2009 DFMA Forum Registration Form

Please fax or mail to:

Boothroyd Dewhurst, Inc.

138 Main Street

Wakefield, RI 02879

Tel: 401-783-5840

Fax: 401-783-6872
Name
Position
Company
Address
City State Zip
Country
Tel
Fax
E-mail

Please charge my:

Visa/Mastercard

American Express
Card Holder
Card Number Expiration Date

_______________________________________
Signature

P.O. Number
Check enclosed payable to Boothroyd Dewhurst, Inc
Conference Fee - US $890

After completing this form, please print, then mail or fax to Boothroyd Dewhurst, Inc.

The Forum fee is $890, which includes all materials, the Networking Reception,
continental breakfasts and lunches.

Group rate, save $200 per attendee! Groups of 3 or more, the forum fee is $690 each.

EARLY BIRD DISCOUNT: Register by May 9th and receive a $200 discount off the conference fee.

All registrations canceled after June 6, 2009,
are subject to a $100 service charge. Substitute attendees are welcome.