Workshop Dates Name Title Name Title Company Address City/State/Zip Phone Fax Email

_________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________

Are you a current powder user? yes / no

Transportation is provided from the hotel to the workshop facility, but space must be reserved. Will you need a ride? yes / no

Registration Fee
______ $425 for each PCI Company Member
______ $450 for each PCI Affiliate Member
______ $500 for each Non-member
______ Total enclosed

Payment Method

___ Check (payable to PCI and drawn on a US bank)
___ VISA, MasterCard, or American Express

Card #___________________________ Exp. Date ___________
Name________________________________________________
Signature_____________________________________________

Please return this form with your payment to

THE POWDER COATING INSTITUTE
2121 Eisenhower Ave., Suite 401
Alexandria, VA 22314
or Fax to 703-684-1771

Confirmation will be sent to all registrants.