Registration Form2010 by HC120727111749

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									    USE THE "TAB" KEY or "POINT AND CLICK" THE WHITE BLANKS TO ENTER INFORMATION.
                                                   Problems??? Feel free to call Jim at (410) 889-3860.

        EMAIL                 THIS FORM TO: JIM DURKAY @ AssociateSocietyCouncilESB@verizon.net




                                                   Team Name
                                                                                                                            I am not with a team, please assign me to a table

                               Name                                              I am Team Captain                                                Telephone

                                                                                 I am a Spectator
                                                     Address                                                                                        Fax



                    City                               State                 Zip+4                                                       E-mail


                                                                                                    Quantity             Regis'n Fee              Extension        Total Due:

                    Team members paid with this registration:                                                            x $25 =
                            Spectators paid with this registration:                                                      x $25 =

Payment Method --                                                                                                                                                               If you did not ENABLE macros
                                                                                                                                                                                when you opened Excel, you will
    Engineers Club Members only:                                                                                                                                                not be able to use these print
                 I would like to charge this to my account #                                                                                                                    buttons which will print out
                                                                                                                                                                                black/white versions of the form.
    PayPal* (you can use any major credit card or your checkcard if you do not have your own PayPal account)                                                                    The easiest way to enable
                           I have paid using PayPal by using the link in the Registration Form or the ESB.org web site link.                                                    macros is close Excel, open the
                                                                                                                                                                                Registration form and select
                           Please send me a PayPal invoice by email using the email address above.                                                                              "Enable Macros" when that
* The American Institute of Chemical Engineers (an Associate Society member of the Engineers Club) is serving as the “Bank” for this                                            dialog box opens.
event in order to provide the PayPal payment option. You will see “AIChE MD” on your statement for this transaction. You will see
“American Institute of Chemical Engineers” at the top of the PayPal pages. If you do not have a PayPal account, look for “Don’t have a
PayPal account?” and the word “Continue”. The word “Continue” should be the link to the page where you can use your credit card or
checkcard. For additional information see below.


                                                                         Names for Name Badges
Team Participants:




Spectators:

								
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