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DIERS Users Group Meeting Registration Form

Please complete this response form no later than April 30, 2012. For meeting details click here.

Complete the form whether or not you plan to attend the meeting. To cancel please call H. G. Fisher at (304) 776-6371 no later than the Tuesday before the 1st day of the meeting since we must give the hotel a guarantee.

(Fields containing an asterisk * are required)
Attend Meeting
I plan to attend the DIERS Users Group meeting on May 7-9, 2012 in Independence, MO

My name/the name of my company representative is as follows:
Name:
* 
Work Phone:
*  		Work Fax:
Email Address:
*   
About Your Company
Company Name:
* 
Street Address:
* 
City:
*  		State:
*		 Province:
Zip/Postal Code:
* 
Country/Region
*
Meeting Schedule
Date Activity Attendance Reserve
Lunch
Monday, 05/07/12 Meeting (8:00am-5:00pm)
Tuesday, 05/08/12 Meeting (8:00am-5:00pm)
Wednesday, 05/09/12 Meeting (8:00am-3:00pm)
Thursday, 05/10/12 DIERs @ FIKE Corporation (9:00am-2:00pm)
I will participate in the Kansas City Royals Baseball Game 05/09/2012
I will be able to participate in future DIERS Users Group activities:
My company will participate in future DIERS Users Group activities:
Comments:
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