Automotive TPO Global Conference 2009
Proceedings Book Order Form

Fax or Mail

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.

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

First Name:
Last Name:
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:

____I AUTHORIZE SPE TO CHARGE MY CREDIT CARD IN THE AMOUNT OF US$100.

____I HAVE INCLUDED A CHECK FOR $100 PAYABLE TO SPE DETROIT SECTION.

_________________________________________   ____________________
Signature                                                                                      Date