Workshop registration form

Please complete the form below and then click on the submit button to order now with a credit card or click here to print and mail an order form.

Improvement Technologies, LLC
Support
P O Box 30074, Tucson, AZ 85751-0074
520/721-2856

* = Required Fields.

Date		Vendor Number (if required)
WORKSHOP PARTICIPANT
Title
Name*
Job Title
Responsible For	Safety Risk Mgt Clin. Eng. Compliance Other (please describe)
Organization*
Address*
Address 2
City*	State* Zip*
Telephone*
Fax
Email*

Workshop Name, Date, Location		Number Of Registrants	Individual Price	Total Cost
			$	$
			$	$
			$	$

Please add $20 for processing a purchase order.				$
Subtotal:				$

Less discount, if applicable. Enter discount code and amount:$ substract amount				$

TOTAL:				$
Special requests, comments

Confirmation and Receipt: You will receive an email confirmation within 7 days.

Cancellation: The workshop/conference may be cancelled if there is insufficient registration. You will be notified at least 72 hours in advance.

Refund: You may cancel up to 72 hours in advance. You may be charged a $25 cancellation fee.

WORKSHOP PARTICIPANT