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Northern California Mid-Year Seminar Registration Form


Name (Last,First,MI)    
Title
Employer
Employers Address
City, State, Zip  
Phone - -    Fax  - -    Cell  - -
Mailing Address (if different from work) 
City, State, Zip  
eMail
Mail To
Credit Card  Cardholder:   Amount to charge:
Number:          Expires: 
Registration Fees will increase by $25 after 10/1/08
CSHE Member$95  (Fee includes: materials, breakfast, and lunch)
Non-Member* $130  (Fee includes: materials, breakfast, and lunch)
    *(Facility registrants will receive membership in CSHE)
 
Lunch Only (guest ticket)$30
Golf$20
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$145


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