AeA New England -- Registration Form

NAME OF EVENT: __________________________________________________________

DATE OF EVENT: ______________________________________________

REGISTRATION FEE: ______________________         [    ] MEMBER    [   ]  NON-MEMBER

You may register for this event by:
-- Completing and faxing this form to:  781.938.0091
-- Mailing to: Event Registration, AeA New England, 444 Washington St., Woburn, MA 01801
-- You may also register online for AeA events at: www.aeanet.org/Events/NewEngland
-- Sorry, no refunds for cancellations can be accepted after 2 days prior to event; substitute attendees from same company allowed with advance notice.

Name(s):_____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Company: ____________________________________________________________________

Title(s): ______________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Address: _____________________________________________________________________

City/State/Zip:  ________________________________________________________________

Phone: _______________________ E-mail: _________________________________________

Payment Information:
Check (payable to AeA)      VISA       MC         AMEX

Card Number: __________________________________________   Exp date: _____________

Security verification code (on back of card): _________________

Cardholder name: ______________________________________________________________

Questions?  Call AeA's New England Council at 781.938.1925.

EVENT CODE (for internal use only): ______________

This page was last updated on 08/29/08.  
Copyright © 2003 American Electronics Association.  All rights reserved.