| 1. | Conference registration fee - discount before September 1, 2012 $1295, but after September 1, 2012 $1595 One day conference ticket $895 - (Circle date) Thursday, October 4, 2012 or Friday, October 5, 2012 Vendor Exhibitor? $600 |
$ $ $ |
| 2. | Please circle your Conference Dinner attendance for October 4, 2012? Yes / No No charge to attendees, guests $50. |
$ |
| 3. | Taking a short course? Yes / No Please circle your choice(s) | |
| 4. | Short course manuals can be purchased for $195 each, without attendance - circle course titles. | $ |
| 5. | Send 100 marketing items and $150 for inclusion in the Conference Proceedings. No cost for conference and course attendees to include marketing in Conference Proceedings. |
$ |
| 6. | Unable to attend. Enclosed is $250 for a copy of the Conference Proceedings. | $ |
| Check or PO #_______________________ payable to PACS, Inc. Credit cards accepted - provide card information: number, expiration date, and name on card. |
Total $ | |
| Name: | Address: |
| Company: | City / Postal Code: |
| Telephone: | E-mail: |
| http://pacslabs.com/conferences/ | |
| Print this form and mail with payment information to: | |
| PACS, Inc. 409 Meade Drive Coraopolis, PA 15108 | |
| Telephone: 1.800.367.2587 | Fax: 1.724.457.1214 |
| Website: http://pacslabs.com | E-mail: Henry at pacslabs.com |