2011 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 $795   Early bird discount  Group discount (3 +)
Pre-Conference Workshop Fee  - US $95
  Check here if you wish to receive a printed copy of the conference proceedings.
All attendees will be able to download the proceedings in PDF format.
Shirt size: 
Total fee $

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

The Forum fee is $795, which includes all materials, the Networking Reception,
continental breakfasts and lunches.  The Pre-Conference Workshop fee is $95.

Group rate, save $200 per attendee! Groups of 3 or more, the forum fee is $595 each.

EARLY BIRD DISCOUNT: Register by May 21th and receive a $100 discount off the conference fee.

All registrations canceled after June 6, 2011, are subject to a $100 service charge.
Substitute attendees are welcome.