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