Name (Last,First,MI)
Title
Employer
Employers Address
City, State, Zip
Phone	- -    Phone  - -    Fax  - -    Cell
Mailing Address (if different from work)
City, State, Zip
eMail
Mail To	(Select One) Mailing Work
Credit Card	(Select One) Visa MasterCard   (No American Express)
	Amount to charge
	Cardholder
	Number
	Security Code What's this?
	Expires:  01 02 03 04 05 06 07 08 09 10 11 12 1111 1111 1111 1111 1111 1111 1111 1111 1111
	Billing Zip
CSHE/HASC	$129  (Fee includes: materials, breakfast, and lunch)
(Lunch only)
Lunch (guest ticket)	$45
9-Hole Executive Golf Course	$40
(Includes golf fee, pull cart, and box meal)
MECH Certification Test	$145