Monthly Meeting Registration

Registration Information:

Full Name: *

Company Name

Street Address

Address continued

City

State

Zip

Phone #:

( )

Email Address *

Member of Tri-State YesNo

If you are not a member of Tri-State, how did you hear about this event?

Month *

Please indicate method and amount of payment

Method of Payment Credit Card OnlineCheck or Cash at the Door

Member registrations: * x $40.00

Non-member registrations: * x $50.00

Student Rate * x $20.00

Additional Registrants: Please list name and company

Special Instructions