Fall 2017 Chemical Grouting Institute Enrollment Form

Spring 2018 Chemical Grouting Institute Registration
Name (Attendee 1)*

First NameLast Name
Company*
Email for attendee 1:*
Additional Attendees Full Names:
Email for attendee 2:
Email for attendee 3:
Address*

Street Address

Street Address Line 2

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Postal / Zip CodeCountry
Phone Number*

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We will provide lunch on both days. Please let us know if attendees have dietary restrictions so that we may accommodate them.
If the best contact differs from the name(s) of the attendee(s), please leave your information here:
Are you a current Prime Resins customer?

YESNO
For current Prime Resins customers ONLY:

(A) Pay by check(B) Invoice us(C) Pay upon arrival(D) None of the above (pay online)
If you are a current customer choosing any of options A-C above, please select 'pay later' from the 'My Products' option below. Only select 'single attendee' or 'single attendee' plus 'additional attendee' if you wish to pay online.
There is a $75.00 cancellation fee for all registrations cancelled within five business days of the training.

NO DAY-OF, ON-SITE (WALK UP) REGISTRATIONS.
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Spring 2018 Chemical Grouting Institute Registration