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									     WORKSHOP REGISTRATION FORM – CHARLOTTE, NORTH CAROLINA – APRIL 3-6, 2011
                      EUCG, INC. ENERGY INFORMATION – Drafting for the Future
  Simply fill out the registration form & fax it to EUCG by March 16th, 2011 (accepted late at late fee).
       Submit this registration form on-line at www.eucg.org OR FAX to 623.572.4141 OR Mail to
                                                th
                     EUCG Inc – 20165 N. 67 Ave., Suite 122-A – Glendale, AZ - 85308
                                    CALL 623.572.4140 WITH QUESTIONS

NAME:_______________________________________________________________________________________

CO.NAME:___________________________________TITLE:___________________________________________

ADDRESS:___________________________________________________________________________________

CITY, STATE, ZIP:_____________________________________________________________________________

PHONE:_________________________________E-MAIL: (req’d. for receipt)_______________________________

REGISTRANT PROFILE : □ Fossil                 □ Info Tech     □ Hydro         □ Trans           □ Dist
                             □ Nuclear                               □ Safety & Health

Member of :               □ Site Org.               □ Central Org

Function in Company:      □ Business Improvement                        □ Planning
        □ Reporting               □ Engineering              □ Supply            □ Ops & Mtc

Database Function:        □ Data Provider           □ User

                                 HOTEL RESERVATION INFORMATION
              Request a room in the EUCG block – MARRIOTT DOWNTOWN CHARLOTTE
              100 WEST TRADE STREET - – your rate is $139 – see link at www.eucg.org
                                 Deadline for hotel rate – March 16, 2011
            WE CANNOT GUARANTEE A ROOM FOR YOU AT THIS RATE AFTER THIS DATE
          Government rate qualifiers – make your reservation then NOTIFY Pat at 623.572.4140
                          Only 20 government rooms are available – don’t wait!
                                       PAYMENT INFORMATION
EUCG Member Registration                                                  $875.

EUCG Member Late Fee (after 3/16/11)                                            $975.

Non EUCG Member Fee                                                             $1275

Nuclear Pre-Paid Conference Fee (Circle here)       NC2011S             $0

Hydro Pre-Paid Conference Fee      (Circle here)    HY2011S             $0

                                     Total payment          $_____________
    MC Card #_______________________________________Expiration Date;___________SEC Code:_______

    VISA Card #_____________________________________ Expiration Date:___________SEC Code:_______

    AMEX Card #_____________________________________Expiration Date:___________SEC Code:_______

   Discover Card #___________________________________Expiration Date:___________SEC Code:_______
CARD HOLDER NAME &
   ADDRESS________________________________________________________________________________

____________________________________________________________________________________________

    Cash or Check at check-in or mailed prior to the conference. For fund transfer contact Pat at eucgexec@cox.net

     TO PAY WITH CREDIT CARD PRINT OFF THIS FORM AND COMPLETE THEN FAX TO 623.572.4141
Cancellation Policy: * 14 days or more prior to conference – refund less $125 admin fee: * 7-14
days prior to conference - ½ conference fee refund or apply all to next conference: * less than 7
days – no refund, but apply to next conference. No exceptions. Thank you.
    EUCG, INC. WELCOMES GUESTS OF WORKSHOP DELEGATES
       All spouses & attendee guests should register using this form.
                        Fill in all details and fax to EUCG today – 1.623.572.4141
           (Registrations are accepted until arrival in Charlotte, but for planning purposes
                           we’ll appreciate your information by March 16th)
GUEST NAME: (First and last – please print)
________________________________________________________________________________________

EUCG DELEGATE YOU ARE ATTENDING WITH:
Name:________________________________________Co.Name:_______________________________

CITY AND STATE YOU ARE ATTENDING FROM:
________________________________________________________________________________________

                          PAYMENT INFORMATION
                         REGISTRATION FEE $225.
          Fee includes Sunday hospitality, Monday networking event,
                      Monday guest outing and all meals.

                                      TOTAL$___________

 
 MC Card #_____________________________Expiration Date;_______SEC Code:______

 
 VISA Card #____________________________Expiration Date:_______SEC Code:______

 
 AMEX Card #__________________________ Expiration Date:_______SEC Code:______

 
 Discover Card #_________________________Expiration Date:_______SEC Code:______

 
 Cash or Check at check-in or mailed prior to the conference.

 
 If you wish to transfer funds, please e-mail us at eucgexec@cox.net for deposit information.


           CALL US WITH ANY QUESTIONS YOU MIGHT HAVE!



       VISIT www.charlottesgotalot.com FOR LOCATION INFORMATION



                                             (3/3/11)

								
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