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Printable MEHRC Course Registration Form
Print out this form, fill it out and mail or FAX it to:
MEHRC
1936 Olney Avenue, Cherry Hill, NJ 08003
Yes, please enroll me for:
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| Course Name (s) |
Course Date(s) |
Price |
1.
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2.
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3.
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4.
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Your Name (as it should appear on course certificate), please print:
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Position Title:
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Company/Agency:
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Address:
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City, State, Zip:
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Phone:
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FAX:
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Email:
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| Payment
(Note: $50 minimum on credit card charges) |
Check Enclosed: $_________________
(make check payable to P&K Microbiology) |
For charges $50 or more, bill my credit card for $______________
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Circle one: VISA | MC | American Express
Card Number: _________ - _________ - __________ - _________
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Expiration Date:
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Cardholder Signature:
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| Travel directions and information on accommodations will be
provided to registrants. Credit card charges will appear as P&K Microbiology. |
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| Since MEHRC is a self
supporting organization, classes may require a minimum registration
of 10 people |
