Automotive TPO Global Conference 2010

Fax or Mail Registration Form

You may fill in this form on the computer and then print it, or you can print it out and fill it in by hand.  Use the print function on your browser to print.   Then fax it with your credit card information, or mail it with your check or credit card information.  You will receive confirmation back within about 5-10 business days.

• Fax:  248-244-8925
• Mail:
  American Chemicals Council, Attn. Pat Levine, 1800 Crooks Rd., Suite A, Troy, MI 48084

Make check payable to SPE DETROIT SECTION.

First Name:
Last Name:
SPE Membership Number:	(Required for reduced SPE rate.)
Company Name:
Street Address 1:
Street Address 2:
City:
State:
Zip Code:
Country:
Work Phone:
Fax:
E-mail:
Credit Card (Circle One):	Visa         MasterCard           American Express
Credit Card Number:
Expiration Date:	Month:        Year:

  Please check the appropriate box to be billed on your credit card.

If postmarked 9/15/10 or earlier OR faxed on 9/26/10 or earlier.  If  postmarked after 9/15/10 or faxed after 9/26/10,  $50 will be added to the above amount.

I AUTHORIZE SPE TO CHARGE MY REGISTRATION FEE TO MY CREDIT CARD

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