www asqbuffalo org Buffalo ASQ Registration Form Course_____ Complete by Yearoveryear

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									                                                                 www.asqbuffalo.org

Buffalo ASQ Registration Form: Course_______________________
1. Complete one registration form for each registrant, Space Limited - Register Early!
2. To register by check or Purchase Order, make payable to “ASQ-Buffalo Section 0201” and send this
   form along with payment to: ASQ-Buffalo Section 0201, P.O. Box 345, Elma, NY 14059-0345
note: it is advisable to notify the education chair of the mail in registration at nsdaveauda@aol.com
3. To Register by Credit Card, Go to www.asqbuffalo.org/ceritifcation and follow the link for online
   registration.

  If you experience difficulty, call (716) 686-1548
For further information: nsdaveauda@aol.com or call 686-1548 to register by
phone.

Attendee’s name: _______________________________________________
Position: ______________________________________________________
Company: _____________________________________________________
Address (no P.O. Boxes): _________________________________________
City: _____________________________ State: ____ Zip: _____________
Phone (Office): _________________________________________________
Phone (Home/Cell): _____________________________________________
E-mail Address: ________________________________________________
Managers name: ________________________________________________
Course Start date:_______________________________________________
(Office phone #) contact in case of cancellation: _______________________

Registration fees for CMQ/OE, CQI, and CQT Classes beginning early August, 2008:
Early bird (postmarked on or before Aug 11, 2008):
 $355 (Non ASQ Members)          $325 (ASQ Members)

Fees before August start date (after Aug 11, 2008):
 $405 (Non ASQ Members)           $375 (ASQ Members)

Registration fees for CSSBB and CRE Classes beginning early August, 2008:
Early bird (postmarked on or before Aug 11, 2008):
 $700 (Non ASQ Members)          $625 (ASQ Members)

Fees before August start date (after Aug 11, 2008):
 $750 (Non ASQ Members)           $675 (ASQ Members)

ASQ member number_____________ (if applicable)
Payment: Enclosed Check #________ Bank: _______________________
Purchase Order: #________________ Company: ____________________
Registered Online: Credit Card # _________ (Last 4 digits)
Name as you would like it to appear on your Certificate

								
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