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First Name _____________________________________

Last Name ___________________________________

Title ____________________________________________________

Company_________________________________________________

Address _________________________________________________

City, State, Zip/Postal Code _________________________________

Country _________________________________________________

Telephone Number_________________________________________

Fax Number ______________________________________________

E-Mail Address ____________________________________________

SEMINAR FEE

Please check appropriate spaces below:

Basic Program - Day 1

Chemical Coaters Association International (CCAI) Member $195

Electrocoat Association Member $195

I am not a member of either Association $225

I will attend the Max Coating plant tour from 2-4:00 pm (transportation provided)

I will attend the Networking Reception at the hotel on November 11, 6:30 - 8 pm.

Advanced Program - Day 2

Chemical Coaters Association International (CCAI) Member $195

Electrocoat Association Member $195

I am not a member of either Association $225

I will attend the Networking Reception at the hotel on November 11, 6:30 - 8 pm.

Basic and Advanced Program - Both Day 1 and Day 2

Chemical Coaters Association International (CCAI) Member $295

Electrocoat Association Member $295

I am not a member of either Association $325

I will attend the Max Coating plant tour from 2-4:00 pm (transportation provided)

I will attend the Networking Reception at the hotel on November 11, 6:30 - 8 pm.

PAYMENT

Check payable to: "The Electrocoat Association - E-Coat Seminar"

Company Purchase Order #:

Charge to: Visa - MasterCard - American Express - Discover (circle one)

Account Number (Include 3 or 4 digit Auth. Code) / Exp. Date:

____________________________________________

Cardholder Name________________________________________________