Company:______________________________________ Phone #______________________
Infrared class ( 14 CEU for BPI)
To reserve your spot, please e-mail the registration form along with your payment to Ken Provlic at email@example.com. Payment is due at time of your registration. We do except credit card payments. You will get a receipt. We are pleased to assist you in your continuing professional development!
Please make all checks payable to PCBPI when you submit your registration.
We also take Visa – Master Card – Discover – American Express:
Name on Card:___________________________________________________
Card Number: – – – 3 Digit security #: __________
Expiration Date: ___________________
PLEASE PRINT THIS PAGE, COMPLETE AND EITHER FAX ( 724-437-5559) 550-4092) OR SCAN AND EMAIL TO Ken Provlic (firstname.lastname@example.org). Any questions call Ken at 724-550-4092 or contact Monroe Infrared Technology at 800-221-0163.