Technical Symposium Registration

16-18 March 2011 -- Newport, RI

Please complete the form below to register for the NortekUSA Technical Symposium. You may address any questions to Eric Siegel (eric@nortekusa.com).

Your Name (Required)

Your Affiliation (Required)

Your E-Mail Address (Required)

Your Phone Number (Required)

Registration Type (Required)

Professional
Student

Registration Cost (Required)

Taxes may be applicable in some areas.

Presenter ($175.00 Professional / $125.00 Student)
MREC or MI partner member ($375.00 Professional / $275.00 Student)
Standard registration ($450.00 Professional / $350.00 Student)

Total Cost of Registration (Required)

You authorize NortekUSA to charge your credit card for this value.

Will you be attending the dinner party on Wednesday, 16 March? (Required)

Yes
No

Name on Credit Card

Credit Card Billing Address

Credit Card Billing City

Credit Card Billing State

Credit Card Billing Zip Code

Credit Card Number (MC/VISA only)

Leave this field blank if you wish to call in the credit card number (410-295-3733 ext.0) or if you will be sending a Purchase Order via FAX (410-295-2918).

Credit Card Expiration Date (mm/yy)

How did you learn about the NortekUSA Technical Symposium (Required)

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