To register, please print, fill out,
and fax to this form to 7573510 or 7573511.
YES! PLEASE
SIGN ME UP!
Name ____________________________________________________________________
Position __________________________________________________________________
Company
_________________________________________________________________
Address
__________________________________________________________________
Tel
______________________________ Fax ____________________________________
Email
____________________________________________________________________
Mobile
___________________________________________________________________
Registration
date ___________________________________________________________
PAYMENT DETAILS
[ ] Cash
[ ] Check
for [ ] payable to HAMLIN-ITURRALDE CORPORATION
[ ] Charge
my credit card
[ ] American Express [ ] Bankard [ ] Diners
[ ] Mastercard [ ] RCBC [ ] Visa
Cardholder's name _________________________________________________________
Card number ______________________________________________________________
Expiry date ________________________________________________________________
Amount ___________________________________________________________________
Signature__________________________________________________________________