Workshop On-Line Registration

Reminder:  Workshop Registration and Training Registration are separate forms.  If you are attending training you must register for the training course separately.
2004 SHRUG Workshop Registration Form
Individual Attendee Form - Credit Card / PO / Vendor
Unique ID

Submit Date/Time

08/01/2006 10:52 AM

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 Information if different than attendee.
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]

 

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