
Mail To	(Select One) Mailing Work
Credit Card	(Select One) Visa MasterCard   (No American Express)
	Amount to charge
	Cardholder
	Number
	Security Code What's this?
	Expires:  01 02 03 04 05 06 07 08 09 10 11 12 1111 1111 1111 1111 1111 1111 1111 1111 1111
	Billing Zip
Names and titles of additional registrants.
Names and titles of additional registrants.
Registration Fees will increase by $25 after 10/1/2010 CSHE Member $95  (Fee includes: materials, breakfast, and lunch) Non-Member* $145  (Fee includes: materials, breakfast, and lunch) Registration Fees CSHE Member $120  (Fee includes: materials, breakfast, and lunch) Non-Member* $170  (Fee includes: materials, breakfast, and lunch)
*(Facility registrants will receive membership in CSHE)
Lunch Only (guest ticket)	$35
Golf	$25
Renew Membership Dues - Facility	$50
Renew Membership Dues - Affiliate	$150
MECH Study Guide - Member	$51
MECH Study Guide - Non-Member	$58
MECH Certification - Member	$95
MECH Certification - Non-Member	$140