Registration Form -

Register by making a copy of this form and send it complete with contact and payment infomration to the address below. The course fee is to secure your attendance. Please list your special interest on the registration form below.

PACS Course City and Date(s):

Check or PO #	payable to PACS, Inc.
Credit cards accepted - provide card information: number, expiration date, and name on card.

Name:
Job Title:
Company:
Postal Address:

Telephone:
Best Hours Reached:
E-mail Address:
Special Interest:

Please mail this form 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: