2009 Training Course Registration Form

Registration confirmation, including directions and hotel
suggestions will be sent upon receipt of this form

For Reservations

Please complete the following information and
submit with your check, prchase order, or credit card information to: 

Maria Badiee
1410 Gillingham Lane
Sugar Land, Texas, 77478
maria.badiee@thermofisher.com
713-272-2110 (Tel)
713-272-2272 (Fax)

Course Title

Date(s)

Time

8:00 a.m. to 5:00 p.m.

Trainer

Location

Sugar Land, Texas

Cost

Participant's Name

Participant's Telephone

Participant's Fax

Participant's E-Mail

Company Name

Billing Address

City, State, Zip

Billing Contact

E-Mail

Telephone

Fax

Method of Payment

Purchase Order 

Mastercard 

Visa 

American Express 

Card Number (note this is not a secured connection)
You may also FAX your card information to 713-272-2273 or
Call the information in to 713-272-0404

Name of Cardholder

Expiration Date

Included in Contract Purchase 

Serial Number of Instrument

Additional Information:
Please note any dietary restricions/food allergies