SRUG 2004 - Individual Mail-In Workshop Registration Form

2008 SHRUG GIS Work Shop
"GIS Revolution"
November 19th-20th
Training
Technical Presentations
Poster Gallery
Social Events
Vendors
Guest Speakers

The Seven Hills Regional User Group for GIS
Third Annual GIS Workshop
"Mapping our Future"

2004 SHRUG INDIVIDUAL Workshop Registration Form
To register individuals by submitting payment via Check, Money Order, PO, or Credit Card.

Reminder: Workshop Registration and Training Registration are separate forms. If you are attending training you must register for the training course separately.

Attendee First Name:

Attendee Last Name:

Attendee Organization:

Attendee Title:

Attendee Address 1:

Attendee Address 2:

Attendee City:

Attendee State:

Attendee Zip:

Attendee Phone:

Attendee E-mail:

T-Shirt Size:

S M L XL XXL

2002 Attendee?

2003 Attendee?

GIS Experience:

Newbie: This is all new to me
Geek: I have GIS experience
Guru: People ask me for help

Years using GIS?

Presenting?

Yes No

Receive Vendor Info?

Yes No

[ In an effort to assist in requests from our GIS Sponsors, we will provide contact information to them only about our attendees to receive information about their products and services. If you wish to opt out of this information, please select "No". ]

Billing First Name:

Billing Last Name:

Billing Address 1:

Billing Address 2:

Billing City:

Billing State:

Billing Zip:

Billing Phone:

Billing E-mail:

Billing Credit Card Type:

VISA MC AMEX PO Vendor

Account Number:

Expiration Date:

VIN Number:
[Front of AMEX, back of VISA/MC]

MAIL TO:
SHRUG, Inc.
Attn: Workshop Registration
PO Box 3887
Tallahassee, FL 32315-3887

For more information regarding Workshop Registration please contact Patrick Pence registration@shrug-gis.info (850)891-4941