DM CONSULTING

5-6 May 2017 DRY DOCK CONFERENCE/ADVANCED TRAINING FORUM REGISTRATION

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Return by e-mail (joe@drydocktraining.com), by fax (+1-858-538-5372) or by ground mail
(12316 Dormouse Rd, San Diego, CA 92129 USA). Online credit card payment and registration available at www.drydocktraining.com.


          Name/Title:   _________________________________________________

          Organization: _________________________________________________

          Address:   ____________________________________________________

                             ___________________________________________________

                             ___________________________________________________

          Office Phone: _________________________________________________

          Mobile Phone: ________________________________________________

          E-mail: _____________________________________________________

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A conference participant list will be distributed to all attendees. Please check one option below:
____ Use all the above information for a conference participant list.
____ Use all the above information for a conference participant list except __________________________________________________________________.
____ Keep me off the conference participant list.

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     TRAINING FEE (US dollars):
         $700.00 if payment is received by 1 March 2017.
        $800.00 if payment is received by 5 April 2017.
        $900.00 if payment is received after 5 April 2017.
   .

     ___ Payment enclosed.      ___ Check. Make checks payable to DM Consulting.

     ___ Credit card.    Visa      MasterCard     AMEX    (circle one)

     Card holder name ________________________________________________

     Card number and Security Code ______________________________________

     Expiration date __________________________________________________

     ___ Payment will be made at a later date, prior to the start of the Training.

     ___ Bill my organization/me. The reference/purchase order number and invoice address is:

     __________________________________________________________________
     __________________________________________________________________
     __________________________________________________________________
         
      Confirmation of registration will be sent to all attendees.
     All payments are 100% refundable if you cannot attend the Conference.