Registration Information (print this page for fax and
________________________ State: _____
Tel: (____) __________
Fax: (____) __________
Charge My: Visa
/ MC / Disc / Amex # __________________________
Check enclosed, payable to:
The Supply Center
I acknowledge and agree that The Supply Center and the
respective locations in which the seminars are held assume no liability or
responsibility for any damage or loss that
might be incurred by me.
Signature (required): ____________________________________
(1) Print this form.
(2) Check the seminar date & location you want to attend.
(3) Mail or fax completed form with your check or payment information.