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__2007 Conference "FUSE" __________Online Registration (please complete ALL fields)

_____* If Registering more than 4 Participants, please use additional Form(s)

___City: State: Zip

___Telephone: FAX:

___Email Address:

___ Registration Cost:

___ Check Here to Join ACTC Now and SAVE on Registration - Only $25

___Please indicate which sessions you plan on attending (See Brochure for Complete Schedule)

___Session I (9:00 - 10:00 am):

___Session II (10:30 - 11:30 am):

___Session III (1:00 - 2:00 pm):

___Session IV (2:15 - 3:15 pm):

___Session V (3:30 - 4:30 pm):

Payment

___Method of Payment: Amount Due: $

___Credit Card Number:

___Expiration Month: Year:

___Security Code: * 3 digit number on back of card

___Name of Cardholder

IMPORTANT: No Refunds for Cancellations! ~ fees will be donated to ACTC

~ DON'T FORGET TO CONTACT THE HOTEL TO RESERVE YOUR ROOM

CLICK HERE to Email Completed Form to ACTC

 

 

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