OPMUG 2012 June Program Registration

1. OPMUG June 6th, 2012 Program Registration

OPMUG June 2012 Program

“Intro to Ultrasound”

Presented by: Debra Smith

Description:

Wednesday, June 6th, 2012 8:30 a.m. - 4:00 p.m.

Continental Breakfast - Provided Free

Lunch is available for $9.00

MERIDIAN TECHNOLOGY CENTER
1312 South Sangre Road
Stillwater, OK 74074-1899

DEADLINE to ENROLL: Friday, May 31st, 2012

*
1. First Name:

First Name:

*
2. Last Name:

Last Name:

*
3. Company:

Company:

*
4. Street Address:

Street Address:

*
5. City:

City:

*
6. State:

State:

*
7. ZIP Code (please include your full 9-digit if you know it):

ZIP Code (please include your full 9-digit if you know it):

*
8. Telephone Number:

Telephone Number:

*
9. Email Address:

Email Address:

10. FAX Number:

FAX Number:

11. Last 4 of SSN:

Last 4 of SSN:

*
12. Will you be eating lunch at Meridian? ($9.00)

Will you be eating lunch at Meridian? ($9.00) Yes

13. How did you hear about this program (select all that apply)?

How did you hear about this program (select all that apply)? OPMUG Web Site

Post Card

eMail flier

Other (please specify)

14. Please provide any suggestions you might have for future program topics:

Please provide any suggestions you might have for future program topics:

*
15. Have you completed the 2012 Individual and company PdM certification survey?

Have you completed the 2012 Individual and company PdM certification survey? Yes

OPMUG 2012 June Program Registration

1. OPMUG June 6th, 2012 Program Registration

*1. First Name:

*2. Last Name:

*3. Company:

*4. Street Address:

*5. City:

*6. State:

*7. ZIP Code (please include your full 9-digit if you know it):

*8. Telephone Number:

*9. Email Address: