National Association PHCC 2012 Legislative Conference
Plumbing-Heating-Cooling Contractors – National Association PHCC 2012 Legislative Conference - Registration Form Hotel Information – Key Bridge Marriott - 1401 Lee Highway, Arlington, VA 22209 (703) 524.6400 Name ____________________________________________________________________________________ Name as you would like it to appear on your name badge ____________________________________ Company
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Address
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______________________________________________________________________________ City State Zip Phone/Fax _____ Click here if you have any accessibility or dietary requirements - Attach a description _____ Check here if you are a first time attendee Registration Fee Schedule Important: For those who are 2012 PHCC 535 Congressional Club Members, the Congressional Reception on Capitol Hill honoring Colonel George D. Scott – as well as the Washington, DC bus tour, are free of charge. PHCC Member PHCC Chapter Staff
_____ $175.00 = _____ $175.00 =
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Events Colonel George D. Scott Congressional Reception _____ 535 Congressional Club Members - Free _____ Non 535 Congressional Club Member _____ @ $100.00 = _____ Washington, DC Bus Tour _____ 535 Congressional Club Members – Free _____ Non 535 Congressional Club Member _____ @ $100.00 = _____ Payment Method Check Total: _______ Credit Card (Circle One) American Express Master Card Visa ______________________________________________________________________________ Full Name on Card Credit Card Number Expiration Date Billing Address: _______________________________________________________________ Street Address City State ZIP Total Amount Processed: $_______________ Signature: ____________________________ Return to:
PHCC – 180 S. Washington Street, Falls Church, VA 22046 – fax (703) 237.7442 Questions: Contact Mark Riso or Laura Beymer (800) 533.7694
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Address
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______________________________________________________________________________ City State Zip Phone/Fax _____ Click here if you have any accessibility or dietary requirements - Attach a description _____ Check here if you are a first time attendee Registration Fee Schedule Important: For those who are 2012 PHCC 535 Congressional Club Members, the Congressional Reception on Capitol Hill honoring Colonel George D. Scott – as well as the Washington, DC bus tour, are free of charge. PHCC Member PHCC Chapter Staff
_____ $175.00 = _____ $175.00 =
_____ _____
Events Colonel George D. Scott Congressional Reception _____ 535 Congressional Club Members - Free _____ Non 535 Congressional Club Member _____ @ $100.00 = _____ Washington, DC Bus Tour _____ 535 Congressional Club Members – Free _____ Non 535 Congressional Club Member _____ @ $100.00 = _____ Payment Method Check Total: _______ Credit Card (Circle One) American Express Master Card Visa ______________________________________________________________________________ Full Name on Card Credit Card Number Expiration Date Billing Address: _______________________________________________________________ Street Address City State ZIP Total Amount Processed: $_______________ Signature: ____________________________ Return to:
PHCC – 180 S. Washington Street, Falls Church, VA 22046 – fax (703) 237.7442 Questions: Contact Mark Riso or Laura Beymer (800) 533.7694
