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Please print, complete and mail (or fax) the following form to PCRIA to prior to September 10, 2006 to register as an attendee for the 2006 Annual Seminar in Orange Beach, Alabama. Do not forget to include your check payment or PO #!
Name:________________________________________________________
Title:_________________________________________________________
Company:_____________________________________________________
Address:______________________________________________________
City:_________________________________________________________
State:_______________ Zip:_______________ Phone:__________________
Email:________________________________________________________
Select from the following:
____ Check / Money Order Enclosed ($99.00 per person)
____ Pay At Door
Mail Registration & Check / Money Order
payable to PCRIA to:
PCRIA, PO Box 661164, Birmingham,
AL 35266
Fax Registration to: 205-791-6235
Contact Paul Logan at 205-706-2303 with any questions.