Seminar Registration 2017

NRCA Weed Control Seminar Registration 
January 30, 2017- February 2, 2017        SN20075/SA/17FY
Training materials for Session I, Core and Category 6 manuals can be obtained from the Media Distribution Center, Purdue University:  888-398-4636.

You may download and print the  2017 NRCA Seminar Program
You may download and print 2017 Program Registration to register
OR register on-line atwww.conf.purdue.edu/nrca2017 Program Registration
OR  Fill in all information below and

Mail to:            Purdue Extended Campus Business Services   OR        FAX:  765-494-0567                          Purdue University
Stewart Center, Room 116
128 Memorial Mall
West Lafayette, IN 47907-2034

Enroll the following person in the NRCA Weed Control Seminar,  SN20075/SA/17FY
Register by January 14, 2017.
Photocopy this form for each registrant.
There will be a $50 late fee for each person registered after this date.

 The cancellation date is January 14, 2017.  If you cancel before January 14, you will receive a full refund, but if you cancel after January 14, there will be no refund.  Any cancellation refund request after January 14 will be considered on a case by case basis by Dr. Reid Smeda. 

Name _________________________________________Title     ___________

Company ______________________________Address  __________________

City _____________________________________ State ______ Zip ________

Social Security number________________________ Phone _________________

(SSN Required if you are claiming Lifetime Learning Tax Credit)

E-mail Address* ______________________________________________________________

Please sign me up for (CIRCLE) — SESSION 1 —-SESSION 2—-BOTH


Amount
                     
Registration for NRCA member or railroad employee @ $425 per person $__________
Registration for non-NRCA member @ $2,000 per person $__________
                                                                 TOTAL $__________

 You will receive an email confirmation from Purdue Conferences regarding your registration. 

Payment Information

Make checks payable to Purdue University. Payment required with submission of registration.

Guarantee my registration by credit card:

____ VISA ____ MasterCard ____ Discover ____ Am Ex

 

____________________________________________________________

Account number                                                                                             Expiration date

 

Authorized signature

I have the following dietary restrictions._____________________________________________