***Registration fee is $125. If you register before October 31st, it is $95. The registration fee covers the cost of the conference, materials, social hours, and luncheon.*** The mailing address for your check is listed below.

(Company)

(First Name)

(Last Name)

(Position)

(Email)

(Address 1)

(Address 2)

(City) (State) (Zip)

(Phone)

Method of Payment:

Purchase Order / Invoice (PO Number - You will receive an invoice from Midland Scientific)

Check

Credit Card (Please Call Midland Scientific at (402) 346-8352 to Make Payment)

(Comments)